Spring and Fall Parent Interviews

Appendix A
Parent Interview

Appendix A.1
1998-99 Fall Kindergarten Parent Interview

Note. The current parent interview item pool is comprised of items fielded as part of:
Page
number
The Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (ECLS-K)
Fall Kindergarten Parent Interview……………………………………………………………………………
Spring Kindergarten Parent Interview………………………………………………………………………..
Select Items from the Fall First, Spring First, Sring Third, Spring Fifth, or Spring Eighth Grade
Parent Interview…………………………………………………………………………………………….
The Early Childhood Longitudinal Study, Birth Cohort (ECLS-B)…………………………………………….
Other Large Scale Studies…………………………………………………………………………………………

A-1

A-2
A-79
A-142
A-213
A-217

*The following items were fielded as part of the ECLS-K: 1998-99 Fall Kindergarten Parent Interview.

A-2

INTRODUCTION – INQ

INQ.010

ENTER THE RESPONDENT'S FIRST NAME.
RULES FOR SELECTING RESPONDENTS:
1.
2.
3.

CHILD'S MOTHER/GUARDIAN
CHILD'S FATHER/GUARDIAN, IF MOTHER IS UNAVAILABLE
HH MEMBER (OVER 18) WHO IS MOST KNOWLEDGEABLE ABOUT THE CHILD'S
CARE AND EDUCATION IF MOTHER AND FATHER ARE NEVER AVAILABLE OR NOT IN
HOUSEHOLD

________________________________________________________
ENTER NAME

INQ.020

{Before we begin the interview, I would like to verify some information.}
I have recorded {CHILD's FIRST, MIDDLE, AND LAST NAME} as {CHILD}'s full name. Is this correct?

Current Info:

[CHILD'S FIRST NAME]
[CHILD'S MIDDLE NAME]
[CHILD'S LAST NAME]
FIRST NAME : [___________________]
MIDDLE NAME : [___________________]
LAST NAME : [___________________]
INQ.030

Are there any other names {CHILD} goes by?

YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

INQ.040
What are those names?
________________________________________________________
ENTER FIRST OTHER NAME

________________________________________________________
ENTER SECOND OTHER NAME

________________________________________________________
ENTER THIRD OTHER NAME
A-3

1
2 (INQ.050)
7 (INQ.050)
9 (INQ.050)

INQ.050
ASK IF NOT OBVIOUS: I have {CHILD} recorded as {male/female}. Is that correct?
Current Info: [GENDER]
MALE ............................................................
FEMALE .......................................................
REFUSED ....................................................
DON'T KNOW ..............................................

1
2
7
9

INQ.060

{I have recorded that {CHILD} was born on {DATE OF BIRTH}. Is that correct?/What is {CHILD}'s date of
birth?}
Current Info: [DATE OF BIRTH]
|___|___| / |___|___| / |___|___|
ENTER DATE OF BIRTH (MONTH/DAY/YEAR)
REFUSED .................................................... 77
DON'T KNOW .............................................. 99

INQ.080
So {CHILD} is {AGE CALCULATED FROM DATE OF BIRTH AT INQ.060} years old. Is that correct?

YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

INQ.090

How old is {CHILD}?

|___|
ENTER AGE
INQ.100
I have recorded that {CHILD}'s home address is:

{STREET ADDRESS1..}
{STREET ADDRESS2..}
{CITY..} {ST} {ZIP CODE..}

A-4

1 (INQ.100)
2
7
9

Is this correct?
CORRECT ADDRESS ..................................
SAME ADDRESS - MINOR
CORRECTIONS ..........................................
NEW ADDRESS ...........................................

1 (INQ.130)
2
3

INQ.110
MAKE CORRECTIONS TO ADDRESS BELOW.

STREET ADDRESS1 :
STREET ADDRESS2 :
CITY :
STATE :
ZIP CODE :

INQ.130

[___________________]
[___________________]
[___________________]
[___________________]
[___________________]

{I have recorded that {PHONE NUMBER} is {CHILD}'s family's current home phone number. Is this
correct? /What is {CHILD}'s family's current phone number?}

Current Info:

[TELEPHONE NUMBER]

|___|___|___| - |___|___|___| -|___|___|___|___|
ENTER TELEPHONE NUMBER
REFUSED ....................................................
DON'T KNOW ..............................................

A-5

7
9

PARENT'S INVOLVEMENT WITH THE CHILD'S SCHOOL – PIQ

PIQ.020
First, I'd like to ask you about {CHILD}'s school. Did {CHILD}'s school or teacher send home information
about any of the following when {CHILD} started kindergarten?
RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9

a.
b.
c.
d.

PIQ.030

How to prepare {CHILD} for kindergarten?........................................ ____
Topics or skills that are part of the kindergarten program? ............... ____
What to do if {CHILD} will be late or absent from school?................. ____
How to get in touch with a teacher or school staff to discuss
any concerns or questions about {CHILD}? ...................................... ____

Have you met {CHILD}'s teacher yet?
YES ..............................................................
NO ................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

PIQ.050

Did you [or {CHILD}'s parents] choose where to live so that {CHILD} could attend {his/her} current school?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

PIQ.060

1
2
7
9

1
2
7
9

Is {CHILD} in {his/her} regularly assigned school or a school that you {or {CHILD}’s parents} chose?
ASSIGNED ....................................................
CHOSEN .......................................................
ASSIGNED SCHOOL IS SCHOOL OF
CHOICE.......................................................
CHILD IS HOMESCHOOLED .......................
REFUSED ....................................................
DON'T KNOW ..............................................

A-6

1
2
3
4
7
9

PIQ.070

Most schools have guidelines about when a child can start school based on his or her birth date.
Did you [or {CHILD}'s parents] enroll {CHILD} in kindergarten when {he/she} was old enough based on
{his/her} birth date, or did you [or {CHILD}'s parents] wait until {he/she} was older?
WHEN OLD ENOUGH .................................
WAITED ........................................................
ENTERED EARLY ........................................
REFUSED .....................................................
DON'T KNOW ...............................................

PIQ.080

Is this {CHILD}'s first or second year of kindergarten?
FIRST ...........................................................
SECOND ......................................................
THIRD OR MORE ........................................
REFUSED .....................................................
DON'T KNOW ...............................................

PIQ.090

1
2
3
7
9

1
2
3
7
9

Children sometimes have problems adjusting to kindergarten. On the average, during the first two months
of this school year …
RESPONSES: 1 = MORE THAN ONCE A WEEK, 2 = ONCE A WEEK OR LESS, 3 = NOT AT ALL, 7 =
REFUSED, 9 = DON'T KNOW
a.
b.
c.
d.
e.
f.

PIQ.110

Did {CHILD} complain about school more than once a week,
once a week or less, or not at all? ..................................................... ____
Was {CHILD} upset or reluctant to go to school? .............................. ____
Did {he/she} pretend to be sick to stay home from school? .............. ____
Did {he/she} say good things about school? ..................................... ____
Did {CHILD} say {he/she} liked {his/her} teacher?............................. ____
Did {he/she} look forward to going to school? ................................... ____

Now I'm going to ask you how important you think it is for children to know or do certain things to be ready
for kindergarten.
How important do you think it is that a child ...

***
RESPONSES: 1 = ESSENTIAL, 2 = VERY IMPORTANT, 3 = SOMEWHAT IMPORTANT, 4 = NOT VERY
IMPORTANT, 7 = REFUSED, 9 = DON'T KNOW
a.
b.
c.
d.
e.
f.

Can count to 20 or more? Would you say it is essential,
very important, somewhat important, or not very important? ............ ____
Takes turns and shares? .................................................................. ____
Is able to use pencils and paint brushes? ........................................ ____
Sits still and pays attention? .............................................................. ____
Knows most of the letters of the alphabet? ....................................... ____
Communicates needs, wants, and thoughts verbally in primary
language?.......................................................................................... ____

A-7

PIQ.120

How far in school do you expect {CHILD} to go? Would you say you expect {him/her} …
To receive less than a high school diploma, ...............
To graduate from high school, ....................................
To attend two or more years of college, ......................
To finish a four- or five-year college degree, ..............
To earn a master's degree or equivalent, or ...............
To finish a Ph.D., MD, or other advanced degree? .....
REFUSED ...................................................................
DON'T KNOW .............................................................

A-8

1
2
3
4
5
6
7
9

FAMILY STRUCTURE – FSQ

FSQ.020

{Now I have a few questions about your household. We have noted that you and {CHILD} currently live in
this household. Please tell me the names and ages of all the other people who normally live here. Please do
not include anyone staying here temporarily who usually lives somewhere else.}
{How old {are you/is {NAME}}?}
{CODE IF OBVIOUS. OTHERWISE, ASK: {Are you/Is {NAME}} male or female?}
PROBE: Anyone else (living in this household)?
ENTER AGE AND GENDER OF RESPONDENT.
ENTER FIRST NAME, LAST NAME, AGE, AND GENDER OF EACH HOUSEHOLD MEMBER NAMED.
FIRST NAME

FSQ.045

LAST NAME

AGE

R

{Display Respondent First Name}

{Display
Respondent
Last Name}

[Enter Age - 3]

[Enter Gender - M/F]

C

{Display Child First Name}

{Display Child
Last Name}

{Display Age}

{Display Gender}

[Enter First Name - 20]

[Enter Last
Name - 20]

[Enter Age - 3]

[Enter Gender - M/F]

[Enter First Name - 20]

[Enter Last
Name - 20]

[Enter Age - 3]

[Enter Gender - M/F]

IS THE MATRIX COMPLETE?
YES ...............................................................
NO ................................................................

FSQ.060

1 (FSQ.060)
2 (COMPLETE MATRIX)

Have we missed anyone who usually lives here who is temporarily away from home or living in a dorm at
school, or any babies or small children?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

FSQ.110

GENDER

1 (FSQ.020)
2
7
9

Do you have a spouse or partner who lives in this household?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

A-9

1
2 (BOX 2)
7 (BOX 2)
9 (BOX 2)

FSQ.120

Who in the household is your spouse or partner?

FSQ.130

What {is your/is {NAME}'s} relationship to {CHILD}?
MOTHER/FEMALE GUARDIAN....................
FATHER/MALE GUARDIAN .........................
SISTER..........................................................
BROTHER .....................................................
GIRLFRIEND OR PARTNER OF {CHILD}'S
PARENT/GUARDIAN ...................................
BOYFRIEND OR PARTNER OF {CHILD}'S
PARENT/GUARDIAN ...................................
GRANDMOTHER ..........................................
GRANDFATHER ...........................................
AUNT.............................................................
UNCLE ..........................................................
COUSIN.........................................................
OTHER RELATIVE........................................
OTHER NONRELATIVE................................

FSQ.140

5 (BOX 3)
6
7
8
9
10
11
12
13

(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(FSQ.180)

{Are you/Is {NAME}} {CHILD}’s ...

Birth mother, ..................................................
Adoptive mother, ...........................................
Step mother, or..............................................
Foster mother or female guardian? ...............
REFUSED .....................................................
DON’T KNOW ...............................................

FSQ.150

1
2 (FSQ.150)
3 (FSQ.160)
4 (FSQ.170)

1
2
3
4
7
9

(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)

1
2
3
4
7
9

(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)

{Are you/Is {NAME}} {CHILD}’s ...

Birth father, ....................................................
Adoptive father, .............................................
Step father, or................................................
Foster father or male guardian? ....................
REFUSED .....................................................
DON’T KNOW ...............................................

A-10

FSQ.160

{Are you/Is {NAME}} {CHILD}’s ...

Full sister, ......................................................
Half sister,......................................................
Step sister,.....................................................
Adoptive sister, or..........................................
Foster sister?.................................................
REFUSED .....................................................
DON’T KNOW ...............................................

FSQ.170

(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)

1
2
3
4
5
7
9

(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)
(BOX 3)

{Are you/Is {NAME}} {CHILD}’s ...

Full brother, ...................................................
Half brother,...................................................
Step brother,..................................................
Adoptive brother, or .......................................
Foster brother? ..............................................
REFUSED .....................................................
DON’T KNOW ...............................................

FSQ.180

1
2
3
4
5
7
9

CODE NON-RELATIVE RELATIONSHIP BELOW IF MORE DESCRIPTIVE.

Girlfriend or Partner of {CHILD}'s Parent/Guardian .................................. 1
Boyfriend or Partner of {CHILD}'s Parent/Guardian ................................. 2
FEMALE GUARDIAN ............................................................................... 3
MALE GUARDIAN .................................................................................... 4
DAUGHTER/SON OF {CHILD}'s PARENT’S PARTNER ......................... 5
OTHER RELATIVE OF {CHILD}'s PARENT’S PARTNER ....................... 6
OTHER NON-RELATIVE (SPECIFY)___________________________ 91
REFUSED................................................................................................. 77
DON’T KNOW........................................................................................... 99
FSQ.181

SPECIFY OTHER NON-RELATIVE.
_______________________________________
OTHER NON-RELATIVE

A-11

FSQ.190

{Are you/Is {NAME}} Hispanic or Latino?}
RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9
{What is {your/{NAME} 's } race? You may name more than one.
[IF ”HISPANIC” PROBE “Is that White Hispanic, Black Hispanic, both, or something else?”]

CODE ALL THAT APPLY
RESPONSES:

FSQ.198

AMERICAN INDIAN OR ALASKA NATIVE = 1, ASIAN = 2, BLACK OR AFRICAN
AMERICAN = 3, NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER = 4, WHITE = 5,
OTHER = 91, REFUSED = 7, DON'T KNOW = 9

[What is {your/{NAME}'s} race?]
ENTER OTHER-SPECIFY TEXT.
_______________________________________
OTHER RACE

A-12

PRIMARY LANGUAGE(S) SPOKEN – PLQ

PLQ.020

Is any language other than English regularly spoken in your home?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

PLQ.030

Is English also spoken in your home?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

PLQ.040

1
2 (BOX 3)
7 (BOX 3)
9 (BOX 3)

1
2
7
9

What languages other than English are spoken in your home?
CODE ALL THAT APPLY
ARABIC........................................
CHINESE .....................................
FILIPINO LANGUAGE .................
FRENCH ......................................
GERMAN .....................................
GREEK ........................................
ITALIAN .......................................
JAPANESE ..................................

PLQ.060

1
2
3
4
5
6
7
8

KOREAN ........................................ 9
POLISH ........................................ 10
PORTUGUESE ............................ 11
SPANISH ..................................... 12
VIETNAMESE .............................. 13
SOME OTHER LANGUAGE
(SPECIFY) _________________ 14
REFUSED .....................................77
DON’T KNOW ...............................99

What is the primary language spoken in your home?
ENGLISH .....................................
ARABIC........................................
CHINESE .....................................
FILIPINO LANGUAGE .................
FRENCH ......................................
GERMAN .....................................
GREEK ........................................
ITALIAN .......................................
JAPANESE ..................................

0
1
2
3
4
5
6
7
8

KOREAN ........................................ 9
POLISH ........................................ 10
PORTUGUESE ............................ 11
SPANISH ..................................... 12
VIETNAMESE .............................. 13
SOME OTHER LANGUAGE
(SPECIFY) _________________ 14
REFUSED .....................................77
DON’T KNOW ...............................99

A-13

PLQ.070

How well do you . . .
RESPONSES: VERY WELL = 1, PRETTY WELL = 2, NOT VERY WELL = 3, NOT WELL AT ALL = 4,
REFUSED = 7, DON'T KNOW = 9

a.

b.
c.
d.

PLQ.080

Speak English? Would you say very
well, pretty well, not very well, or not
well at all?............................................... ___
Read English? ....................................... ___
Write English? ....................................... ___
Understand someone speaking
English? ................................................. ___

How often {do/does} {{you/{NAME}}/{CHILD}} use {{NON-ENGLISH LANGUAGE}/a language other than
English} in speaking to {{CHILD}/{you/{NAME}}}?

NEVER, ........................................................
SOMETIMES, ...............................................
OFTEN, OR ..................................................
VERY OFTEN?..............................................
REFUSED .....................................................
DON’T KNOW ...............................................

A-14

1
2
3
4
7
9

HOME ENVIRONMENT, ACTIVITIES, AND COGNITIVE STIMULATION – HEQ
HEQ.010

Now I'd like to talk with you about {CHILD}'s activities with family members. In a typical week, how often do
you or any other family members do the following things with {CHILD}?
PROBE: Would you say not at all, once or twice, 3-6 times, or every day?

NOT
ONCE
3-6
AT ALL OR TWICE TIMES
a.
b.
c.
d.
e.
f.
g.
h.
i.
j1.
j.
k.

HEQ.015

Tell stories to {CHILD}? Would you say
not at all, once or twice, 3-6 times, or
every day?....................................................
Sing songs with {CHILD}?............................
Help {CHILD} to do arts and crafts?.............
Involve {CHILD} in household chores,
like cooking, cleaning, setting the table, or
caring for pets? ...........................................
Play games or do puzzles with {CHILD}? ...
Talk about nature or do science projects
with {CHILD}? ..............................................
Build something or play with construction
toys with {CHILD}? ......................................
Play a sport or exercise together? ..............
Practice reading, writing or working with
numbers? ....................................................
Do any of the activities we just talked about
using {PRIMARY LANGUAGE/a language
other than English}? ....................................
Read books to {CHILD} {in English}?...........
Read books to {CHILD} in {PRIMARY
LANGUAGE/a language
other than English}? .....................................

REF DK

1
1
1

2
2
2

3
3
3

4
4
4

7
7
7

9
9
9

1
1

2
2

3
3

4
4

7
7

9
9

1

2

3

4

7

9

1
1

2
2

3
3

4
4

7
7

9
9

1

2

3

4

7

9

1
1

2
2

3
3

4
4

7
7

9
9

1

2.......

3

4

7

9

Generally, how long is {CHILD} read to {at the times {he/she} is read to in English/at each of these times} {in
any language}?
|___|___|
ENTER MINUTES
or
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

HEQ.015
(alternative)

EVERY
DAY

Generally, how long is {CHILD} read to at each of these times} {in any language}?

|___|___|
ENTER MINUTES
or
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

A-15

HEQ.040

About how many children's books does {CHILD} have in your home now, including library books? Please
only include books that are for children.

|___|___|___|
ENTER # OF BOOKS
or
REFUSED .................................................... 777
DON'T KNOW .............................................. 999

HEQ.050

About how many children's audio tapes, or CD's do you have at home, including any from the library?
Please only include what you have for children.
|___|___|___|
ENTER # OF TAPES OR CDS
REFUSED .................................................... 777
DON'T KNOW .............................................. 999

HEQ.060

Now, please think about the past week. How often did {CHILD} look at picture books or stories on the
computer outside of school in the past week? Would you say ...
Never, ............................................................
Once or twice a week, ...................................
3 to 6 times a week, or ..................................
Every day?.....................................................
REFUSED ....................................................
DON'T KNOW ..............................................

HEQ.070

1
2
3
4
7
9

In the past week, how often did {CHILD} read to or pretend to read to {himself/herself} or to others outside of
school? Would you say ...

Never, ............................................................
Once or twice a week, ...................................
3 to 6 times a week, or ..................................
Every day?.....................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-16

1
2
3
4
7
9

HEQ.080.

Now think about the year before {CHILD} started kindergarten. Please tell me whether (CHILD) watched
any of the following television programs either at home or someplace else, at least once a week for a period
of three months or more.
YES
Sesame Street . . . . . . . . . . . . . . . . . . . . . . . . ………… 1
Between the Lions . . . . . . . . . . . . . . . . . . . . …………….1
Super WHY! . . . . . . . . . . . . . . . . . . . . . . . . ……………. . 1
WordWorld . . . . . . . . . . . . . . . . . . . . . . . . . . . ……………1
Martha Speaks . . . . . . . . . . . . . . . . . . . . . . . …………... 1

HEQ.080

NO
2
2
2
2
2

Now think about the year before {CHILD} started kindergarten. Did {CHILD} watch one of the PBS shows,
such as Sesame Street, Between the Lions, Super WHY!, WordWorld, or Martha Speaks, either at home or
someplace else, at least once a week for a period of three months or more?

YES ...............................................................
NO .................................................................
HAVE NO TV ................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-17

1
2
3
7
9

CRITICAL FAMILY PROCESSES – CFQ
CFQ.010

Now I have some questions about relationships {CHILD} may have with other people. Is there any person
{other than {yourself/the biological mother/the adoptive mother}} who is like a mother to {CHILD}?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................
CFQ.020

1
2 (CFQ.030)
7 (CFQ.030)
9 (CFQ.030)

Who is this person?
CODE ALL THAT APPLY
GRANDMOTHER ........................................................
BIOLOGICAL MOTHER (IF NOT RESPONDENT) .....
STEPMOTHER (IF NOT RESPONDENT)...................
ADOPTIVE MOTHER (IF NOT RESPONDENT) .........
FOSTER MOTHER (IF NOT RESPONDENT).............
RESPONDENT'S GIRLFRIEND/PARTNER ................
TEACHER/COACH......................................................
CLERGY ......................................................................
AUNT ...........................................................................
CHILD'S SIBLING ........................................................
FRIEND OF FAMILY....................................................
BABYSITTER/NANNY/CAREGIVER...........................
OTHER RELATIVE ......................................................
OTHER NON-RELATIVE.............................................
REFUSED ...................................................................
DON'T KNOW .............................................................

CFQ.030

1
2
3
4
5
6
7
8
9
10
11
12
13
14
77
99

Is there any person {other than {yourself/the biological father/the adoptive father}} who is like a father to
{CHILD}?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-18

1
2 (BOX 1)
7 (BOX 1)
9 (BOX 1)

CFQ.040

Who is this person?
CODE ALL THAT APPLY
GRANDFATHER..........................................................
BIOLOGICAL FATHER (IF SOMEONE ELSE IS
PRIMARY FATHER FIGURE) ...................................
STEPFATHER .............................................................
ADOPTIVE FATHER ...................................................
FOSTER FATHER .......................................................
RESPONDENT'S BOYFRIEND/PARTNER.................
TEACHER/COACH......................................................
CLERGY ......................................................................
UNCLE.........................................................................
CHILD'S SIBLING ........................................................
FRIEND OF FAMILY....................................................
BABYSITTER/NANNY/CAREGIVER...........................
OTHER RELATIVE ......................................................
OTHER NON-RELATIVE.............................................
REFUSED ...................................................................
DON'T KNOW .............................................................

CFQ.060

2
3
4
5
6
7
8
9
10
11
12
13
14
77
99

How many of {CHILD}'s grandparents are still living?
NONE ............................................................
ONE...............................................................
TWO ..............................................................
THREE ..........................................................
FOUR ............................................................
MORE THAN FOUR......................................
REFUSED ....................................................
DON'T KNOW ..............................................

CFQ.070

1

0 (BOX 2)
1
2
3
4
5
7 (BOX 2)
9 (BOX 2)

How many grandparents would you say {CHILD} has a close relationship with?
NONE ............................................................
ONE...............................................................
TWO ..............................................................
THREE ..........................................................
FOUR ............................................................
MORE THAN FOUR......................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-19

0
1
2
3
4
5
7
9

CHILD CARE - CCQ

CCQ.005

I'd like to talk to you about all child care {CHILD} now receives on a regular basis before or after school from
someone other than {you/{his/her} {parents/guardians}}. This does not include occasional baby-sitting or
backup care providers.

Relative Care
CCQ.010

Is {CHILD} now receiving care from a relative on a regular basis before or after school? This may include
grandparents, brothers and sisters, or any relatives other than {you/{CHILD}'s {parents/guardians}}.

.
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................
CCQ.015

Has {CHILD} ever received care from a relative on a regular basis?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.020

1 (CCQ.020)
2
7
9

1
2 (CCQ.115)
7 (CCQ.115)
9 (CCQ.115)

How old was {CHILD} in years and months when {he/she} first received care from any relative on a regular
basis?
|___|___|
ENTER YEAR

AND

|___|___|
ENTER MONTH

REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

CCQ.025

Did {CHILD} receive care from a relative on a regular basis the year before {he/she} started kindergarten?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.030

1
2 (BOX 1)
7 (BOX 1)
9 (BOX 1)

How many different regular care arrangements did you have with relatives for {CHILD}'s care in the year
before {he/she} started kindergarten?
ONE ..............................................................
TWO .............................................................
THREE .........................................................
FOUR ...........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-20

1
2
3
4
7
9

CCQ.035

For the next few questions please think about the relative who provided the most care for {CHILD} the year
before {he/she} started kindergarten. Was that care provided in your home or in another home?
OWN HOME ..................................................
OTHER HOME ..............................................
BOTH/VARIES ..............................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.040

1
2
3
7
9

How many days each week did {CHILD} receive care from {his/her} relative the year before {he/she} started
kindergarten?
|___|
ENTER # OF DAYS
or
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.045

How many hours each week did {CHILD} receive care from {his/her} relative the year before {he/she} started
kindergarten?
|___|___|___|
ENTER # OF HOURS
or
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

CCQ.050

For how long did {CHILD} receive care from {his/her} relative the year before {he/she} started kindergarten?
Would you say …

One to two months, ......................................
Three to five months, ....................................
Six to eight months, or ..................................
Nine to twelve months? .................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.060

1
2
3
4
7
9

How many different regular care arrangements do you currently have with relatives before or after school?
ONE ..............................................................
TWO ..............................................................
THREE ..........................................................
FOUR ............................................................
FIVE OR MORE ............................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-21

1
2
3
4
5
7
9

CCQ.065

{Let's talk about the relative who provides the most care for {CHILD} now.} . Who is the relative who cares
for {CHILD} before or after school?

GRANDPARENT ...........................................
AUNT.............................................................
UNCLE ..........................................................
BROTHER .....................................................
SISTER..........................................................
ANOTHER RELATIVE...................................
REFUSED .....................................................
DON'T KNOW ...............................................
CCQ.070

Is the care provided by {{CHILD}'s {RELATIVE}/ that relative} in your home or another home?
OWN HOME ..................................................
OTHER HOME ..............................................
BOTH/VARIES ..............................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.075

1
2
3
7
9

Is the care that {CHILD} receives from {{his/her} {RELATIVE}/that relative} regularly scheduled at least once
each week?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.085

1
2
3
7
9

Does {CHILD} receive that care before school, after school, or on weekends?
BEFORE SCHOOL........................................
AFTER SCHOOL...........................................
WEEKENDS ..................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.080

1
2
3
4
5
6
7
9

1
2 (BOX 2)
7 (BOX 2)
9 (BOX 2)

How many days each week does {CHILD} receive care from {{his/her} {RELATIVE}/that relative}?

|___|
ENTER # OF DAYS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.090

How many hours each week does {CHILD} receive care from {{his/her} {RELATIVE}/that relative}?

|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

A-22

CCQ.095

How many children are usually cared for together, in the same group at the same time, by {{his/her}
{RELATIVE}/that relative}, counting {CHILD}?
|___|___|
ENTER # OF CHILDREN
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.100

How many adults usually care for {CHILD} at the same time {at your home/at {{his/her} {RELATIVE}'s/that
relative's} home}?

|___|
ENTER # OF ADULTS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99
CCQ.110

You said that {CHILD} was cared for by {NUMBER} other {relatives/relative} on a regular basis. How many
hours each week does {CHILD} receive care from {these/this} other {relatives/relative}??
|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

Non-Relative Care
CCQ.115

{Now I'd like to ask you about any care {CHILD} receives from nonrelatives in a private home, not including
child care centers.} Is {CHILD} now receiving care in a private home on a regular basis before or after school
from someone who is not related to {him/her}? This includes home child care providers, regular sitters or
neighbors.
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.120
.

1 (CCQ.125)
2
7
9

Has {CHILD} ever received care in a private home from a nonrelative on a regular basis?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-23

1
2 (CCQ.210)
7 (CCQ.210)
9 (CCQ.210)

CCQ.125

How old was {CHILD} in years and months when {he/she} first received regular care in a private home from
any nonrelative?
|___|___|
ENTER YEAR

AND

|___|___|
ENTER MONTH

REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

CCQ.130

Did {CHILD} receive care from a nonrelative on a regular basis the year before {he/she} started
kindergarten?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.135

How many different regular care arrangements did you have with nonrelatives for {CHILD}'s care the year
before {he/she} started kindergarten?
ONE ..............................................................
TWO .............................................................
THREE .........................................................
FOUR ...........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.140

1
2
3
4
7
9

For the next few questions please think about the nonrelative who provided the most care for {CHILD} the
year before {he/she} started kindergarten. Was that care provided in your home or in another home?

OWN HOME ..................................................
OTHER HOME ..............................................
BOTH/VARIES ..............................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.145

1
2 (BOX 3)
7 (BOX 3)
9 (BOX 3)

1
2
3
7
9

How many days each week did {CHILD} receive care from a nonrelative the year before {he/she} started
kindergarten?
|___|
ENTER # OF DAYS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

A-24

CCQ.150

How many hours each week did {CHILD} receive care from a nonrelative the year before {he/she} started
kindergarten?

|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW................................................ 999

CCQ.155

CCQ.165

For how long did {CHILD} receive care from the nonrelative the year before
Would you say …
One to two months, ......................................
Three to five months, ....................................
Six to eight months, or ..................................
Nine to twelve months? .................................
REFUSED .....................................................
DON'T KNOW ...............................................

1
2
3
4
5
7
9

{Let's talk about the nonrelative who provides the most care for {CHILD} now.} Is that care provided in your
home or another home?
OWN HOME ..................................................
OTHER HOME ..............................................
BOTH/VARIES ..............................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.175

1
2
3
4
7
9

How many different regular care arrangements before or after school do you currently have with
nonrelatives?

ONE ..............................................................
TWO ..............................................................
THREE ..........................................................
FOUR ............................................................
FIVE OR MORE ............................................
REFUSED .....................................................
DON'T KNOW ...............................................
CCQ.170

{he/she} started kindergarten?

1
2
3
7
9

Does {CHILD} receive that care before school, after school, or on weekends?
CODE ALL THAT APPLY
BEFORE SCHOOL........................................
AFTER SCHOOL...........................................
WEEKENDS ..................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-25

1
2
3
7
9

CCQ.180

Is the care that {CHILD} receives from that person regularly scheduled at least once each week?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.185

1
2 (BOX 4)
7 (BOX 4)
9 (BOX 4)

How many days each week does {CHILD} receive care from that person?
|___|
ENTER # OF DAYS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.190

How many hours each week does {CHILD} receive care from that person?

|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

CCQ.195

How many children are usually cared for together, in the same group at the same time, by that person,
counting {CHILD}?
|___|___|
ENTER # OF CHILDREN
or
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.200

How many adults usually care for {CHILD} at the same time {at {your/that} home}?

|___|
ENTER # OF ADULTS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.205

You said that {CHILD} was cared for by {NUMBER} other {nonrelative/nonrelatives} on a regular basis. How
many hours each week does {CHILD} receive care from {this nonrelative/these nonrelatives}?
|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999
A-26

Head Start

CCQ.210

Head Start is a federally sponsored preschool program primarily for children from low-income families. Has
{CHILD} ever attended Head Start?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.215

Did {CHILD} attend Head Start the year before {he/she} started kindergarten?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.240

1
2 (CCQ.260)
7 (CCQ.260)
9 (CCQ.260)

Where was the Head Start program located? For example, was it in its own building, a school, in a church or
synagogue, your home or another home, or some other place?
ITS OWN BUILDING ................................................................................
A PUBLIC ELEMENTARY, JUNIOR HIGH, OR HIGH SCHOOL .............
A PRIVATE ELEMENTARY, JUNIOR HIGH, OR HIGH SCHOOL...........
A COLLEGE OR UNIVERSITY ................................................................
A CHURCH, SYNAGOGUE, OR OTHER PLACE OF WORSHIP............
RESPONDENT'S HOME ..........................................................................
ANOTHER HOME ....................................................................................
A COMMUNITY CENTER ........................................................................
A PUBLIC LIBRARY .................................................................................
MORE THAN ONE PLACE.......................................................................
SOME OTHER PLACE.............................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.245

1
2 (CCQ.260)
7 (CCQ.260)
9 (CCQ.260)

1
2
3
4
5
6
7
8
9
10
11
77
99

How old was {CHILD} in years and months when {he/she} first attended any Head Start program?
|___|___|
ENTER YEAR

AND

|___|___|
ENTER MONTH

REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

CCQ.250

How many days each week did {CHILD} go to the Head Start program?

|___|
ENTER # OF DAYS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99
A-27

CCQ.255

How many hours each week did {CHILD} go to the Head Start program?
|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

Day Care Center/Before- or After-School Program
CCQ.260

{Other than Head Start, is/Is} {CHILD} now attending a day care center or a before or after school program
at a school or in a center on a regular basis?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.265

Has {CHILD} ever attended a day care center, nursery school, preschool, prekindergarten, or before or after
school program at a school or in a center on a regular basis?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.275

1 (CCQ.275)
2
7
9

1
2 (BOX 8)
7 (BOX 8)
9 (BOX 8)

How old was {CHILD} in years and months when {he/she} first attended any day care center, nursery school,
preschool, prekindergarten, or before or after school program on a regular basis?
|___|___|
ENTER YEAR

AND

|___|___|
ENTER MONTH

REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

CCQ.280

Did {CHILD} attend a day care center, nursery school, preschool or prekindergarten program on a regular
basis the year before {he/she} started kindergarten?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-28

1
2 (BOX 5)
7 (BOX 5)
9 (BOX 5)

CCQ.285

How many different day care centers or before or after school programs did {CHILD} attend on a regular
basis the year before {he/she} started kindergarten?
|___|
ENTER # OF DAY CARE CENTERS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.290

What kind of program did {CHILD} attend the most?
DAY CARE CENTER ....................................
NURSERY SCHOOL.....................................
PRESCHOOL ................................................
PREKINDERGARTEN PROGRAM ...............

1
2
3
4

CCQ.300

For the next few questions please think about the {PROGRAM TYPE} that {CHILD} attended the year before
{he/she} started kindergarten.

CCQ.305

How many days each week did {CHILD} go to the program?

|___|
ENTER # OF DAYS
or
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.310

How many hours each week did {CHILD} go to the program?

|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999
CCQ.315

For how long did {CHILD} receive care at that {PROGRAM TYPE}? Would you say …
One to two months, ...................................... 1
Three to five months, .................................... 2
Six to eight months, or .................................. 3
Nine to twelve months? ................................ 4
REFUSED ..................................................... 7
DON'T KNOW ............................................... 9

A-29

CCQ.325

How many different day care centers or before or after school programs does {CHILD} currently go to?
ONE...............................................................
TWO ..............................................................
THREE ..........................................................
FOUR ............................................................
FIVE OR MORE ............................................
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.330

{Let's talk about the program where {CHILD} spends the most time now.} Is that program located in the
school where {CHILD} attends kindergarten?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.335

1
2
3
4
5
7
9

1
2
7
9

Does {CHILD} go to that program before school, after school, or on weekends?
CODE ALL THAT APPLY
BEFORE SCHOOL........................................
AFTER SCHOOL...........................................
WEEKENDS ..................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CCQ.340

1
2
3
7
9

Does {CHILD} go to that program on a regularly scheduled basis at least once each week?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

1
2 (BOX 7)
7 (BOX 7)
9 (BOX 7)

CCQ.350

How many days each week does {CHILD} go to that program?
|___|
ENTER # OF DAYS
or
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.355

Other than regular school hours, how many hours each week does {CHILD} go to that program?

|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

A-30

CCQ.360

How many children are usually in {CHILD}'s room or group, at the same time, at that program?

|___|___|
ENTER # OF CHILDREN
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.365

How many adults are usually in {CHILD}'s room or group, at the same time, at that program?

|___|
ENTER # OF ADULTS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CCQ.375

You said that {CHILD} attended {NUMBER} other day care {center/centers} or before or after school
{program/programs} on a regular basis. How many hours each week does {CHILD} attend {this
program/these programs}?

|___|___|___|
ENTER # OF HOURS
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999

CCQ.380
As part of this study, we will be interviewing the early care and education provider of children in the study.
We would like to talk to {CHILD}’s {relative caregiver/non-relative caregiver/ center director and teacher}.
We would like your permission to contact {CHILD}’s {relative caregiver/non-relative caregiver/center director
and teacher}. Is that OK?

YES ............................................................... 1
NO ................................................................. 2 (GO TO BOX 8)

A-31

CCQ.385
Please tell me anything special that I should know about contacting your {relative caregiver/non-relative
caregiver/center director and teacher}.
PROBE: For example, the best time to call your child care provider about the interview.
ENTER INFORMATION HERE.

CCQ.390
What is the name of {CHILD}’s {relative caregiver/non-relative caregiver/center director}?
ENTER FIRST NAME.

REFUSED ................................................... 7
DON’T KNOW ............................................. 9
CCQ.395
[What is the name of {CHILD}’s {relative caregiver/non-relative caregiver/center director}?]
ENTER LAST NAME.

REFUSED ................................................... 7
DON’T KNOW ............................................. 9

A-32

CCQ.400

What is {FIRST NAME} {LAST NAME/your center director}’s primary language?
ENGLISH.................... ……………………….1
ARABIC ....................................................... 2
CHINESE..................................................... 3
FILIPINO LANGUAGE (E.G., TAGALOG,
ILOCANO, ETC.) ........................................ .4
FRENCH...................................................... 5
GERMAN..................................................... 6
GREEK ........................................................ 7
ITALIAN ....................................................... 8
JAPANESE.................................................. 9
KOREAN ................................................... 10
POLISH ..................................................... 11
PORTUGUESE ......................................... 12
SPANISH................................................... 13
VIETNAMESE ........................................... 14
AFRICAN................................................... 15
EAST EUROPEAN…….................... ……..16
NATIVE AMERICAN.................................. 17
SIGN LANGUAGE..................................... 18
MIDDLE EASTERN ................................... 19
WEST EUROPEAN ................................... 20
INDIAN SUBCONTINENT ......................... 21
SOUTHEAST ASIAN................................. 22
PACIFIC ISLAND ...................................... 23
CANNOT CHOOSE................................... 24
ENTER SOME OTHER
LANGUAGE (SPECIFY)............................ 91
REFUSED .................................................RF
DON’T KNOW .......................................... DK

CCQ.400OS [What primary language does the provider speak?]
SPECIFY LANGUAGE.
___________________________________________________________

A-33

CCQ.405

ASK IF NECESSARY. Is {FIRST NAME} {LAST NAME/your center director} male or female?

MALE........................................................... 1
FEMALE ...................................................... 2
REFUSED ................................................... 7
DON’T KNOW ............................................. 9
CCQ.410

My records indicate that {CHILD} currently attends {NAME OF SCHOOL}. Is this care provided at that
school?
YES .................................................................. 1 (CCQ.420)
NO ................................................................ 2
REFUSED .................................................... 7
DON'T KNOW .............................................. 9

CCQ.415

What is the name of {CHILD}’s child care center?
ENTER NAME.
____________________________________________________
REFUSED ................................................... 7
DON’T KNOW ............................................. 9

CCQ.420

Is {CHILD}’s center director the same person as {his/her} primary {teacher/caregiver}?
YES .............................................................. 1 (CCQ.430)
NO ................................................................ 2 (CCQ.430)
REFUSED .................................................... 7 (CCQ.430)
DON'T KNOW .............................................. 9 (CCQ.430)

CCQ.430

What is the name of {CHILD}’s primary {caregiver/teacher} at {CENTER NAME/the child care center}?
VERIFY SPELLING.
ENTER FIRST NAME.
REFUSED .....................................................
DON'T KNOW ...............................................

CCQ.435

7
9

[What is the name of {CHILD}’s primary {caregiver/teacher} at {CENTER NAME/the child care center}?]

VERIFY SPELLING.
VERIFY NAME.
REFUSED .....................................................
DON'T KNOW ...............................................

A-34

7
9

CCQ.440

What is {FIRST NAME} {LAST NAME/{CHILD}’s caregiver/{CHILD}’s teacher}’s primary language?

ELSE, USE A NULL DISPLAY FOR “FIRST NAME” AND DISPLAY “{CHILD}’s caregiver”.

ENGLISH.................... ……………………….1
ARABIC ....................................................... 2
CHINESE..................................................... 3
FILIPINO LANGUAGE (E.G., TAGALOG,
ILOCANO, ETC.) ........................................ .4
FRENCH...................................................... 5
GERMAN..................................................... 6
GREEK ........................................................ 7
ITALIAN ....................................................... 8
JAPANESE.................................................. 9
KOREAN ................................................... 10
POLISH ..................................................... 11
PORTUGUESE ......................................... 12
SPANISH................................................... 13
VIETNAMESE ........................................... 14
AFRICAN................................................... 15
EAST EUROPEAN…….................... ……..16
NATIVE AMERICAN.................................. 17
SIGN LANGUAGE..................................... 18
MIDDLE EASTERN ................................... 19
WEST EUROPEAN ................................... 20
INDIAN SUBCONTINENT ......................... 21
SOUTHEAST ASIAN................................. 22
PACIFIC ISLAND ...................................... 23
CANNOT CHOOSE................................... 24
ENTER SOME OTHER
LANGUAGE (SPECIFY)............................ 91
REFUSED ................................................... 7
DON’T KNOW ............................................. 9

CCQ.440OS [What primary language does the caregiver/teacher speak?]
SPECIFY LANGUAGE.
___________________________________________________________

A-35

CCQ.445

ASK IF NECESSARY. Is {PROVNAME} male or female?
MALE........................................................... 1
FEMALE ...................................................... 2
REFUSED ................................................... 7
DON’T KNOW ............................................. 8

CCQ.450

Is {PROVNAME} 18 years of age or older?
YES ............................................................. 1
NO ............................................................... 2
REFUSED ................................................... 3
DON’T KNOW ............................................. 4

CCQ.455

What is the mailing address of {{RELATIVE/CAREGIVER’S NAME)/(CENTER NAME}}?
ENTER STREET ADDRESS, LINE 1.
VERIFY SPELLING.

CCQ.460

[What is the mailing address of {{RELATIVE/CAREGIVER’S NAME)/(CENTER NAME}}?]
ENTER STREET ADDRESS, LINE 2.
VERIFY SPELLING.

CCQ.465

[What is the mailing address of {{RELATIVE/CAREGIVER’S NAME)/(CENTER NAME}}?]
ENTER CITY.
VERIFY SPELLING.

CCQ.470

[What is the mailing address of {{RELATIVE/CAREGIVER’S NAME)/(CENTER NAME}}?]
ENTER STATE.

CCQ.475

[What is the mailing address of {{RELATIVE/CAREGIVER’S NAME)/(CENTER NAME}}?]
ENTER ZIP CODE.

CCQ.480

What is {{RELATIVE/CAREGIVER’S NAME}/{CENTER NAME}}’s telephone number?

A-36

CHILD'S HEALTH AND WELL-BEING - CHQ
CHQ.005

Now I have some questions about {CHILD}'s health. How much did {CHILD} weigh when {he/she} was born?
|___|___|
ENTER POUNDS

AND |___|___|
ENTER OUNCES

(BOX 1)

REFUSED .................................................... 77
DON'T KNOW .............................................. 99

CHQ.010

When {he/she} was born, did {CHILD} weigh more than 5 1/2 pounds?
YES ..............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ...............................................

CHQ.015

Did {he/she} weigh more than 3 pounds?
YES ..............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ...............................................

CHQ.025

1
2
7
9

Was {CHILD} born more than two weeks before {he/she} was due?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ..............................................

CHQ.030

1 (BOX 1)
2
7
9

1
2 (CHQ.035)
7 (CHQ.035)
9 (CHQ.035)

How many days or weeks early was {he/she}?

|___|___|
ENTER NUMBER
REFUSED .................................................... 77
DON'T KNOW .............................................. 99
ENTER UNIT
WEEKS..........................................................
DAYS.............................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-37

1
2
7
9

CHQ.035

Was {CHILD} a twin, triplet, or other child born as part of a multiple birth?
NO .................................................................
YES, A TWIN.................................................
YES, A TRIPLET ...........................................
YES, MULTIPLE BIRTH (4 OR MORE) ........
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.040

1 (CHQ.095)
2
3
4
7 (CHQ.095)
9 (CHQ.095)

CODE WITHOUT ASKING IF ALREADY KNOWN. OTHERWISE ASK:
{Is {CHILD}'s twin living?/Are all the other children born in the multiple birth still living?}

YES, TWIN IS LIVING (OR ALL
OTHER CHILDREN ARE LIVING) ...............
NO, TWIN DIED (OR ALL OTHER
CHILDREN DIED) ........................................
[FOR HIGHER-ORDER MULTIPLE
BIRTHS ONLY] ONE OR MORE DIED,
OTHERS ARE LIVING .................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.045

3
7
9

1
2
3
7
9

{What is {CHILD}'s twin's name?/What are the names of the other children born with {CHILD} {who are
living}?}
ENTER CHILD NAME 1 _______________
ENTER CHILD NAME 2 _______________
ENTER CHILD NAME 3 _______________
ENTER CHILD NAME 4 _______________
REFUSED ................................................ 7
DON'T KNOW .......................................... 9

CHQ.060

2 (CHQ.070)

{Does {CHILD}'s twin/Do they} live in this household?
LIVES HERE .................................................
LIVES ELSEWHERE.....................................
SOME LIVE HERE/SOME LIVE
ELSEWHERE ...............................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.050

1

CODE IF OBVIOUS, OTHERWISE ASK:
Is {EACH CHILD NAMED IN CHQ.050} a boy or a girl?
RESPONSES: 1 = BOY, 2 = GIRL, 7 = REFUSED, 9 = DON'T KNOW.
GENDER
|___|
|___|
|___|
|___|

{CHILD 1}
{CHILD 2}
{CHILD 3}
{CHILD 4}
A-38

CHQ.070

{{Are/Were} {CHILD} and {{TWIN's NAME}/{CHILD}'s twin}} identical twins or fraternal (non-identical)
twins?/{Is/Was} {CHILD} identical to any of the other children born with {CHILD}?}
IDENTICAL....................................................
FRATERNAL .................................................
MULTIPLE BIRTH CONTAINING AN
IDENTICAL TWIN PAIR OF WHICH
{CHILD} IS ONE ...........................................
MULTIPLE BIRTH WITH NO IDENTICAL
TWIN PAIR, OR {CHILD} IS NOT ONE
OF THE IDENTICAL TWINS ........................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.075

4
7
9

1
2
7
9

Which one weighed {more/the most} at birth?
FOCAL CHILD...............................................
TWIN (OR OTHER CHILD IN MULTIPLE
BIRTH)..........................................................
BOTH WEIGHED ABOUT THE SAME..........
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.085

3

Which one was born first?
FOCAL CHILD...............................................
TWIN (OR OTHER CHILD IN MULTIPLE
BIRTH)..........................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.080

1
2

1
2
3
7
9

Apart from being a {twin/part of a multiple birth}, were there any complications in {CHILD}'s birth or delivery?
YES. ..............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-39

1
2 (CHQ.095)
7 (CHQ.095)
9 (CHQ.095)

CHQ.090

What were the complications?
CODE ALL THAT APPLY
PREMATURE ................................................
ANOXIA/BABY DIDN'T GET ENOUGH
OXYGEN ......................................................
ECLAMPSIA/PRE-ECLAMPSIA/MOTHER'S
HIGH BLOOD PRESSURE/TOXEMIA/
SWELLING ...................................................
CESAREAN SECTION .................................
RESPIRATORY DISTRESS SYNDROME ....
MECONIUM/BABY'S FECAL MATTER
EXCRETED AT OR NEAR BIRTH ...............
FETAL DISTRESS .......................................
BREECH/MALPRESENTATION/BABY'S
FEET CAME OUT FIRST ............................
PREMATURE RUPTURE OF MEMBRANE..
DYSFUNCTIONAL LABOR ..........................
OTHER (SPECIFY) __________________
__________________________________
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.095

1
2

3
4
5
6
7
8
9
10
11
77
99

For the next set of questions, please base your answer on how {CHILD} compares to other children of the
same age.
{CHILD} is independent and takes care of {himself/herself} ...
Better than other children {his/her} age, .......
As well as other children,...............................
Slightly less well than other children, or ........
Much less well than other children? ..............
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.100

Does {CHILD} pay attention ....
Better than other children {his/her} age, .......
As well as other children,...............................
Slightly less well than other children, or ........
Much less well than other children? ..............
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.105

1
2
3
4
7
9

1
2
3
4
7
9

Does {CHILD} learn, think, and solve problems ...
Better than other children {his/her} age, .......
As well as other children,...............................
Slightly less well than other children, or .......
Much less than other children? .....................
REFUSED ....................................................
DON'T KNOW ..............................................

A-40

1
2
3
4
7
9

CHQ.115

Has {CHILD} ever been evaluated by a professional in response to {his/her} ability to pay attention or learn?
YES ..............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.120

Did you obtain a diagnosis of a problem from a professional?

YES ..............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.125

1
2 (CHQ.140)
7 (CHQ.140)
9 (CHQ.140)

1
2 (CHQ.140)
7 (CHQ.140)
9 (CHQ.140)

What was the diagnosis?

LEARNING DISABILITY................................ 1
ATTENTION DEFICIT DISORDER (ADD) .... 2
ATTENTION DEFICIT HYPERACTIVE
DISORDER (ADHD) ...................................... 3
DEVELOPMENTAL DELAY .......................... 4
AUTISM OR PERVASIVE DEVELOPMENTAL
DISORDER.................................................. 5
DYSLEXIA ..................................................... 6
DYSCALCULIA.............................................. 7
MENTAL RETARDATION ............................. 8
OTHER (SPECIFY) ___________________ 91
___________________________________
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99
CHQ.125OS [What was the diagnosis?]
SPECIFY DIAGNOSIS.
________________________________________________________

CHQ.130

How old was {CHILD} when the first diagnosis of a problem was made?

|___|___|
ENTER AGE
REFUSED .................................................... 77 (CHQ.140)
DON'T KNOW .............................................. 99
ENTER UNIT
MONTHS ......................................................
YEARS .........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-41

1 (CHQ.140)
2 (CHQ.140)
7 (CHQ.140)
9

CHQ.135

What was the month and year when the diagnosis was made?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.140

CHQ.145

Thinking about {CHILD}'s overall activity level, would you say {he/she} is …
Less active than other children of {his/her} age, ................
About as active,...................................................................
Slightly more active, or........................................................
A lot more active than other children of {his/her} age? .......
REFUSED ..........................................................................
DON'T KNOW ....................................................................

1
2 (CHQ.175)
7 (CHQ.175)
9 (CHQ.175)

1
2 (CHQ.175)
7 (CHQ.175)
9 (CHQ.175)

Did you obtain a diagnosis of a problem from a professional?
YES ..............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.160

(CHQ.175)
(CHQ.175)

Has {CHILD} ever been evaluated by a professional in response to {his/her} overall activity level?

YES ..............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.155

(CHQ.175)
(CHQ.175)
(CHQ.175)

Do you have any concerns about {CHILD}'s overall activity level?
YES ..............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.150

1
2
3
4
7
9

1
2 (CHQ.175)
7 (CHQ.175)
9 (CHQ.175)

What was the diagnosis?
LEARNING DISABILITY................................ 1
ATTENTION DEFICIT DISORDER (ADD) .... 2
HYPERACTIVITY .......................................... 3
DYSLEXIA ..................................................... 4
MENTAL RETARDATION ............................. 5
OTHER (SPECIFY) ___________________ 91
___________________________________
REFUSED ..................................................... 7
DON'T KNOW ............................................... 9

A-42

CHQ.160OS [What was the diagnosis?]
SPECIFY DIAGNOSIS.
________________________________________________________

CHQ.165

How old was {CHILD} when the first diagnosis of a problem was made?

|___|___|
ENTER AGE
REFUSED .................................................... 77 (CHQ.175)
DON'T KNOW .............................................. 99
ENTER UNIT
MONTHS ......................................................
YEARS .........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.170

1 (CHQ.175)
2 (CHQ.175)
7 (CHQ.175)
9

What was the month and year when the diagnosis was made?
|___|___|
ENTER MONTH

AND

|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.175

Does {CHILD} show good coordination in moving {his/her} arms and legs? Would you say {he/she} does this
...
Better than other children {his/her} age, .......
As well as other children, ..............................
Slightly less well than other children, or ........
Much less well than other children? ..............
REFUSED .....................................................
DON'T KNOW ...............................................

1
2
3
4
7
9

(CHQ.200)
(CHQ.200)

(CHQ.200)
(CHQ.200)

CHQ.180

Has {CHILD} ever been evaluated by a professional in response to the use of {his/her} limbs?
YES ............................................................... 1
NO ................................................................. 2 (CHQ.200)
REFUSED ..................................................... 7 (CHQ.200)
DON'T KNOW ............................................... 9 (CHQ.200)

CHQ.185

Did you obtain a diagnosis of a problem from a professional?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-43

1
2 (CHQ.200)
7 (CHQ.200)
9 (CHQ.200)

CHQ.190

How old was {CHILD} when the first diagnosis of a problem was made?
|___|___|
ENTER AGE
REFUSED .................................................... 77 (CHQ.200)
DON'T KNOW .............................................. 99
ENTER UNIT
MONTHS ......................................................
YEARS .........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.195

1 (CHQ.200)
2 (CHQ.200)
7 (CHQ.200)
9

What was the month and year when the diagnosis was made?

|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.200

Does {CHILD} pronounce words, communicate with and understand others ...

Better than other children {his/her} age, .......
As well as other children, ..............................
Slightly less well than other children, or ........
Much less well than other children? ..............
REFUSED .....................................................
DON'T KNOW ...............................................

1
2
3 (CHQ.210)
4 (CHQ.210)
7
9

CHQ.205

When {CHILD} was younger, did {he/she} ever have unusual difficulty pronouncing words, communicating
with, or understanding others?
YES ............................................................... 1
NO ................................................................. 2 (CHQ.230)
REFUSED ..................................................... 7 (CHQ.230)
DON'T KNOW ............................................... 9 (CHQ.230)

CHQ.210

Has {CHILD} ever been evaluated by a professional in response to {his/her} ability to communicate?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-44

1
2 (CHQ.230)
7 (CHQ.230)
9 (CHQ.230)

CHQ.215

Did you obtain a diagnosis of a problem from a professional?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.220

1
2 (CHQ.230)
7 (CHQ.230)
9 (CHQ.230)

How old was {CHILD} when the first diagnosis of a problem was made?
|___|___|
ENTER AGE
REFUSED .................................................... 77 (CHQ.230)
DON'T KNOW .............................................. 99
ENTER UNIT
MONTHS ......................................................
YEARS .........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.225

1 (CHQ.230)
2 (CHQ.230)
7 (CHQ.230)
9

What was the month and year when the diagnosis was made?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.230

Does {CHILD} have difficulty hearing and understanding speech in a normal conversation?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.235

Have {CHILD}'s hearing ever been evaluated by a professional?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.245

1
2
7
9

Did you obtain a diagnosis of a problem from a professional?
YES ..............................................................
NO ................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-45

1
2
7
9

1
2 (CHQ.260)
7 (CHQ.260)
9 (CHQ.260)

CHQ.250

How old was {CHILD} when the first diagnosis of a problem was made?

|___|___|
ENTER AGE
REFUSED .................................................... 77 (CHQ.260)
DON'T KNOW .............................................. 99
ENTER UNIT
MONTHS ......................................................
YEARS .........................................................
REFUSED ....................................................
DON'T KNOW ..............................................
CHQ.255

1 (CHQ.260)
2 (CHQ.260)
7 (CHQ.260)
9

What was the month and year {CHILD}'s hearing was evaluated?

|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.260

Which of the following best describes {CHILD}'s hearing loss? Is {he/she} …
Deaf in both ears,...........................................................................
Deaf in one ear and hard of hearing in the other, ..........................
Deaf in one ear and normally hearing in the other,........................
Hard of hearing in both ears, or .....................................................
Hard of hearing in one ear and normally hearing in the other?......
REFUSED .....................................................................................
DON'T KNOW ...............................................................................

CHQ.265

1
2
3
4
5
7
9

Does {CHILD} usually wear a hearing aid?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-46

1
2
7
9

CHQ.270

Does {CHILD} have a cochlear implant(s)?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.271

1
2
7
9

In what year (was it/were they) implanted?
|___|___|___|___| (CHQ.254)
ENTER YEAR................................................

(CHQ.274)

REFUSED ..................................................... 7777 (CHQ.272)
DON'T KNOW ............................................... 9999 (CHQ.272)
CHQ.272

Was it before {YEAR}?
YES ..............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.273

1
2
7
9

Does {CHILD} use the cochlear implant(s) in school?
All the time,....................................................
Some of the time, or .....................................
Not at all? ......................................................
REFUSED .....................................................
DON'T KNOW ...............................................

1
2
3
7
9

CHQ.280

What is the effect of the device on {CHILD}'s ability to hear and understand speech in normal
conversations? Does it ...
Greatly improves {his/her} hearing, ............... 1
Somewhat improves {his/her} hearing,.......... 2
Minimally improves {his/her} hearing, or........ 3
Does it not improves{his/her} hearing?.......... 4
Does not improve {his/her} ability to
understand speech? ...................................... 4
REFUSED .................................................... 7
DON'T KNOW .............................................. 9

CHQ.285

Now I want to ask you about {CHILD}'s vision. Without the use of eyeglasses or contact lenses, does
{CHILD} have difficulty seeing objects in the distance or letters on paper?
YES ............................................................... 1
NO ................................................................. 2
REFUSED ..................................................... 7
DON'T KNOW ............................................... 9

A-47

CHQ.290

Has {CHILD}'s vision ever been evaluated by an eye care professional?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.291

1
2
7
9

Has {CHILD} been prescribed glasses or contact lenses to improve {his/her} ability to see objects in the
distance or letters on paper?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.300

Did you obtain a diagnosis of a vision-related problem from an eye care professional?

YES ..............................................................
NO ................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.301

1
2
7
9

1
2 (CHQ.315)
7 (CHQ.315)
9 (CHQ.315)

What was the diagnosis?
PROBE: What was the primary diagnosis?

NEARSIGHTEDNESS (MYOPIA) ................. 1
FARSIGHTED (HYPEROPIA) ....................... 2
COLOR BLINDNESS OR DEFICIENCY ....... 3
ASTIGMATISM.............................................. 4
CROSSED OR WANDERING EYE
(STRABISMUS)............................................. 5
AMBLYOPIA OR “LAZY EYE” ...................... 6
RETINOPATHY ............................................. 7
OTHER (SPECIFY) ___________________ 91
___________________________________
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99
CHQ.301OS [What was the diagnosis?]
SPECIFY DIAGNOSIS.
________________________________________________________

A-48

CHQ.305

How old was {CHILD} when the first diagnosis of a problem was made?
|___|___|
ENTER AGE
REFUSED .................................................... 77 (CHQ.315)
DON'T KNOW .............................................. 99
ENTER UNIT
MONTHS ......................................................
YEARS .........................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.310

1 (CHQ.315)
2 (CHQ.315)
7 (CHQ.315)
9

What was the month and year when {CHILD}'s vision was evaluated?

|___|___|
ENTER MONTH

AND

|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.315

Is {CHILD}'s eyesight ...
Correctable with glasses, ..............................
Improvable with glasses, or ...........................
Not correctable with glasses?........................
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.320

Please tell me which of the following {CHILD}'s best eyesight {, with glasses,} allows {him/her} to see.

Print in children's story books, ............................................
Form and/or color of distant objects, with details ................
Form and/or color of distant objects, but not detail, ............
Shadows, ............................................................................
Lights, or .............................................................................
Does {CHILD} see no light or have no light perception?.....
REFUSED ..........................................................................
DON'T KNOW ....................................................................

CHQ.325

1
2
3
7
9

1
2
3
4
5
6
7
9

Would you say {CHILD} behaves and relates to other children and adults ...
Better than other children {his/her} age, .......
As well as other children,...............................
Slightly less well than other children, or ........
Much less well than other children? ..............
REFUSED .....................................................
DON'T KNOW ...............................................

A-49

1
2
3
4
7
9

CHQ.330

Would you say {CHILD}'s health is ...
Excellent, .......................................................
Very good, .....................................................
Good,.............................................................
Fair, or ...........................................................
Poor? .............................................................
REFUSED ....................................................
DON'T KNOW ..............................................

CHQ.340

Children with disabilities include children with developmental delays, communication impairments, or special
health care needs. Prior to this school year, did {CHILD} ever receive therapy services or take part in a
program for children with disabilities?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

CHQ.345

1
2
3
4
5
7
9

1
2 (BOX 10)
7 (BOX 10)
9 (BOX 10)

I'm going to read a list of services. For each service, please tell me if {CHILD} or your family ever received
this service before this school year to help with {CHILD}'s special needs.
RESPONSES: 1=YES, 2=NO, 7=REFUSED, 9=DON'T KNOW
a.
b.
c.
d.
e.
f.
g.
h.
i.
l.

Speech or language therapy? .......................................................... ___
Occupational therapy? ...................................................................... ___
Physical therapy? ............................................................................. ___
Vision services? ................................................................................ ___
Social work services? ....................................................................... ___
Psychological services? ................................................................... ___
Home visits? ..................................................................................... ___
Parent support or training? ............................................................... ___
Special class with other children some or all of whom also had
special needs? .................................................................................. ___
Private tutoring or schooling for learning problems? ........................ ___

k.

Instruction in Braille .......................................................................... ___

l.

Instruction in sign language, Cued Speech, ASL, TOCO ........... ___

m. Other (SPECIFY) ______________________________________
_____________________________________________________

A-50

CHQ.375

How old was {CHILD} when {this service/the earliest of these services} began?

|___|___|
ENTER YEARS
REFUSED .................................................... 77 (CHQ.375B)
DON'T KNOW .............................................. 99 (CHQ.375B)
CHQ.375B

[How old was {CHILD} when {this service/the earliest of these services} began?]
|___|___|
ENTER MONTHS
REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.380

What is the month and year when {{CHILD} first received {NAME OF SINGLE SERVICE}/the first of these
services began}?

|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99

CHQ.385

CHQ.390

Is {CHILD} still receiving {this service/any of these services}?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

1 (CHQ.400)
2
7
9

What is the month and year when {{CHILD} last received {NAME OF SINGLE SERVICE}/the last of these
services was received}?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 77
DON'T KNOW ............................................... 99
CHQ.400

Overall, how helpful {are/were} the special services your child or family {is receiving/received}?
Very helpful,...................................................
Helpful, ..........................................................
Not helpful, or ................................................
Not at all helpful?...........................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-51

1
2
3
4
7
9

CHQ.410

Does {CHILD} currently use special equipment for children with special needs such as a wheelchair,
communication board, electronic Braille device, or other assistance device, etc.?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-52

1
2
7
9

SOCIAL SKILLS, PROBLEM BEHAVIORS, AND APPROACHES TOWARD LEARNING - SSQ

Twenty-four items ask parents to rate their children’s social skills (including their ability to exercise self-control, interact with
others, resolve conflict, and participate in group activities); problem behaviors (e.g., fighting, bullying, arguing, anger,
depression, low self-esteem, impulsiveness, etc.); and learning dispositions (e.g., curiosity, self-direction, and
inventiveness). The items are not listed as they are copyright protected.

A-53

BEHAVIOR REGULATION - BRQ

Source: Behavioral Regulation subscales from the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith,
Guy, & Kenworthy, (2000)
Twenty-eight items from the BRIEF ask parents to assess their children’s executive functioning, such as inhibition, shifting
and flexibility, and emotional control. The items are not listed as they are copyright protected.

A-54

PARENT MARITAL HISTORY - MHQ

MHQ.010

Next are a few questions about {your/{CHILD}'s parents'} marital history.

MHQ.020

Are you legally married to {CHILD}'s biological {father/mother}?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.025

1
2 (MHQ.030)
7 (MHQ.030)
9 (MHQ.030)

When did you get married?

|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.165)

REFUSED ..................................................... 777 (MHQ.165)
DON’T KNOW ............................................... 999 (MHQ.165)

MHQ.030

Are you and {CHILD}'s biological {father/mother} currently living together in a marriage-like relationship?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.035

1
2 (MHQ.040)
7 (MHQ.040)
9 (MHQ.040)

When did you and {CHILD}'s biological {father/mother} begin living together?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.165)

REFUSED ..................................................... 777 (MHQ.165)
DON’T KNOW ............................................... 999 (MHQ.165)

A-55

MHQ.040

Are you currently married to someone who is not {CHILD}'s biological {father/mother}?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.045

Are you currently living in a marriage-like relationship with someone who is not {CHILD}'s biological
{father/mother}?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.050

1 (MHQ.050)
2
7
9

1
2
7
9

(MHQ.055)
(MHQ.125)
(MHQ.125)
(MHQ.125)

When did your current marriage begin?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.125)

REFUSED ..................................................... 777 (MHQ.125)
DON’T KNOW ............................................... 999 (MHQ.125)

MHQ.055

When did you and this person begin living together?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.125)

REFUSED ..................................................... 777 (MHQ.125)
DON’T KNOW ............................................... 999 (MHQ.125)

MHQ.060

Are {CHILD}'s biological parents legally married?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.065

1
2 (MHQ.070)
7 (MHQ.070)
9 (MHQ.070)

When did their marriage begin?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.165)

REFUSED ..................................................... 777 (MHQ.165)
DON’T KNOW ............................................... 999 (MHQ.165)

A-56

MHQ.070

Are {CHILD}'s biological parents currently living together in a marriage-like relationship?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.075

1
2 (MHQ.125)
7 (MHQ.125)
9 (MHQ.125)

When did {CHILD}'s biological parents begin living together?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.165)

REFUSED ..................................................... 777 (MHQ.165)
DON’T KNOW ............................................... 999 (MHQ.165)

MHQ.080

Are you and {CHILD}'s biological parent legally married?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.085

1
2 (MHQ.090)
7 (MHQ.090)
9 (MHQ.090)

When did you get married?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.125)

REFUSED ..................................................... 777 (MHQ.125)
DON’T KNOW ............................................... 999 (MHQ.125)

MHQ.090

Are you and {CHILD}'s biological {father/mother} living together in a marriage-like relationship?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.095

1
2 (MHQ.125)
7 (MHQ.125)
9 (MHQ.125)

When did you first start living together?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.125)

REFUSED ..................................................... 777 (MHQ.125)
DON’T KNOW ............................................... 999 (MHQ.125)

MHQ.100

Are you legally married?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................
A-57

1
2 (MHQ.110)
7 (MHQ.110)
9 (MHQ.110)

MHQ.105

When did you get married?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.120)

REFUSED ..................................................... 777 (MHQ.120)
DON’T KNOW ............................................... 999 (MHQ.120)

MHQ.110

Are you living with someone in a marriage-like relationship?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.115

1
2 (MHQ.120)
7 (MHQ.120)
9 (MHQ.120)

When did you begin living together?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 777
DON’T KNOW ............................................... 999

MHQ.120

To the best of your knowledge, are {CHILD}'s biological parents currently married to each other?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.125

[To the best of your knowledge] {Have you/Has {CHILD}'s biological {mother/father}} EVER been married to
{CHILD}'s biological {father/mother}?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.130

1 (MHQ.130)
2
7
9

1
2 (MHQ.150)
7 (MHQ.150)
9 (MHQ.150)

[To the best of your knowledge] When did that marriage begin?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 777
DON’T KNOW ............................................... 999

A-58

MHQ.135

[To the best of your knowledge] Did that marriage end in…
Legal separation, ...........................................
Divorce, or .....................................................
Death? ...........................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.145

1
2
3
7
9

[To the best of your knowledge] When did {CHILD} stop living in a household with at least one biological
parent?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

(MHQ.165)

REFUSED ..................................................... 777 (MHQ.165)
DON’T KNOW ............................................... 999 (MHQ.165)

MHQ.150

[To the best of your knowledge] Since {CHILD} was born, have {you/{CHILD}'s biological {mother/father}}
and {CHILD}'s biological {father/mother} ever lived together in a marriage-like relationship?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.155

1
2 (MHQ.165)
7 (MHQ.165)
9 (MHQ.165)

[To the best of your knowledge] When did {you/{CHILD}'s biological {mother/father}} and {CHILD}'s
biological {father/mother} first live together in the same household?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 777
DON’T KNOW ............................................... 999

MHQ.160

[To the best of your knowledge] When did {you/{CHILD}'s biological {mother/father}} and {CHILD}'s
biological {father/mother} last live together?
|___|___|
ENTER MONTH

AND

|___|___|___|___|
ENTER YEAR

REFUSED ..................................................... 777
DON’T KNOW ............................................... 999

A-59

MHQ.165

How old {were you/was {CHILD}'s biological mother} when {you/she} gave birth for the first time?
|___|___|
ENTER AGE IN YEARS
or
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

MHQ.175

I just wanted to double check: {Were you/Was {CHILD}'s biological mother} married to anyone when
{CHILD} was born?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

MHQ.180

1 (BOX 5)
2
7
9

{Were you/Was {CHILD}'s biological mother} living in a marriage-like relationship with anyone when {CHILD}
was born?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

A-60

1
2
7
9

CHILD ALWAYS LIVED WITH PERSON - ALQ

ALQ.010

{I now have just a few questions about the past living arrangements of your household.}
How long has {CHILD} lived with {you/{NAME}}?

FIRST NAME

YEARS

MONTHS

{Display HH Member Name}

|___|___|

|___|___|

{Display HH Member Name}

|___|___|

|___|___|

{Display HH Member Name}

|___|___|

|___|___|

A-61

HISTORICAL ROSTER - HRQ

HRQ.030

I'd like to ask you a few questions about {CHILD}'s biological {mother/father}. Is {CHILD}'s biological
{mother/father} currently living?
YES ...............................................................
NO .................................................................
DON’T KNOW WHO BIOLOGICAL
{MOTHER/FATHER} IS................................
REFUSED .....................................................
DON’T KNOW ...............................................

HRQ.040

1
2
3 (BOX 6)
7
9

What is {CHILD}'s biological {mother’s/father’s} date of birth?
|___|___|
ENTER MONTH

AND

|___|___|
ENTER YEAR

REFUSED ..................................................... 777
DON’T KNOW ............................................... 999
HRQ.060

How old {is/was} {CHILD}'s biological {mother/father} {when {he/she} died}?
|___|___|
ENTER AGE IN YEARS
REFUSED ..................................................... 777
DON’T KNOW ............................................... 999

HRQ.080

What is {CHILD}'s biological {mother’s/father’s} date of death?
|___|___|
ENTER MONTH

AND

|___|___|
ENTER YEAR

REFUSED ..................................................... 777
DON’T KNOW ............................................... 999

HRQ.090

{Is/Was} {he/she} Hispanic or Latino?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

A-62

1
2
7
9

HRQ.100

What {is/was} {his/her} race? You may name more than one.
CODE ALL THAT APPLY
AMERICAN INDIAN OR ALASKA NATIVE ...
ASIAN............................................................
BLACK OR AFRICAN AMERICAN................
NATIVE HAWAIIAN OR OTHER
PACIFIC ISLANDER ...................................
WHITE ...........................................................
ANOTHER RACE (SPECIFY) ___________
___________________________________
REFUSED .....................................................
DON’T KNOW ...............................................

HRQ.110

4
5
6
7
9

To the best of your knowledge, {has/did} {CHILD} ever {lived/live} with {his/her} biological {mother/father}?
YES ...............................................................
NO .................................................................
{FATHER DECEASED BEFORE
CHILD BORN ...............................................
REFUSED .....................................................
DON’T KNOW ...............................................

HRQ.120

1
2
3

1
2 (BOX 6)
3 (BOX 6)}
7 (BOX 6)
9 (BOX 6)

When did {CHILD}'s {mother/father} last live in the same household as {CHILD}?
|___|___|
AND
|___|___|
ENTER MONTH
ENTER YEAR
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

HRQ.130

{Besides {CHILD}'s biological {mother/father/parents}, are/Are} there any {other} adults, 18 years or older at
the time, who do not currently live with {CHILD} who have lived with {him/her} in the past for at least four
months?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

HRQ.140

1
2 (BOX 7)
7 (BOX 7)
9 (BOX 7)

{Besides {CHILD}'s biological {mother/father/parents}, how/How} many adults, 18 years or older at the time,
once lived with {CHILD} for at least four months, but no longer do?
|___|___|
ENTER # OF ADULTS
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

A-63

HRQ.150

How {were the other {NUMBER} adults/was the other person} related to {CHILD}?
MOTHER FIGURE/FEMALE GUARDIAN ..... 1
FATHER FIGURE/MALE GUARDIAN........... 2
GIRLFRIEND OR PARTNER OF {CHILD}'S
PARENT/GUARDIAN ................................... 3
BOYFRIEND OR PARTNER OF {CHILD}'S
PARENT/GUARDIAN ................................... 4
SISTER/BROTHER ....................................... 5
GRANDMOTHER/GRANDFATHER.............. 6
OTHER RELATIVE........................................ 7
OTHER NON-RELATIVE .............................. 8
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

A-64

NON-RESIDENT PARENT QUESTIONS - NRQ

NRQ.030

You said before that {you/{NAME}} {are/is} {CHILD}'s adoptive {mother/father}. Does {CHILD} have an
adoptive {father/mother}?
YES ...............................................................
NO ................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

NRQ.040

The next questions are about {CHILD}'s contact with {his/her} {biological/adoptive} {father/mother}.
Less than one month ....................................
More than a month but less than a year, .......
More than a year, or ......................................
No contact since birth ....................................
PARENT IS DECEASED...............................
NO CONTACT SINCE ADOPTION ...............
NO ADOPTIVE (MOTHER/FATHER)............
REFUSED .....................................................
DON’T KNOW ...............................................

NRQ.050

1
2 (BOX 4)
7 (BOX 4)
9 (BOX 4)

1
2
3
4
5
6
7
7
9

(NRQ.060)
(NRQ.060)
(NRQ.060)
(BOX 8)
(BOX 8)
(BOX 8)
(NRQ.060)
(NRQ.060)

How many days has {CHILD} seen {his/her} {biological/adoptive} {father/mother} in the past 4 weeks?
|___|___|
ENTER # OF DAYS
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

NRQ.060

How many days was {CHILD} scheduled to see {his/her} {biological/adoptive} {father/mother} in the past 4
weeks?
|___|___|
ENTER # OF DAYS
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

A-65

PARENT EDUCATION AND HUMAN CAPITAL - PEQ
PEQ.020

{Now I have a few questions about education and job training.} What is the highest grade or year of school
that {you/{NAME}/{CHILD}'s {mother/father}} {have/has} completed?
1ST GRADE .............................................................................................
2ND GRADE ............................................................................................
3RD GRADE ............................................................................................
4TH GRADE ............................................................................................
5TH GRADE ............................................................................................
6TH GRADE ............................................................................................
7TH GRADE ............................................................................................
8TH GRADE ............................................................................................
9TH GRADE ............................................................................................
10TH GRADE ..........................................................................................
11TH GRADE ..........................................................................................
12TH GRADE BUT NO DIPLOMA ..........................................................
HIGH SCHOOL DIPLOMA OR VOC/TECH PROGRAM
AFTER HIGH SCHOOL BUT NO VOC/TECH DIPLOMA .....................
GED .........................................................................................................
VOC/TECH PROGRAM AFTER HIGH SCHOOL.....................................
SOME COLLEGE BUT NO DEGREE .....................................................
ASSOCIATE'S DEGREE ..........................................................................
BACHELOR'S DEGREE...........................................................................
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ...........
MASTER'S OR DOCTORATE (MA, MS) .................................................
DOCTORATE DEGREE (PHD, EDD) ......................................................
PROFESSIONAL DEGREE AFTER BACHELOR'S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) ....................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

PEQ.030

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
77
99

PEQ.030 {Do/Does/Did} {you/{NAME}/{CHILD}'s {biological/adoptive} {mother/father}} have a high school
diploma or its equivalent, such as a GED?

HIGH SCHOOL DIPLOMA ...........................1
GED .............................................................2
NO HIGH SCHOOL DIPLOMA OR GED......3
REFUSED .................................................. 7
DON'T KNOW ............................................. 9

A-66

PEQ.050

{Are you/Is {NAME}} currently attending or enrolled in any courses from a school, college, or university?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

PEQ.060

{Are you/Is {NAME}} currently taking courses full-time or part-time?
FULL-TIME ...................................................
PART-TIME ..................................................
REFUSED ....................................................
DON'T KNOW ..............................................

PEQ.070

1
2
7
9

{Are you/Is {NAME}} currently participating in a job-training or on-the-job-training program?

YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................
PEQ.080

1
2 (PEQ.070)
7 (PEQ.070)
9 (PEQ.070)

1
2 (BOX 4)
7 (BOX 4)
9 (BOX 4)

About how many hours a week {do/does} {you/NAME}} spend in that program? Please include hours spent
on homework for the training program.

|___|___|
ENTER HOURS PER WEEK
REFUSED .................................................... 77
DON'T KNOW .............................................. 99
PEQ.100

Now I have some questions about your high school education. What grades did you usually get in high
school?
MOSTLY A's (NUMERICAL AVERAGE OF 90-100) ... 1
MOSTLY A's AND B's (85-89) .................................... 2
MOSTLY B's (80-84) ................................................... 3
MOSTLY B's AND C's (75-79) .................................... 4
MOSTLY C's (70-74) .................................................. 5
MOSTLY C's AND D's (65-69) .................................... 6
MOSTLY D's AND LOWER (64 AND BELOW) ........... 7
NEVER IN HIGH SCHOOL ......................................... 8 (PEQ.140)
REFUSED ................................................................... 77
DON'T KNOW ............................................................. 99

PEQ.110

Was your high school program ...
Academic or college preparatory, .................
Commercial or business training, or .............
Vocational or technical? ...............................
REFUSED ....................................................
DON'T KNOW ..............................................

A-67

1
2
3
7
9

PEQ.120

Now I have a list of high school mathematics and technical courses. As I read each one, please tell me
whether you have taken that course in regular high school.
RESPONSES: TAKEN = 1, NOT TAKEN = 2, REFUSED = 7, DON'T KNOW = 9
a.
b.
c.
d.
e.
f.
g.

PEQ.140

Elementary Algebra or Algebra I? .......... ___
Plane Geometry? .................................. ___
Business Math? ..................................... ___
Intermediate Algebra or Algebra II? ...... ___
Trigonometry? ....................................... ___
Calculus? ............................................... ___
Physics? ................................................ ___

What is the highest grade or year of regular school your father completed?
1ST GRADE .............................................................................................
2ND GRADE ............................................................................................
3RD GRADE ............................................................................................
4TH GRADE ............................................................................................
5TH GRADE ............................................................................................
6TH GRADE ............................................................................................
7TH GRADE ............................................................................................
8TH GRADE ............................................................................................
9TH GRADE ............................................................................................
10TH GRADE ..........................................................................................
11TH GRADE ..........................................................................................
12TH GRADE BUT NO DIPLOMA ..........................................................
HIGH SCHOOL DIPLOMA/EQUIVALENT OR VOC/TECH PROGRAM
AFTER HIGH SCHOOL BUT NO VOC/TECH DIPLOMA ......................
VOC/TECH PROGRAM AFTER HIGH SCHOOL.....................................
SOME COLLEGE BUT NO DEGREE .....................................................
ASSOCIATE'S DEGREE ..........................................................................
BACHELOR'S DEGREE...........................................................................
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ...........
MASTER'S OR DOCTORATE (MA, MS) .................................................
DOCTORATE DEGREE (PHD, EDD) ......................................................
PROFESSIONAL DEGREE AFTER BACHELOR'S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) .....................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

A-68

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
77
99

PEQ-150.

What is the highest grade or year of regular school your mother completed?
1ST GRADE .............................................................................................
2ND GRADE ............................................................................................
3RD GRADE ............................................................................................
4TH GRADE ............................................................................................
5TH GRADE ............................................................................................
6TH GRADE ............................................................................................
7TH GRADE ............................................................................................
8TH GRADE ............................................................................................
9TH GRADE ............................................................................................
10TH GRADE ..........................................................................................
11TH GRADE ..........................................................................................
12TH GRADE BUT NO DIPLOMA ..........................................................
HIGH SCHOOL DIPLOMA/EQUIVALENT OR VOC/TECH PROGRAM
AFTER HIGH SCHOOL BUT NO VOC/TECH DIPLOMA ......................
VOC/TECH PROGRAM AFTER HIGH SCHOOL.....................................
SOME COLLEGE BUT NO DEGREE .....................................................
ASSOCIATE'S DEGREE ..........................................................................
BACHELOR'S DEGREE...........................................................................
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ...........
MASTER'S OR DOCTORATE (MA, MS) .................................................
DOCTORATE DEGREE (PHD, EDD) ......................................................
PROFESSIONAL DEGREE AFTER BACHELOR'S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) .....................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

A-69

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
77
99

PARENT EMPLOYMENT - EMQ
EMQ.020

During the past week, did {you/{NAME}} work at a job for pay?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

EMQ.030

{Were you/Was {NAME}} on leave or vacation from a job?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

EMQ.040

1
2 (EMQ.060)
7 (EMQ.060)
9 (EMQ.060)

How many jobs {do you/does {NAME}} have now?
|___|
ENTER # OF JOBS
or
REFUSED ....................................................
DON'T KNOW ..............................................

EMQ.050

1 (EMQ.040)
2
7
9

7
9

About how many total hours per week {do you/does {NAME}} usually work for pay, counting all (# of jobs
from EMQ.040, IF MORE THAN ONE) jobs?
|___|___|
ENTER # OF WEEKLY HOURS

(BOX 4)

REFUSED ..................................................... 777 (BOX 4)
DON'T KNOW ............................................... 999 (BOX 4)

EMQ.060

{Have you/Has {NAME}} been actively looking for work in the past 4 weeks?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-70

1
2 (EMQ.080)
7 (EMQ.080)
9 (EMQ.080)

EMQ.070

What {have you/has {NAME}} been doing in the past 4 weeks to find work?
CODE ALL THAT APPLY
CHECKED WITH PUBLIC EMPLOYMENT AGENCY.............................. 1
CHECKED WITH PRIVATE EMPLOYMENT AGENCY .......................... 2
CHECKED WITH EMPLOYER DIRECTLY/SENT RESUME .................. 3
CHECKED WITH FRIENDS OR RELATIVES ......................................... 4
PLACED OR ANSWERED ADS/SENT RESUME ................................... 5
READ WANT-ADS ................................................................................... 6
SOMETHING ELSE (SPECIFY) _______________________________
7
________________________________________________________
REFUSED ................................................................................................ 77
DON'T KNOW .......................................................................................... 99

EMQ.070OS [What {have you/has {NAME}} been doing in the past 4 weeks to find work?]

EMQ.080

What {were you/was {NAME}} doing most of last week? Would you say …

EMQ.100

Keeping house or caring for children, ...........
Going to school, ............................................
Retired, .........................................................
Unable to work, or ........................................
Something else? What was that?
(SPECIFY) _________________________
REFUSED ....................................................
DON'T KNOW ..............................................
Could {you/{NAME}} have taken a job last week if one had been offered?
YES ..............................................................
NO ................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

EMQ.120

1
2
3
4
5
7
9

1
2
7
9

For whom {do/does/did} {you/{NAME}} work {when {you/{he/she}} last worked}?
________________________________________________________
ENTER EMPLOYER NAME

REFUSED ................................................................................................
DON'T KNOW ..........................................................................................

A-71

7
9

(EMQ.100)
(EMQ.100)
(EMQ.100)
(EMQ.100)
(EMQ.100)

EMQ.130

What kind of business or industry {is/was} this?
________________________________________________________
ENTER INDUSTRY DESCRIPTION
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

EMQ.140

7
9

What kind of work {are/is/were/was} {you/{NAME}} doing?
________________________________________________________
ENTER JOB TITLE
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

EMQ.150

7
9

What {are/is/were/was} {your/{NAME}'s} most important activities or duties on this job? What {do/does/did}
{you/{NAME}} actually do at this job?
PROBE: For example, typing, keeping account books, filing, selling cars, operating a printing press, finishing
concrete.
________________________________________________________
ENTER JOB DUTIES
REFUSED ................................................................................................
DON'T KNOW ..........................................................................................

EMQ.170

Between {CHILD}'s birth and when {he/she} entered kindergarten, did {you/{CHILD}'s mother} work outside
the home for pay?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

EMQ.180

7
9

1
2
7
9

Since {CHILD} was born, was there any time in which {his/her} family had serious financial problems or was
unable to pay the monthly bills?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

A-72

1
2 (BOX 7)
7 (BOX 7)
9 (BOX 7)

EMQ.190

During how many years or months since {he/she} was born has {CHILD}'s family had serious financial
problems?

|___|___|
ENTER NUMBER
REFUSED .................................................... 77
DON'T KNOW .............................................. 99
ENTER UNIT
MONTH ........................................................
YEAR ............................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-73

1
2
7
9

WELFARE AND OTHER PUBLIC TRANSFERS - WPQ

WPQ.030

When {you were/{CHILD}'s mother was} pregnant with {CHILD}, did {you/she} receive any WIC benefits?

YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

WPQ.040

Did {CHILD} receive any WIC benefits as an infant or child?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON'T KNOW ...............................................

WPQ.050

1
2
7
9

1
2
7
9

In the past 12 months, have you or anyone in your household received Temporary Assistance for Needy
Families, sometimes called TANF {or{STATE TANF PROGRAM NAME}}?
PROBE: TANF was formally known as Aid to Families with Dependent Children, or AFDC.

YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

WPQ.060

1
2 (WPQ.070)
7 (WPQ.070)
9 (WPQ.070)

During those 12 months, how many months did your household receive TANF {or {STATE TANF
PROGRAM NAME}}?
|___|___|
ENTER NUMBER OF MONTHS.
REFUSED .................................................... 77
DON'T KNOW ............................................... 99

WPQ.070

Since {CHILD} was born, has {CHILD}'s family ever received TANF {or {STATE TANF PROGRAM NAME}}?
YES ...............................................................
NO .................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

WPQ.080

1
2
7
9

In the past 12 months, have you or anyone in your household received food stamps or EBT (Electronic
Benefit Transfer)?
YES ..............................................................
NO ................................................................
REFUSED ....................................................
DON'T KNOW ..............................................
A-74

1
2 (WPQ.100)
7 (WPQ.100)
9 (WPQ.100)

WPQ.090

During those 12 months, how many months did your household receive food stamps or EBT (Electronic
Benefit Transfer)?

|___|___|
ENTER NUMBER OF MONTHS.
REFUSED .................................................... 77
DON'T KNOW .............................................. 99

WPQ.100

Since {CHILD} was born, has {CHILD}'s family ever received food stamps or EBT (Electronic Benefit
Transfer)?

YES ..............................................................
NO ................................................................
REFUSED ....................................................
DON'T KNOW ..............................................

A-75

1
2
7
9

CHILD MOBILITY AND PLANS TO MOVE - CMQ

CMQ.010

Since {CHILD} was born, how many different places has {he/she} lived for four months or more?

PROBE: IF RESPONDENT SAYS ZERO, ASK: By saying zero places, do you mean that {CHILD} did not
live anywhere since spring 2004 for four months or more?

|___|___|
ENTER # OF PLACES
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99
CMQ.030

How long has {CHILD} lived in {his/her} current residence?
|___|___|
AND
|___|___|
ENTER YEARS
ENTER MONTHS
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

CMQ.050

Thank you for your cooperation and for taking the time to participate in this important study. Just to make
sure I can reach you for the next interview, which will take place in the spring, I’d like to ask a few questions
about how to find you.
First, what are the last names of the household members living here?

R
C

FIRST NAME
{Display Respondent First Name}
{Display Child First Name}
{Display HH Member Name}

LAST NAME
[Enter Respondent's Last Name - 25]
{Display Child's Last Name - 25}
[Enter HH Member Last Name - 25]

A-76

CMQ.070

Is there a second phone number, such as a work number, a friend or relative’s number, or a beeper or cell
phone number, where you can sometimes be reached?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.080

What is that telephone number?
|__|__|__| – |__|__|__| –|__|__|__|__|
SECOND TELEPHONE NUMBER
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.090

1
2 (CMQ.100)
7 (CMQ.100)
9 (CMQ.100)

________________
EXTENSION
7 (CMQ.100)
9 (CMQ.100)

Where is that telephone located?
OFFICE/PLACE OF BUSINESS ................... 1
RELATIVE (SPECIFY) ________________
2
NEIGHBOR (SPECIFY)________________
3
FRIEND (SPECIFY) __________________
4
BEEPER NUMBER ....................................... 5
CELL PHONE................................................ 6
OTHER (SPECIFY) ___________________
7
REFUSED ..................................................... 77
DON’T KNOW ............................................... 99

CMQ.090OS [Where is that telephone located?]

CMQ.100

Is there a relative or friend, who does not live in this household, who will always know where you are if you
move?
IF NECESSARY SAY: I will only contact this person if I cannot locate you for the next interview.
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.110

1
2 (BOX 3)
7 (BOX 3)
9 (BOX 3)

What is the name, address, and telephone number of that person?

PROBE: What is this person’s relationship to you?
First Name: ________________
Last Name: ____________________
Street Address: ____________________________________________________
____________________________________________________
City: ____________________
State: ___________
Zip: ____________
Phone: (_____)__________________
Relationship:
____________________________________________________

A-77

CMQ.130

Besides {PERSON AT CMQ.110}, is there another relative or friend, who does not live in this household,
who will always know where you are if you move?
IF NECESSARY SAY: I will only contact this person if I cannot locate you for the next interview.
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.140

1
2 (BOX 3)
7 (BOX 3)
9 (BOX 3)

What is the name, address, and telephone number of that person?

PROBE: What is this person’s relationship to you?
First Name: ______________________
Last Name: ____________________
Street Address: ____________________________________________________
____________________________________________________
City: ____________________
State: ___________
Zip: ____________
Phone: (_____)________________________
Relationship:
____________________________________________________

CMQ.170

What is the name, address, and telephone number of {CHILD}'s {biological mother/ {or} biological father /
{or} adoptive mother / {or} adoptive father}?
First Name: ______________________
Last Name: ____________________
Street Address: ____________________________________________________
____________________________________________________
City: ____________________
State: ___________
Zip: ____________
Phone: (_____)________________________
Relationship:
____________________________________________________

CMQ.190

Are you, or is someone else, planning to move to a new home with {CHILD} before the spring of 2011?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.200

What is the address and telephone number where {CHILD} will move?

CMQ.205

[What is the address and telephone number where {CHILD} will move?]

A-78

1
2 (CMQ.230)
7 (CMQ.230)
9 (CMQ.230)

CMQ.220

CODE IF OBVIOUS. OTHERWISE, ASK:
Will {CHILD} move . . .
To a new state, ..............................................
To a new city or town in the same state, or ...
To a new home in the same city or town? .....
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.230

Do {you/{CHILD}'s parents/{CHILD}'s {mother/father}} plan to transfer {CHILD} to a new school before the
end of this school year?
YES ...............................................................
NO .................................................................
REFUSED .....................................................
DON’T KNOW ...............................................

CMQ.240

1 (CMQ.240)
2
3
7
9

1
2 (CMQ.260)
7 (CMQ.260)
9 (CMQ.260)

What school will {CHILD} attend for kindergarten in the spring of 2011?
School Name: ______________________________________________________
Street Address: ____________________________________________________
____________________________________________________
City: ____________________
State: ___________
Zip: ____________
Phone: (_____)__________________

CMQ.260

Thank you again for your cooperation in participating in the Early Childhood Longitudinal Study.

A-79

ADDITIONAL ITEMS FROM ECLS-K FALL KINDERGARTEN PARENT INTERVIEW

CCQ.051

Was there any charge or fee for the care {CHILD} received [the year before {he/she} started kindergarten]
from this relative, paid either by you or someone else?
IF NECESSARY SAY, Please only think about the relative who provided the most care for {CHILD}.
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.052

1
2 (BOX 1)
7 (BOX 1)
9 (BOX 1)

Did any of the following people or organizations help to pay for this relative care provider to care for {CHILD}
the year before {he/she} started kindergarten?
How about…
RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9
CAPI INSTRUCTION: FOR ITEMS B – D DISPLAY THE FIRST PARAGRAPH (DID ANY …
KINDERGARTEN) IN BRACKETS.
CAPI INSTRUCTION: IF D = 1 (YES), FOR THE FOLLOW-UP SPECIFY QUESTION, DISPLAY "WHO
WAS THAT?" IN MIXED CASE AND IN GRAY.
Yes
No
DK REF
a.
A relative of {CHILD} outside your household who provided
money specifically for that care?....................................................
1
2
7
9
b.
A social service or welfare agency?.................................................
1
2
7
9
c.
An employer? ...................................................................................
1
2
7
9
d.
Someone else? (SPECIFY) _____________________________
1
2
7
9

A-80

CCQ.053

How much did your household pay this relative to care for {CHILD} the year before {he/she} started
kindergarten?
IF NONE, ENTER ZERO.
CAPI INSTRUCTION: IF ZERO ENTERED FOR AMOUNT, SKIP THE UNIT FIELD AND GO TO BOX 1.
CAPI INSTRUCTION: RANGE CHECK:
WHEN UNIT IS PER HOUR: .50 – 10.00 (HARD), 1.00 – 6.00 (SOFT);
WHEN UNIT IS PER DAY: 1.00 – 50.00 (HARD), 1.00 – 10.00 (SOFT);
WHEN UNIT IS PER WEEK: 5.00 – 200.00 (HARD), 10.00 – 100.00 (SOFT);
WHEN UNIT IS PER MONTH: 20.00 – 400.00 (HARD), 40.00 – 240.00 (SOFT);
WHEN UNIT IS PER YEAR: 240.00 – 4800.00 (HARD), 480.00 – 2000.00 (SOFT);
WHEN UNIT IS OTHER: 0.00 – 4800.00 (HARD), .00 – 2000.00 (SOFT).
CAPI INSTRUCTION: EDIT: IF CCQ.051 = 1 AND ITEMS A-D AT CCQ.052 ALL = 2, THEN CCQ.053
CANNOT EQUAL ZERO.
$|___|___|___|___|.|___|___|
ENTER AMOUNT
or
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

7
9

ENTER UNIT
PER HOUR...............................................................................................
PER DAY ..................................................................................................
PER WEEK...............................................................................................
PER MONTH ............................................................................................
PER YEAR5..............................................................................................
OTHER (SPECIFY) ________________________________________
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.054

Was this amount for {CHILD} only or did it include other children in your household?
CHILD ONLY ............................................................................................
CHILD AND OTHER(S) ............................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.055

1
2
3
4
5
6
7
9

1 (BOX 1)
2
7 (BOX 1)
9 (BOX 1)

How many children was this amount for, including {CHILD}?
CAPI INSTRUCTION: HARD RANGE CHECK: 2-12; SOFT RANGE CHECK; 2-6.
|___|___|
ENTER # OF CHILDREN
or
REFUSED................................................................................................. 77
DON'T KNOW........................................................................................... 99

A-81

CCQ.155

For how long did {CHILD} receive care from the nonrelative the year before {he/she} started kindergarten?
Would you say …
One to two months,...................................................................................
Three to five months, ................................................................................
Six to eight months, or .............................................................................
Nine to twelve months? ...........................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.156

1
2
3
4
7
9

Was there any charge or fee for the care {CHILD} received [the year before {he/she} started kindergarten]
from this nonrelative, paid either by you or someone else?
IF NECESSARY SAY, Please only think about the nonrelative who provided the most care for {CHILD}.
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.157

1
2 (BOX 3)
7 (BOX 3)
9 (BOX 3)

Did any of the following people or organizations help to pay for this nonrelative care provider to care for
{CHILD} the year before {he/she} started kindergarten?
How about…
RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9
CAPI INSTRUCTION: FOR ITEMS B – D DISPLAY THE FIRST PARAGRAPH (DID ANY KINDERGARTEN)
IN BRACKETS.
CAPI INSTRUCTION: IF D = 1 (YES), FOR THE FOLLOW-UP SPECIFY QUESTION, DISPLAY "WHO
WAS THAT?" IN MIXED CASE AND IN GRAY.

a.
b.
c.
d.

A relative of {CHILD} outside your household who provided
money specifically for that care?....................................................
A social service or welfare agency?.................................................
An employer? ...................................................................................
Someone else? (SPECIFY) _____________________________

A-82

Yes

No

DK

REF

1
1
1
1

2
2
2
2

7
7
7
7

9
9
9
9

CCQ.158

How much did your household pay this nonrelative to care for {CHILD} the year before {he/she} started
kindergarten?
IF NONE, ENTER ZERO.
CAPI INSTRUCTION: IF ZERO ENTERED FOR AMOUNT, SKIP THE UNIT FIELD AND GO TO CCQ.159.
CAPI INSTRUCTION: RANGE CHECK:
WHEN UNIT IS PER HOUR: 1.00 – 10.00 (HARD), 1.00 – 6.00 (SOFT);
WHEN UNIT IS PER DAY: 3.00 – 100.00 (HARD), 10.00 – 40.00 (SOFT);
WHEN UNIT IS PER WEEK: 5.00 – 500.00 (HARD), 30.00 – 200.00 (SOFT);
WHEN UNIT IS PER MONTH: 30.00 – 2000.00 (HARD), 120.00 – 800.00 (SOFT);
WHEN UNIT IS PER YEAR: 360.00 – 20000.00 (HARD), 1400.00 – 5000.00 (SOFT);
WHEN UNIT IS OTHER: .00 – 20000.00 (HARD), .00 – 5000.00 (SOFT).
CAPI INSTRUCTION: EDIT: IF CCQ.156 = 1 AND ITEMS A-D AT CCQ.157 ALL = 2, THEN CCQ.158
CANNOT EQUAL ZERO.
$|___|___|___|___|___|.|___|___|
ENTER AMOUNT
or
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

7
9

ENTER UNIT
PER HOUR...............................................................................................
PER DAY ..................................................................................................
PER WEEK...............................................................................................
PER MONTH ............................................................................................
PER YEAR5..............................................................................................
OTHER (SPECIFY) ________________________________________
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.159

Was this amount for {CHILD} only or did it include other children in your household?
CHILD ONLY ............................................................................................
CHILD AND OTHER(S) ...........................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.160

1
2
3
4
5
6
7
9

1 (BOX 3)
2
7 (BOX 3)
9 (BOX 3)

How many children was this amount for, including {CHILD}?
CAPI INSTRUCTION: HARD RANGE CHECK: 2-12; SOFT RANGE CHECK; 2-6.
|___|___|
ENTER # OF CHILDREN
or
REFUSED................................................................................................. 77
DON'T KNOW........................................................................................... 99

A-83

CCQ.251

How many hours each week did {CHILD} go to the Head Start program?
IF RESPONDENT SAYS SCHEDULE CHANGED, ANSWER FOR THE LAST YEAR IN HEAD START.
CAPI INSTRUCTION: SOFT RANGE CHECK 1-50. HARD RANGE CHECK 1-70.
|___|___|
ENTER # OF HOURS
or
REFUSED................................................................................................. 77
DON'T KNOW........................................................................................... 99
HELP AVAILABLE

CCQ.252

How many children were usually in {CHILD}'s room or group, at the same time, at the Head Start program,
counting {CHILD}?
CAPI INSTRUCTION: SOFT RANGE CHECK 5-25. HARD RANGE CHECK 1-40.
|___|___|
ENTER # OF CHILDREN
or
REFUSED................................................................................................. 77
DON'T KNOW........................................................................................... 99

CCQ.253

How many adults were usually in {CHILD}'s room or group, at the same time, at the Head Start program?
CAPI INSTRUCTION: SOFT RANGE CHECK 1-5. HARD RANGE CHECK 1-10.
|___|
ENTER # OF ADULTS
or
REFUSED................................................................................................. 77
DON'T KNOW........................................................................................... 99

CCQ.254

Was there any charge or fee for the Head Start program, paid either by you or someone else?
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.303

1
2 (CCQ.259)
7 (CCQ.259)
9 (CCQ.259)

Was that program located in the school where {CHILD} now attends kindergarten?
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

A-84

1
2
7
9

CCQ.316

Was there any charge or fee for the {PROGRAM TYPE} {CHILD} attended [the year before {he/she} started
kindergarten], paid either by you or someone else?
CAPI INSTRUCTION: FOR "PROGRAM TYPE", DISPLAY "DAY CARE CENTER" IF CCQ.290 = 1;
DISPLAY "NURSERY SCHOOL" IF CCQ.290 = 2; DISPLAY "PRESCHOOL" IF CCQ.290 = 3; DISPLAY
"PREKINDERGARTEN PROGRAM" IF CCQ.290 = 4.
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.317

1
2 (BOX 6)
7 (BOX 6)
9 (BOX 6)

Did any of the following people or organizations help to pay for {CHILD} to go to that program the year
before {he/she} started kindergarten?
How about…
RESPONSES: YES = 1, NO = 2, REFUSED = 7, DON'T KNOW = 9
CAPI INSTRUCTION: FOR ITEMS B – D DISPLAY THE FIRST PARAGRAPH (DID ANY …
KINDERGARTEN) IN BRACKETS.
CAPI INSTRUCTION: IF D = 1 (YES), FOR THE FOLLOW-UP SPECIFY QUESTION, DISPLAY "WHO
WAS THAT?" IN MIXED CASE AND IN GRAY.

a.
b.
c.
d.

A relative of {CHILD} outside your household who provided
money specifically for that care?....................................................
A social service or welfare agency?.................................................
An employer? ...................................................................................
Someone else? (SPECIFY) _____________________________

A-85

Yes

No

DK

REF

1
1
1
1

2
2
2
2

7
7
7
7

9
9
9
9

CCQ.318

How much did your household pay for {CHILD} to go to the {PROGRAM TYPE} the year before {he/she}
started kindergarten?
IF NONE, ENTER ZERO.
CAPI INSTRUCTION: IF ZERO ENTERED FOR AMOUNT, SKIP THE UNIT FIELD AND GO TO BOX 6.
CAPI INSTRUCTION: RANGE CHECK:
WHEN UNIT IS PER HOUR: 1.00 – 10.00 (HARD), 1.00 – 6.00 (SOFT);
WHEN UNIT IS PER DAY: 3.00 – 100.00 (HARD), 10.00 – 40.00 (SOFT);
WHEN UNIT IS PER WEEK: 5.00 – 500.00 (HARD), 30.00 – 200.00 (SOFT);
WHEN UNIT IS PER MONTH: 30.00 – 2000.00 (HARD), 120.00 – 800.00 (SOFT);
WHEN UNIT IS PER YEAR: 360.00 – 20000.00 (HARD), 1400.00 – 5000.00 (SOFT);
WHEN UNIT IS OTHER: .00 – 20000.00 (HARD), .00 – 5000.00 (SOFT).
CAPI INSTRUCTION: EDIT: IF CCQ.316 = 1 AND ITEMS A-D AT CCQ.317 ALL = 2, THEN CCQ.318
CANNOT EQUAL ZERO.
$|___|___|___|___|___|.|___|___|
ENTER AMOUNT
or
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

7
9

ENTER UNIT
PER HOUR...............................................................................................
PER DAY ..................................................................................................
PER WEEK...............................................................................................
PER MONTH ............................................................................................
PER YEAR5..............................................................................................
OTHER (SPECIFY) ________________________________________
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.319

Was this amount for {CHILD} only or did it include other children in your household?
CHILD ONLY ............................................................................................
CHILD AND OTHER(S) ...........................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.320

1
2
3
4
5
6
7
9

1 (BOX 6)
2
7 (BOX 6)
9 (BOX 6)

How many children was this amount for, including {CHILD}?
CAPI INSTRUCTION: HARD RANGE CHECK: 2-12; SOFT RANGE CHECK; 2-6.
|___|___|
ENTER # OF CHILDREN
or
REFUSED.................................................................................................

A-86

9

CCQ.319

Was this amount for {CHILD} only or did it include other children in your household?
CHILD ONLY ............................................................................................
CHILD AND OTHER(S) ............................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CCQ.320

1 (BOX 6)
2
7 (BOX 6)
9 (BOX 6)

How many children was this amount for, including {CHILD}?
CAPI INSTRUCTION: HARD RANGE CHECK: 2-12; SOFT RANGE CHECK; 2-6.
|___|___|
ENTER # OF CHILDREN
or
REFUSED................................................................................................. 77
DON'T KNOW........................................................................................... 99

CHQ.326

Did {CHILD} ever have frequent or repeated ear infections?
IF NECESSARY SAY: Consider 3 or more ear infections in a 12 month time period as frequent or repeated.
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

CHQ.327

1
2 (CHQ.330)
7 (CHQ.330)
9 (CHQ.330)

Did {CHILD} have frequent or repeated ear infections in the last 12 months?
IF NECESSARY SAY: Consider 3 or more ear infections in the last 12 months as frequent or repeated.
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON'T KNOW...........................................................................................

MHQ.120

1
2
7
9

{[Next are a few question about {CHILD}'s biological parents. We understand that some of these questions
may be difficult {for adoptive parents} to answer, however, these are standard questions we ask when a
child does not live with {his/her} biological parents. Any information you can provide will be helpful.]}
To the best of your knowledge, are {CHILD}'s biological parents currently legally married to each other?
CAPI INSTRUCTION: DISPLAY "[NEXT ARE …. BE HELPFUL.]" IF THERE ARE NO BIOLOGICAL
PARENTS IN THE HOUSEHOLD (NO HOUSEHOLD MEMBER WITH A CODE '1' AT FSQ.140 OR
FSQ.150. OTHERWISE, USE A NULL DISPLAY.
CAPI INSTRUCTION: DISPLAY "FOR ADOPTIVE PARENTS" IF THE RESPONDENT IS AN ADOPTIVE
PARENT (FSQ.140 OR FSQ.150 IS CODED '2' FOR THE PERSON FLAGGED AS THE RESPONDENT).
YES...........................................................................................................
NO ............................................................................................................
REFUSED.................................................................................................
DON’T KNOW...........................................................................................
A-87

1 (MHQ.130)
2
7
9

CMQ.263

WAS THIS INTERVIEW CONDUCTED BY TELEPHONE OR IN-PERSON?
TELEPHONE ............................................................................................
IN-PERSON..............................................................................................

A-88

1
2