National Agriculture Workers Survey (NAWS)

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.wpd

ENGLISH
Cycle 63, SPRING 2008
OMB NO. 1205-0453

6
COUNTY

EXPIRATION DATE: XX/XX/XX

3

FARM WORKER ID
[FOR OFFICE USE ONLY]

[REV.10/07/08]

NATIONAL AGRICULTURAL WORKERS SURVEY - 2009 (“NAWS”)
CS2

DATE:

/

/
[FOR OFFICE USE ONLY]

CROP CODE
CS5

CROP:

CS6 TASK:

TASK CODE

LANGUAGE DURING INTERVIEW: __________________

GN:

ID:
IF GN REFERRED TO CONTRACTOR, GROWER OR OTHER,
WRITE INFORMATION)
NAME :
_______________________________________
ADDRESS:
_______________________________________
TELEPHONE:
(_________)___________-________________

GN REFERRED TO:

9 “CONTRACTOR”?:
9 OTHER GROWER?
9 OTHER?:_______

WORKER IS ACTUALLY EMPLOYED BY?:
TYPE OF WORK?: 91 FIELD WORK

9 1 GROWER

92 NURSERY

9 2 CONTRACTOR

93 PACKING HOUSE

97 OTHER:________

FARM WORKER’S
NAME:
LOCAL ADDRESS:
TELEPHONE:
INTERVIEWER’S
NAME:
CP5 TIME BEGAN:

CS9 INTERVIEWER’S ID:

:

9 AM
9 PM

CP6 TIME ENDED:

:

9 AM
9 PM

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control
number. Public reporting burden for this collection of information, which is voluntary, is estimated to average 1 hour
(or 60 minutes) per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate to the Office of Policy, Development and Evaluation, ETA, Department of
Labor, Room N5641, 200 Constitution Avenue, N.W., Washington, D.C. 20210.

1

(REV.1/21/09)

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HOUSEHOLD GRID

___ ___ ___ ___ ___

___ ___ ___ ___ __

County

NAME

A.

(FARMWORKER)

S
E
X

M
F

B.

M
F

C.

M
F

D.

M
F

E.

M
F

F.

M
F

G.

M
F

H.

M
F

MARITAL

*A2 A3 A5

RELATION
[CODE]

A1

A6

/

S
M
O

/

S
M
O

/

S
M
O

**A10

A8

A4
[ASK ALL IN A1]:
DOES S/HE LIVE WITH
YOU NOW?
IF NOT, WHERE?
[STATE/COUNTRY]

***A31

A16

Farmworker ID
A32

A11

A12

A13

LAST 12 12 MONTHS
MONTHS,
BEFORE
[NAME]
(A16),
ANY U.S. ANY
ANY U.S.
JOINED
[NAME]
SCHOOL U.S.
FW LAST
IF NOT
YOU
JOINED
LAST 12 WORK
12
HERE,
WHEN
YOU WHEN MONTHS? NOW? MONTHS?
WHY NOT? TRAVELED TRAVELED
[CODE]
FOR FW? FOR FW?
Y

/
N

S
M
O

/

1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS, UNCLES, ETC.)
7 = OTHER: __________________________

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

/
Y

Y

Y

Y

N

N

N

N

/
Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

/

/

/

/

*CODES FOR A2
(RELATIONSHIP):

Y

/

/

/

Y
/

/

S
M
O

S
M
O

A9

HIGHEST
MONTH
GRADE LEVEL
AND
BIRTH COUNTRY [FOR MINORS COUNTRY
YEAR
DATE OF BIRTH INCLUDE PRE- SCHOOL
FIRST
MM/YY [CODE] SCHOOL (“PS”) [CODE]
ENTERED
AND KINDER
U.S.?
(“K”)

S
M
O

S
M
O

**A7

** CODES FOR A7 AND A10 (COUNTRIES AND REGIONS):
1= U.S.A.
2= PUERTO RICO
3= MEXICO
4= CENTRAL AMERICA
5= SOUTH AMERICA
6= CARIBBEAN

7= SOUTHEAST ASIA (INDONESIA, CAMBODIA, VIETNAM,
LAOS, THAILAND)
8= PACIFIC ISLANDS (THE PHILIPPINES, GUAM, FIJI, ETC.)
9= ASIA (CHINA, JAPAN, KOREA, ETC.)
97= OTHER: _________________
99= NOT ANSWERED

2

FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW

Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N

***CODES FOR AXX

1=
2=
3=
7=

NO CHILD CARE IN THIS
LOCATION
NO HOUSING IN THIS LOCATION
CHILD IN SCHOOL, AFFECTED IF
MOVED
OTHER: _________________

(REV.1/21/09)

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HOUSEHOLD GRID

___ ___ ___ ___ ___
County

NAME

A.

(FARMWORKER)

S
E
X

M
F

B.

M
F

C.

M
F

D.

M
F

E.

M
F

F.

M
F

G.

M
F

H.

M
F

MARITAL

*A2 A3 A5

RELATION
[CODE]

A1

A6

/

S
M
O

/

A8

A4
[ASK ALL IN A1]:
DOES S/HE LIVE WITH
YOU NOW?
IF NOT, WHERE?
[STATE/COUNTRY]

***A31

A16

A32

A11

A12

A13

LAST 12 12 MONTHS
MONTHS,
BEFORE
[NAME]
(A16),
ANY U.S. ANY
ANY U.S.
JOINED
[NAME]
SCHOOL U.S.
FW LAST
IF NOT
YOU
JOINED
LAST 12 WORK
12
HERE,
WHEN
YOU WHEN MONTHS? NOW? MONTHS?
WHY NOT? TRAVELED TRAVELED
[CODE]
FOR FW? FOR FW?

/
N

/

S
M
O

/

S
M
O

/

S
M
O

**A10

Farmworker ID

Y

S
M
O

S
M
O

A9

HIGHEST
MONTH
GRADE LEVEL
AND
BIRTH COUNTRY [FOR MINORS COUNTRY
YEAR
DATE OF BIRTH INCLUDE PRE- SCHOOL
FIRST
MM/YY [CODE] SCHOOL (“PS”) [CODE]
ENTERED
AND KINDER
U.S.?
(“K”)

S
M
O

S
M
O

**A7

___ ___ ___ ___ __

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

/

/
Y

Y

Y

Y

N

N

N

N

/

/

Y

Y

Y

Y

N

N

N

N

/
Y

Y

Y

Y

N

N

N

N

/

/

1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS, UNCLES, ETC.)
7 = OTHER: __________________________

Y

/

/

*CODES FOR A2
(RELATIONSHIP):

Y
/

** CODES FOR A7 AND A10 (COUNTRIES AND REGIONS):
1= U.S.A.
2= PUERTO RICO
3= MEXICO
4= CENTRAL AMERICA
5= SOUTH AMERICA
6= CARIBBEAN

7= SOUTHEAST ASIA (INDONESIA, CAMBODIA, VIETNAM,
LAOS, THAILAND)
8= PACIFIC ISLANDS (THE PHILIPPINES, GUAM, FIJI, ETC.)
9= ASIA (CHINA, JAPAN, KOREA, ETC.)
97= OTHER: _________________
99= NOT ANSWERED

3

FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW
FW
NF
NW

Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N

***CODES FOR A31
1=
2=
3=
7=

NO CHILD CARE IN THIS
LOCATION
NO HOUSING IN THIS LOCATION
CHILD IN SCHOOL, AFFECTED IF
MOVED
OTHER: _________________

(REV.2/26/08)

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[ASK ONLY TO RESPONDENTS WHO - IN FAMILY GRID- HAVE CHILDREN UNDER 6 YEARS OLD
WHO HAVE BEEN OR ARE CURRENTLY IN THE U.S.A.]

Now I’d like to ask you some questions about child care. There are many places and persons that take care of
children while parents work. Parents use childcare or a neighbor’s home; other times the kids stay at home with
their mother, siblings or other relatives...
[IF MSHS (“a”) WAS NOT MENTIONED IN “HS1",
HS1. ...Now that you’re working here in [NAME OF
ASK HS4]: ...
LOCALITY], how have you arranged for your child
(-dren) to be taken care of while you work (FW)?
HS4. ...Have you ever heard of MSHS?
Please tell me all the types of child care arrangements
you have used [IF ONLY ONE RESPONSE, PROBE FOR 9 0 NO [EXPLAIN MSHS. MENTION LOCAL MSHS
MORE. CHECK ALL THAT APPLY]

NAMES, IF STILL “NO,” SKIP TO “A15"
NEXT SECTION]

9 a. MSHS

9 1 YES

9 b. Spouse
9 c. Child(-ren)’s older sibling(s).Age(s)?:___ ___ ___
9 d. Other relatives (not spouse or child(-dren)’s older
siblings)
9 e. Out of home (DAYCARE / CENTER / BABYSITTER)
9 f. Friends / Neighbors
9 g. Take them to the field (FW)
9 z. Other (specify): _______________
HS2.

HS5. Has/Have your child(-dren) ever used MSHS?
(When?)
9 0 NO
[ASK ONLY “HS6"]
9 1 YES. NOW, IN THIS LOCATION [SKIP TO “HS7"]
9 2 YES. NOT NOW, BUT WITHIN THE LAST 12
MONTHS. [ASK HS6 AND HS7]
9 3 YES. BUT, MORE THAN 12 MONTHS [ASK ONLY
“HS6"]

[IF MORE THAN ONE ANSWER IN HS1, ASK]: Which

one do you use most often during an average work
week (FW)? [ENTER LETTER CODE IN HS1]:
----------------------------------------------------------HS3. [ASK ALL] Why do you use this type (the most) while
doing FW? [CHECK ALL THAT APPLY]
9 a.
9 b.
9 c.
9 d.
9 e.
9 f.
9 z.

Trust
Flexible / Convenient hours
Convenient location
Culturally compatible (same language, food, staff, etc.)
Prepares child for school (e.g., English)
Don’t know (e.g., spouse decides)
Other (specify):_________________

HS6. Why aren’t you (or your spouse) using MSHS
at this location? [CHECK ALL THAT APPLY]

9 a.
9 b.

Prefer own child care arrangements
No MSHS in this area

9 c.
9 d.
9 e.
9 f.
9 g.
9 h.
9 i.

MSHS not open entire season (FOR FW)

9 z.

Inconvenient hours
MSHS full (applied, but no openings)
Applied, but did not qualify
Does not serve infants / older children
Do not like it. Specify: ___________________
Do not qualify. (Specify) Why?:
_______________________________________
Other (specify): _________________

HS7. [ASK QUESTIONS IN REFERENCE TO CHILDREN WHO USE/ USED MSHS IN THE LAST 12 MONTHS]
a
b
c
d
e
f
CHILD(-REN) WHO
USE/USED MSHS
[ENTER NAMES]
1

2

DATE LAST USED
MSHS?
(MONTH/YEAR)
START:
_______ / _______
END:
_______ / _________
START:
_______ / _______
END:
_______ / _________

LOCATION
(CITY/STATE)?

NAME OF
CENTER?

CITY:
______________
STATE:
______________
CITY:
______________
STATE:
______________
CODES FOR “e”:

1 = PREVIOUS MSHS REFERRED US
2 = RECRUITER FROM MSHS CONTACTED US
3 = SOCIAL WORKER (AGENCY, CLINIC, ETC.) REFERRED ME (SPOUSE)

4

HOW DID YOU LEARN [INTERVIEWER: CHECK
ABOUT MSHS?
IF CENTER IN “d” is in
[ENTER CODE]
MSHS LIST]

9 0 NO
9 1 YES
9 0 NO
9 1 YES
4 = SAW A FLYER WITH MSHS INFORMATION
5 = A RELATIVE/FRIEND TOLD US ABOUT IT
6 = OTHER:_____________________________

(REV.1/21/09)

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[THE FOLLOWING QUESTIONS REFER TO OTHER INDIVIDUALS WHO LIVE WITH THE WORKER AND
WERE NOT MENTIONED IN THE “HOUSEHOLD GRID”!]
A15 Other than those you have already mentioned, how many people live with you now?
TOTAL

Out of those (TOTAL IN “A15” ), ...
...how many are: ...

A20
... your
relatives?

A16
... doing
FW?

A17
A18
How many
How many
are doing NF?
NW?

a. ...ADULTS?
(18 YEARS OR OLDER)?

b. ...CHILDREN?
(17 YEARS OR YOUNGER)?

c. ...DO NOT KNOW AGE?

INSURANCE QUESTIONS ABOUT RESPONDENT AND HIS/HER FAMILY
(INDIVIDUALS IN THE “HOUSEHOLD GRID”) [DESCRIBE/EXPLAIN “HEALTH INSURANCE”]
A21

A23

Who pays for it?
In the U.S.A.,... Who has Health (Medical) Insurance in your family? ...
[USE
CODES.
MARK ALL
[ONLY FOR CHILDREN: IF YES, ASK HOW MANY OF THE CHILDREN
How about...
UNDER AND OVER 18 YRS. OLD HAVE INSURANCE. MATCH TOTAL THAT APPLY]
NUMBER WITH FAMILY GRID]

a. ...you (farm
worker)?

b. ...your spouse?

90

NO

91

YES

97

DON’T KNOW

90

NO

91

YES

97

DON’T KNOW
A21c2

9 0 NO
9 1 YES, ALL HAVE IT [ASK

c. ...your
children?

92

95

9 6:

91

92

95

9 6:

91

92

95

9 6:

93

94

93

94

93

94

A24
(a) How many under 18 yrs?:

A23]

9 2 YES, ONLY
SOME HAVE IT

91

(b) How many over 18 yrs?:

9 7 DON’T KNOW

CODES FOR “A23” (WHO PAYS?):
1= I PAY

3= MY EMPLOYER

5= GOVERNMENT

2= MY SPOUSE

4= MY SPOUSE’S EMPLOYER

6= OTHER:

5

(REV.1/21/09)

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B4 In the last 2 years, has anyone in your
G7 [ONLY FOR THOSE BORN OUTSIDE THE
U.S.A.] ...And in your home country, do you
household (from “Family Grid”)- excluding
own
or are you buying any of the following
yourself - attended, training, special classes
items? [READ CHOICES. CHECK ALL THAT
or schools in the U.S.? [READ CHOICES.
APPLY]: ...

CHECK ALL THAT APPLY]: ...

9 a.
9 b.
9 c.
9 d.
9 e.
9 f.
9

9 a. ...Adult Education such as English/
ESL/Adult Basic Education/ Citizenship?
9 d. ...Job training?:
9 f. ...GED (High School Equivalency)?
9 j. ...Migrant Education?
9 k. ...Head Start?
9 l. ...Migrant Head Start?
9 n. ...Other?:
9
Don’t know

B1 Which of the following describes you? [READ
CHOICES. CHECK ONLY ONE]: ...

91
92
93
95
94
97

G4 In the last 2 years, have you or anyone in
your household received benefits or used
the services of any of the following social
programs? [READ CHOICES. CHECK ALL
THAT APPLY]: ...

9 p.
9 b.
9 c.
9 d.
9 e.
9 f.
9 g.
9 h.
9 i.
9 j.
9 k.
9 l.
9 m.
9 n.
9

...(TANF) Temporary assistance for
needy families?
...Food stamps?
...Disability insurance?
...Unemployment insurance?
...Social Security?
...Veteran’s pay?
...General assistance/welfare?
...Low income housing?
...Public Health Clinic?
...Medicaid?
...WIC?
...Disaster Relief?
...Legal Services?
...Other?:
Don’t know

...MEXICAN-AMERICAN?
...MEXICAN?
...CHICANO?
...PUERTO RICAN?
...OTHER HISPANIC?:
...NOT HISPANIC OR LATINO?

B2 Which of the following do you consider
yourself? [READ CHOICES EXCEPT “OTHER.”
MARK ONE OR MORE RESPONSE]: ...

91
92
94
95
96

...White?
...Black or African Amaerican?
...American Indian/Alaskan Native?
...Asian?
...Native Hawaiian or Pacific Islander?

9 7 ...Other?:

G6 Do you own or are you buying any of the
following items in the U.S.? [READ CHOICES.
CHECK ALL THAT APPLY]: ...

9 a.
9 b.
9 c.
9 d.
9 e.
9 f.
9

...a plot of land?
...a house?
...a mobile home?
...a car/truck?
...a business?
...other?:
None

B3 Have you received any job training or
attended any of the following special classes
or school in the U.S.? [READ CHOICES.
CHECK ALL THAT APPLY]: ...

9 d.
9 a.
9 b.
9 c.
9 e.
9 f.
9 g.
9 h.
9 i.
9 j.
9

...a plot of land?
...a house?
...a mobile home?
...a car/truck?
...a business?
...other?:
None

(REV.1/21/09)

...Job training?:
...English/ESL?
...Citizenship?
...Literacy?
...GED, High School Equivalency?
...College or University?
...Adult Basic Education?
...Even Start?
...Migrant Education?
...Other?:
None
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6

[IF FOREIGN BORN, ASK];

B16. When you lived in your

B18. Where were you born? In what...
(d)
...STATE?:
(DEPARTMENT)

(e)
...MUNICIPALITY
(EQUIVALENT)?:

(f)
...TOWN (OR
CITY)?:

country, did you work
in...
9 1 ...AGRICULTURE [FW]?
9 2 ...NON-AGRICULTURE
[NF]?
9 3 ...PART FARM AND PART
NON-FARM [FW AND NF]?
9 5 ...NEVER WORKED?
9 8 NOT APPLICABLE [ONLY
FOR THOSE BORN IN THE
U.S.]

B17-18.

Before coming to the USA, you
lived in what...
(B17)
...COUNTRY?:

(B18)
...STATE (OR
DEPARTMENT)?:

LANGUAGE SECTION

B7 How well do you speak English? [READ
CHOICES. MARK ONLY ONE RESPONSE]: ...
91
...Not at all? 9 3
...Somewhat?
92
...A little?
94
...Well?
B20

When you were a
child, in what
languages did adults
speak to you at
home? [CHECK ALL
THAT APPLY]
U
a

b

c

d

e

f

z

B8 How well do you read English? [READ
CHOICES. MARK ONLY ONE RESPONSE]: ...
9 1 ...Not at all?
9 3 ...Somewhat?
9 2 ...A little?
9 4 ...Well?
B21

B24

And now, as an adult, what languages can you speak?

In which
language do you
believe you are
most dominant
(comfortable)
conversing?

[FOR EACH CHECKED ANSWER, ASK]:
[CHECK
B22
B23
ALL THAT
And
now,
how
well
do
you
And
now,
how
well do you
APPLY]
speak
it?
[READ
CHOICES.
read
it?
[READ
CHOICES.
U
MARK ONLY ONE PER CHECK]: MARK ONLY ONE PER CHECK]: [CHECK ONE] U

ENGLISH

SPANISH

9 2 ...A LITTLE?
9 3 ...SOMEWHAT?
9 4 ...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

CREOLE

9 2 ...A LITTLE?
9 3 ...SOMEWHAT?
9 4 ...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

MIXTEC

9 2 ...A LITTLE?
9 3 ...SOMEWHAT?
9 4 ...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

KANJOBAL

9 2 ...A LITTLE?
9 3 ...SOMEWHAT?
9 4 ...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

ZAPOTEC

9 2 ...A LITTLE?
9 3 ...SOMEWHAT?
9 4 ...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

OTHER:

9 2 ...A LITTLE?
9 3 ...SOMEWHAT?
9 4 ...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

7

(REV.1/21/09)

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B10 In what month and year did you first do any

D33a

farm work in the U.S.? (First time FW in the
U.S.) [ASK FOR MONTH AND YEAR]
/
MONTH /

YEAR

B11 Approximately how many years have you

done farmwork in the U.S.? [COUNT ANY
YEAR IN WHICH 15 DAYS OR MORE
WERE WORKED].

9 10

I (OR I AND MY FAMILY) RECEIVE FREE
HOUSING FROM MY EMPLOYER. [SKIP TO
D34A]

93

I PAY FOR HOUSING PROVIDED BY MY
EMPLOYER. (I PAY DIRECTLY OR THROUGH
WAGE DEDUCTION).

95

I PAY FOR HOUSING PROVIDED BY THE
GOVERNMENT, A CHARITY, OR OTHER
NON-WORK RELATED INSTITUTION.

9 11

DO NOT PAY RENT. (I OR FAMILY MEMBER
OWN THE HOUSE OR LIVE FOR FREE WITH
FRIENDS OR RELATIVES) [SKIP TO D34A]

9 12

I RENT FROM NON-EMPLOYER (RELATIVE
OR NON-RELATIVE)

9 97

OTHER:

years
B12 Approximately how many years have you

done non-farmwork in the U.S.? [COUNT
ANY YEAR IN WHICH 15 DAYS OR MORE
WERE WORKED]
years
B13 When was the last time your parents did

hired farm-work in the U.S.?

90
91
92
93
94
97
B26-27

NEVER
NOW / WITHIN LAST YEAR
ONE TO FIVE YEARS AGO
SIX TO TEN YEARS AGO
OVER 11 YEARS AGO
DON’T KNOW

(B27a)

housing (including housing for your family, if
they live with you)?

91

MOTHER?:

[ASK QUESTIONS BELOW ONLY FOR FOREIGN
COUNTRY in “B26a” and “B27a”]: ...
...STATE (OR DEPARTMENT OR EQUIVALENTE)?:
(B26b) FATHER:
(B27b) MOTHER?:

...MUNICIPALITY (OR DISTRICT OR EQUIVALENT)?:
(B26c)

D50 At this location how much do you pay for

...And where were your parents born?
...In what...

...COUNTRY?:
(B26a)
FATHER:

While you are working for this grower/
contractor, what type of payment arrangement
do you have for your living quarters? [IF
PAYMENT IS ONLY FOR UTILITIES,
CONSIDER IT FREE. DO NOT READ
CHOICES. MARK ONLY ONE]:

FATHER:

(B27c)

MOTHER?:

...TOWN (OR CITY) ?
(B26d) FATHER:

(B27d)

MOTHER?:

per week $

,

.

or
per month $

,

.

or
per day

,

.

$

9 2 DON'T KNOW, TAKEN OUT OF MY
PAYCHECK
9 3 DON'T KNOW/DON'T REMEMBER, BUT
NOT TAKEN OUT OF MY PAYCHECK
9 7 OTHER:

8

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D54

D34a In what type of living quarters do you live
now (housing structure at this location)?
[READ CHOICES. MARK ONLY ONE]:

How many of the following do you have in
your current living quarters (dwelling)...

9 a. ...Bedrooms?:

...Is it a (an)...

9 b. ...Bathrooms?:

9 1 ...Mobile home?

9 c. ...Kitchens?:

9 2 ...Single-family home (detached)?
9 f. ...Other rooms?:

9 3 ...Duplex, triplex, etc. (attached, own parking
space with direct access to home)?

D52 How many people total sleep in these
rooms? [VERIFY RESPONSE BY
ADDING TOTAL NUMBER GIVEN IN
HOUSEHOLD GRID PLUS TOTAL IN
A15. IF ANSWERS DO NOT MATCH
MAKE APPROPRIATE CHANGES]

9 4 ...Apartments (two or more in a building,
shared parking spaces)?
9 5 ...Dormitory or barracks?
9 6 ...Campsite or tent?
9 7 ...Motel or hotel?
9 8 ...Without shelter, “homeless.” (Includes
“sleeping in a car”)? [SKIP TO D36a]

9 97

...Other:

D36a [FOR PARENTS OF CHILDREN 12 YEARS
OLD OR YOUNGER] I already asked you
about the daycare arrangements for your
children under 6 years old here in (NAME
OF LOCATION)...How about in all the
places you’ve lived in the past 12
MONTHS, where have all your children
12 years old or younger stayed while
you are working (FW in the USA)?

D35 Where are your living quarters located?
[READ CHOICES. MARK ONLY ONE]: ...

9 1 ...Off farm in property not owned or
administered by your present employer?

[CHECK ALL THAT APPLY]

9 2 ...Off farm in property owned or administered
by your present employer?

91

9 3 ...On farm of the grower you currently work
for?

THEY'VE STAYED HOME ALONE, AT
LEAST SOMETIMES

9 13 WITH MY SPOUSE, OTHER FAMILY

9 7 ...Other?:

9 14 WITH A NEIGHBOR / BABYSITTER,
MIGRANT HEAD START, HEAD START,
MIGRANT EDUCATION, DAYCARE
CENTER, ETC.
9 11 WITH ME IN THE FIELDS
9 12 OTHER:

9

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REMINDER FOR INTERVIEWER:
BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE
DAYS ...HAVE YOU BEEN ILL OR SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU TRAVELED OUT OF THE COUNTRY?” [USE THE
AFFIRMATIVE RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:

WORK GRID

___ ___ ___ ___ ___ 63 ___ ___ ___ ___
County

[C1-C2 FOR OFFICE USE ONLY]

Farmworker ID

C15

C3

C4

C5

C6

NW?
AB?
FW
NF

Y

FW?
GR
PER.
AND
SUB
PER.
NO.

CO
[FW
ONLY]

EMPLOYER’S
NAME ( FARM
WORK, NONFARM WORK
AND WORK
ABROAD)

CROP

WRITE
ACTIVITY OR
TASK WHILE
FW AND NF
[USE CODES
FOR *NW
AND**AB]

NF?

GR
CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF
NW
AB

CO
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)

[WRITE ACTIVITY FOR FW AND NF]
201 = LOOKING FOR FW AND NF
WORK
202 = LOOKING FOR FARM
WORK
203 = LOOKING FOR NF WORK
204 = WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF
SEASON

C8
RECEIVED
UNEMPLOYMENT?

C1-C2

206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)

C9

C10

DATES FOR PERIODS OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW & NF

C11

C12

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

** C-5 ACTIVITY CODES: ONLY FOR “AB”
(WHILE IN A FOREIGN COUNTRY OR ABROAD):
311 = FW IN FAMILY RANCH
312 = FW-HIRED
320 = NF IN OWN BUSINESS: (SPECIFY IN
GRID)
341 = NF IN “MAQUILA”
359 = NF- OTHER: (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
10

C13

C7

C16

STATE/COUNTRY

REPORT FROM FIRST PERIOD COVERING FEBRUARY 01, 2008 TO PRESENT

***FW
AND
NF:
WHY
LEFT?

WERE YOUR
SPOUSE
AND KIDS
WITH YOU?

[CODES]

SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO

*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF
SEASON
2 = FIRED
3 = FAMILY
RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION

8 = RETIRED
10 = QUIT
11 = CHANGE JOBS
9 = OTHER
(SPECIFY):

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WORK GRID
[C1-C2 FOR OFFICE USE ONLY]

___ ___ ___ ___ ___
County

63 ___ ___ ___ ___
Farmworker ID

C15

C3

GR

EMPLOYER’S
NAME (FARM
WORK, NONFARM WORK
AND WORK
ABROAD)

C4

C5

CROP

WRITE
ACTIVITY OR
TASK WHILE
FW AND NF
[USE CODES
FOR *NW
AND**AB]

C6

C9

NW?
AB?

GR

FW
NF

Y

CO

NW
AB

GR

FW
NF

FW?
PER.
AND
SUB
PER.
NO.

C8
RECEIVED
UNEMPLOYMENT?

C1-C2

CO
[FW
ONLY]

NF?

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW AND NF]
201 = LOOKING FOR FW AND NF
WORK
202 = LOOKING FOR FARM
WORK
203 = LOOKING FOR NF WORK
204 = WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF
SEASON

206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN
JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)

C10

DATES FOR PERIODS OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW & NF

C11

C12

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

** C-5 ACTIVITY CODES: ONLY FOR “AB”
(WHILE IN A FOREIGN COUNTRY OR
ABROAD):
311 = FW IN FAMILY RANCH
312 = FW-HIRED
320 = NF IN OWN BUSINESS: (SPECIFY IN
GRID)
341 = NF IN “MAQUILA”
359 = NF- OTHER: (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
11

C13

C7

STATE/COUNTRY

REPORT FROM FIRST PERIOD COVERING FEBRUARY 01, 2008 TO PRESENT

***FW
AND
NF:
WHY
LEFT?

C16

WERE
YOUR
SPOUSE
AND KIDS
WITH YOU?

[CODES]

SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO

*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF SEASON 8 = RETIRED
2 = FIRED
10 = QUIT
3 = FAMILY
11 = CHANGE JOBS
RESPONSIBILITIES
9 = OTHER
4 = SCHOOL
(SPECIFY):
5 = MOVED
6 = HEALTH REASON
7 = VACATION

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WORK GRID

___ ___ ___ ___ ___
County

[C1-C2 FOR OFFICE USE ONLY]

63 ___ ___ ___ ___
Farmworker ID

C15

C3

C4

C5

C6
FW?
NF?

CROP

WRITE
ACTIVITY OR
TASK WHILE
FW AND NF
[USE CODES
FOR *NW AND
**AB]

NW?
AB?

GR

FW
NF

Y

CO

NW
AB

GR

FW
NF

GR
PER.
AND
SUB
PER.
NO.

C8
RECEIVED
UNEMPLOYMENT?

C1-C2

CO
[FW
ONLY]

EMPLOYER’S
NAME FOR:
FW, NF AND
WORK AB

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF
NW
AB

CO

* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW AND NF]
201 = LOOKING FOR FW AND NF
WORK
202 = LOOKING FOR FARM
WORK
203 = LOOKING FOR NF WORK
204 = WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF
SEASON

206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)

C9

C10

DATES FOR PERIODS OF
FW , NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW & NF

C11

C12

CITY

COUNTY
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

** C-5 ACTIVITY CODES: ONLY FOR “AB”
(WHILE IN A FOREIGN COUNTRY OR ABROAD):
311 =
312 =
320 =
341 =
359 =
361 =
362 =
369 =

FW IN FAMILY RANCH
FW-HIRED
NF IN OWN BUSINESS: (SPECIFY IN GRID)
NF IN “MAQUILA”
NF- OTHER: (SPECIFY IN GRID)
NW - MEDICAL TREATMENT
NW - VACATION
NW - OTHER: (SPECIFY IN GRID)

12

C13

C7

STATE/COUNTRY

REPORT FROM FIRST PERIOD COVERING FEBRUARY 01, 2008 TO PRESENT

***FW
AND
NF:
WHY
LEFT?

C16

WERE
YOUR
SPOUSE
AND KIDS
WITH YOU?

[CODES]

SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO
SPOUSE
CHILDREN
ALL
NO

*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF
8 = RETIRED
SEASON
10 = QUIT
2 = FIRED
11 = CHANGE JOBS
3 = FAMILY
9 = OTHER
(SPECIFY):
RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION

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WORK GRID

___ ___ ___ ___ ___
County

[C1-C2 FOR OFFICE USE ONLY]

63 ___ ___ ___ ___
Farmworker ID

C15

C3

C4

C5

C8

C9
DATES FOR PERIODS OF
FW,NF, NW,AB

NW?
AB?

GR

FW
NF

Y

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

GR

FW
NF

CO

NW
AB

FW?

GR
PER.
AND
SUB
PER.
NO.

CO
[FW
ONLY]

C6

EMPLOYER
(FARM WORK,
NON-FARM AND
ABROAD JOB)

CROP

ACTIVITY OR
TASK WHILE
FW AND NF
[USE CODES
FOR *NW AND
**AB]

NF?

* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)

[WRITE ACTIVITY FOR FW AND NF]
201 = LOOKING FOR FW AND NF
WORK
202 = LOOKING FOR FARM
WORK
203 = LOOKING FOR NF WORK
204 = WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF
SEASON

206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)

FROM:

C10

TO:

# OF
WORK
DAYS
PER
WEEK?
FW & NF

C11

C12

CITY

COUNTY
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

C13

C7

STATE/COUNTRY

C1-C2

RECEIVED
UNEMPLOYMENT?

REPORT FROM FIRST PERIOD COVERING FEBRUARY 01, 2008 TO PRESENT

***FW
AND
NF:
WHY
LEFT?

SPOUSE
CHILDREN
ALL
NO
N/A
SPOUSE
CHILDREN
ALL
NO
N/A

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

SPOUSE
CHILDREN
ALL
NO
N/A

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

SPOUSE
CHILDREN
ALL
NO
N/A

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

SPOUSE
CHILDREN
ALL
NO
N/A

Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

** C-5 ACTIVITY CODES: ONLY FOR “AB”
(WHILE IN A FOREIGN COUNTRY OR ABROAD):
311 = FW IN FAMILY RANCH
312 = FW-HIRED
320 = NF IN OWN BUSINESS: (SPECIFY IN
GRID)
341 = NF IN “MAQUILA”
359 = NF- OTHER: (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)

13

WERE
YOUR
SPOUSE
AND KIDS
WITH YOU?

[CODES]

COMMUTE FROM
MEXICO TO DO FW?
Y
N

N

C16

*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF
SEASON
2 = FIRED
3 = FAMILY
RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION

8
10
11
9

=
=
=
=

RETIRED
QUIT
CHANGE JOBS
OTHER
(SPECIFY):

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D1 In the year before last [FROM FEBRUARY 2007 TO D61
FEBRUARY 2008, YEAR BEFORE THE ONE
COVERED IN WORK GRID], how many months

did you do (FW) in the U.S.? [1 DAY OR MORE
PER MONTH EQUALS 1 MONTH]

months

90

NO

91

YES

D7 For what time period was that payment?

hours
D3 [IF NON-FARM JOB LISTED] For your most
recent non-farm employer (NF), how much were
you paid per week on average?
,

9 1 ...PAYROLL CHECK? 9 4 ...OTHER CHECK?
9 2 ...PERSONAL CHECK? 9 5 ...CASH?
9 3 ...CASH AND CHECK? 9 6 ...OTHER:
D62 Did you get a receipt?

D2 [IF NON-FARM JOB LISTED ON WORK GRID]:
For your most recent non-farm (NF) employer,
how many hours per week did you work on
average?

$

Were you paid by [READ CHOICES. MARK
ONE RESPONSE]:...

9 1 ONE DAY?
9 4 ONE MONTH?
9 2 ONE WEEK? 9 7 OTHER?:
9 3 TWO WEEKS?
D8 How many hours did you work during that
period (in D7)?

.
hours
CURRENT FARM JOB

D9 Now - with your current employer - you
already told me that the crop you are
currently working is:...

Now I am going to ask you some questions about
the crop/task you are CURRENTLY performing for
the EMPLOYER through whom we contacted you
[LAST PERIOD IN WORK GRID].
D4 How many hours did you work last week at
your current farm job?

D10

And you told me that - with your current
employer - the task you are now doing is:

hours
D11 Are you paid: ...

[D5 TO D8: IF SHE/HE HAS NOT RECEIVED
PAYMENT YET FOR CURRENT CROP, ASK FOR
ESTIMATES]: Can you tell me how you were paid

9 1 ...BY THE HOUR?
9 2 ...BY THE PIECE? [SKIP TO D13]
and the amount your employer paid you on your last
9 3 ...COMBINATION HOURLY WAGE AND
pay day?
PIECE RATE? [ASK D12 THRU D18]
9 4 ...SALARY OR OTHER? [SKIP TO D19]
D5
After taxes:
$

D6

,

D12

.

Before taxes:
$

,

How much per hour (to nearest cent)? [IF
PAID ONLY BY THE HOUR, ENTER
AMOUNT AND SKIP TO D20. IF
COMBINATION, ENTER AMOUNT AND
CONTINUE WITH D13]:

.
$

14

.

PER HOUR

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In the last 12 months, aside from your
wages, have you received (do you receive)
any money bonus from your current
employer?

D20
D13 [IF PAID BY THE PIECE]: Are you paid as an
individual or by the crew? [IF THE ANSWER
IS "CREW", ASK QUESTIONS D14 to D18
CONSISTENTLY IN REFERENCE TO THE
CREW]

91
92

INDIVIDUAL [SKIP TO D15]
CREW

9 0 NO [SKIP TO D22]
9 1 YES
9 7 DON’T KNOW [SKIP TO D22]

D14 [IF CREW PIECE RATE]: How many people
are in your crew? [ONE IS NOT A POSSIBLE
ANSWER]

9 g.
9 a.
9 b.
9 c.
9 d.
9 e.
9 f.

D15 [IF BY PIECE]: How do they pay you/your

crew [i.e., UNIT OF MEASURE SUCH AS
BOX, BIN, BUCKET, ETC.]?

D16 [IF BY PIECE]: How many of these (in D15

[IF PAID A BONUS]: How and when do you
receive the money bonus? [READ
CHOICES. MARK ALL THAT APPLY]:...

D21

...retention (return or rehire) bonus?
...holiday bonus?
...incentive bonus (rewards)?
...dependent on grower profit?
...end of season bonus?
...money for transportation?
...Other?:

How much money bonus have you been
given (TOTAL last 12 months with current
employer)?

D63

e.g., boxes, bins, buckets, etc.) you/your
crew do in an average day?
$
D17 [IF BY PIECE]: How many hours per day

D22

you/your crew work on average at this task?
hours

,

If you are injured at work or get sick as a
result of your work, does your employer
provide health insurance or pay for your
health care?

90
91

D18 [IF BY PIECE]: How much do “they” pay

you/your crew on average for each (box bin,
bucket, etc. In D15)?

.

NO
YES

97

DON’T KNOW

D23 If you are injured at work or get sick as a

$

,

result of your work, do you get any payment
while you are recuperating (i.e., “workers'
compensation”)?

.

D19 [IF PAID BY SALARY, OR OTHER]: Explain

fully how and how much you are
paid (salary or other). Explain thoroughly
the method and amount of payment.
[USE BACK OF PAGE IF NEEDED]:

90
91

NO
YES

97

DON’T KNOW

D24 If you are injured or get sick off the job

(e.g., at home), does your employer provide
health insurance or pay for your health care?

[USE BACK OF PAGE IF NEEDED]

[WHETHER OR NOT THE WORKER TAKES IT
OR USES IT]

90
91
97
15

NO
YES
DON’T KNOW

D26 Are you covered by unemployment insurance if D37a

you lose this job?

90
91

NO
YES

91
92
93
94
95
96

9 7 DON’T KNOW

D27 How many years have you worked for this
employer? [ONE DAY/PER YEAR=ONE YEAR]

years

How far is your current job from your current
residence?
I'M LOCATED AT THE JOB
WITHIN 9 MILES
10-24 MILES
25-49 MILES MILES
50-74 MILES
75 OR MORE

D37 At your current job, how do you usually get to

D28 Do you work for (current employer) year

work? [READ CHOICES. MARK ONE]:...

round or on a seasonal basis?

9 1 ...DRIVE CAR? [SKIP TO D39a]
9 2 ...WALK [SKIP TO D39a]
9 5 ...PUBLIC TRANSPORTATION (BUS, TRAIN,
ETC.)? [SKIP TO D39a]
9 6 ...LABOR BUS, TRUCK, VAN?
9 8 ...“RAITERO”:?
9 4 ...RIDE WITH OTHERS (SHARES RIDE)?
9 7 ...OTHER?:

9 0 YEAR ROUND [SKIP TO D30]
9 1 SEASONAL
9 7 DON’T KNOW (FIRST TIME) [SKIP TO D30]
D29 [IF WORKED ON A SEASONAL BASIS] Does

this employer keep in contact with you about
future employment? [READ CHOICES. MARK
ALL THAT APPLY]: ...

D38a

9 a. ... Yes, before leaving at the end of the
season?
9 b. ... Yes, by letter (written message)?
9 c. ... Yes, by phone/in person?
9 d. ... Yes, by someone else?
9 e. ... No, you contact employer?
9 f. ... Other?:
9
Don’t know

Do you have to use the transport (in D37) (IS
IT MANDATORY OR OBLIGATORY)?

9 0 NO

9 1 YES

D38 Do you pay a fee to (responsible in D37 and/or
"raiteros") for rides to work?

90
91
92

D30 How did you get this job? [DO NOT READ

CHOICES. MARK ONLY ONE RESPONSE]

D39a

91
94

I APPLIED FOR THE JOB ON MY OWN
I WAS RECRUITED BY A GROWER OR HIS
FOREMAN
9 5 I WAS RECRUITED BY FARM LABOR
CONTRACTOR OR HIS FOREMAN
9 6 I WAS REFERRED BY THE EMPLOYMENT
SERVICE
9 7 I WAS REFERRED BY THE WELFARE
OFFICE
9 8 I WAS REFERRED BY RELATIVE / FRIEND /
WORKMATE
9 9 I WAS REFERRED BY LABOR UNION
9 10 DAY LABORER / PICKED UP AT SHAPE UP
9 97 Other:

91
92
93
95

NO
YES, A FEE
YES, JUST FOR GAS
At your current job, who pays for the
equipment you use at work? [READ
CHOICES. MARK ONLY ONE]:...

...DON'T NEED ANY EQUIPMENT?
...(YOU) PAY ALL?
...THE GROWER/CONTRACTOR PAYS ALL?
...A FRIEND / RELATIVE PAYS SOME OR
ALL?
9 6 ...(YOU) PAY SOME?
910 ...(YOU) PAY ONLY FOR REPLACEMENT OF
DAMAGED TOOLS?
911 ... THE GROWER/CONTRACTOR PROVIDES
YOU WITH TOOLS, BUT YOU PREFER TO
BUY/BRING YOUR OWN?
912 ...THE GROWER/CONTRACTOR PROVIDES
SOME AND YOU HAVE TO BRING/BUY THE
REST?
9 97 ...OTHER?:

16

“Now I’m going to ask you some questions about your individual
and family income for last year (2007)”...
G1A What was your total personal income last year - in 2008

- in U.S. dollars [U.S. earnings only FOR FW AND NF]?
[READ OR SHOW CHOICES. MARK ONLY ONE]

90
91
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 97
G2A

G3 What was your family’s total income last
year - in 2008 - in U.S. dollars [U.S.
EARNINGS FW AND NF FOR ALL IN
“FAMILY GRID”]? [READ OR SHOW
CHOICES. MARK ONLY ONE]

DID NOT WORK AT ALL IN 2008
LESS THAN 500
500 TO 999
1,000 TO 2,499
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
OVER 40,000
DON’T REMEMBER (DON’T KNOW)

90
91
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 97

How much of that income was from agricultural
employment (U.S. earnings only)? [READ / SHOW

E1

CHOICES. MARK ONLY ONE]

90
91
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 97

DID NOT WORK AT ALL IN 2008
LESS THAN 500
500 TO 999
1,000 TO 2,499
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
OVER 40,000
DON’T REMEMBER (DON’T KNOW)

DID NOT WORK AT ALL IN 2008
LESS THAN 500
500 TO 999
1,000 TO 2,499
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
OVER 40,000
DON’T REMEMBER (DON’T KNOW)

At any time during the last 2 years (in the
U.S.), were you covered by a union
contract while doing farm work (FW)?

9 0 NO
9 1 YES
9 7 DON’T KNOW
E2

How long do you expect to continue doing
farm work (FW in the U.S.)? [READ
CHOICES. MARK ONLY ONE]

91
92
93
94
95

LESS THAN ONE YEAR
ONE TO THREE YEARS
FOUR TO FIVE YEARS
OVER FIVE YEARS
OVER FIVE YEARS/ AS LONG AS I AM
ABLE
9 7 OTHER?:
E4 Could you get a U.S. non-farm job (NF)
within a month?

9 0 NO
9 1 YES
9 7 DON’T KNOW
17

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SCREENING FOR INJURY SUPPLEMENT
[INTERVIEWER: ...ONLY IF THE RESPONDENT SEEMS HESITANT TO TALK ABOUT INJURIES, e.g.,
BECAUSE HE/SHE IS FEARFUL, SHOULD YOU REMIND THE RESPONDENT THAT ALL THE
INFORMATION HE/SHE SHARES WITH YOU IS CONFIDENTIAL. USE YOUR JUDGMENT ABOUT
REMINDING THE INTERVIEWER ABOUT CONFIDENTIALITY AT ANY POINT WHILE ADMINISTERING THIS
SUPPLEMENT].

“I would like to ask you some questions about injuries or accidents that you may have had while doing
farm work in the United States. These injuries include a car accident while traveling to and from work.
They could also be things like:...
...cutting yourself with a sharp tool or knife;
...hurting yourself lifting heavy objects, such as crates;
...hurting yourself by falling, for example falling off a ladder or crate, or tripping in the field; or
...getting sick from working too long in the hot sun, being bitten or stung by an insect, or breathing
pesticides while working in the fields.”
...In the past 12 months, have you had any injury or accident that made you...
NLS03

...use any type of first aid, such as a
bandage to stop bleeding or antiseptic to
clean a wound (or ice packs for a bruise,
etc.) or seek medical treatment at a clinic or
from a nurse or doctor?

90
91
NLS02

NLS01

...unable to work for at least 4 hours?

90
91
NLS04

NO
YES

...unable to work as hard as you normally
do for at least 4 hours? [or were assigned a
different job (or different task) that was easier
because the injury prevented you from doing
the first job (or task)]

NO
YES

...take strong medicine, except aspirin
(or Tylenol or ibuprofen), to allow you to
keep working?

90
91

NO
YES

9 0 NO
9 1 YES
INTERVIEWER:...
...IF THE RESPONDENT ANSWERED “NO”
TO ALL OF THE PREVIOUS QUESTIONS
(NLS01 TO NLS04), SKIP TO NEXT SECTION
(“NP1f", PAGE 19).
NL1E.

...IF THE RESPONDENT ANSWERED “YES”
TO ANY OF THE PREVIOUS QUESTIONS
(NLS01 TO NLS04), ASK NL1E

HOW MANY OF THESE TYPES OF INJURIES HAVE YOU HAD?

[INTERVIEWER: Write here any spontaneous response related to an injury or injuries (e.g., type of injuries and
dates) so you can refer to it when completing the “Injury Supplement”]:

CONTINUE WITH NEXT SECTION (“NP1f”) UNTIL COMPLETION OF QUESTIONNAIRE, THEN
COMPLETE “INJURY / ACCIDENT -SUPPLEMENT QUESTIONNAIRE”!!!

18

[REV.10/13/08]

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NP – HANDLING PESTICIDES (IN THE U.S.A.)
NP1f. In the last 12 months, have you loaded, mixed or applied pesticides?
90
NO [SKIP TO “SECTION NT”]
91
YES
P10
P11
P12
Which of the following classes of
[IF YES:] When
pesticides have you loaded, mixed or
was the last
applied in the last 12 months (in the USA, time?
NAME OF
doing FW)?
[MONTH/YEAR]
CROP?

P13
[IF WITHIN THE
LAST 30 DAYS
IN P11]
How many
days?

a ...INSECTICIDE?
b ...HERBICIDE?
c ...FUNGICIDE?
d ...RODENTICIDE?
...OTHER. SPECIFY:

z

..DON’T KNOW THE TYPE?

f

90
91
90
91
90
91
90
91
90
91
90
91

No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes

NT – TRAINING AND INSTRUCTIONS
NT2a.

In the last 12 months, with your current employer, has anyone given you training or
instructions in the safe use of pesticides (through video, audio, cassette, classroom
lectures, written material, informal talks or by any other means)?

90

91

NO

YES

NS – SANITATION SECTION
“The following questions refer to sanitation at your job with your current FW employer: ...
... Does your current employer provide EVERY DAY...
NS1

90
91
92
97

... (potable) clean drinking water and
disposable cups?

NS4 ... a toilet (EVERY DAY)?

9 0 NO
9 1 YES
9 7 DON’T KNOW

NO WATER, NO CUPS
YES, WATER ONLY
YES, WATER AND DISPOSABLE CUPS
DON’T KNOW

NS9 ... (provide) water to wash hands (EVERY

DAY)?

9 0 NO
9 1 YES
9 7 DON’T KNOW

19

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NMS - MUSCULOSKELETAL: [INTERVIEWER: FIRST ASK ALL FIRST COLUMN QUESTIONS]

During the last 12 months [from
Oct. of last year until now
(month of current year)], have
you had pain or discomfort in
your...

What type of
work were you
doing when this
pain/discomfort
began?

NMS (1 TO 6)

a.

9 FW

1

...BACK?
90
91

NO
YES

9 NF

...SHOULDER / NECK?
90
91

NO
YES

9 NF

...ELBOW / ARM?
90
91

NO
YES

9 NF

...HAND, / WRIST / FINGER?
90
91

NO
YES

9 NF

...LEGS / FEET / TOES?

90
91

NO
YES

9 NF

...OTHER?
90
91

NO
YES

A LITTLE

9 NF
9 NW

e.
9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 3 UNBEARABLE

9 3 UNBEARABLE

9 3 UNBEARABLE
9 1 A LITTLE

NO

YES:

9 2 A LOT
9 3 UNBEARABLE
9 1 A LITTLE

NO

YES:

9 2 A LOT

DAYS

90
91

d.
9 LESS THAN A DAY
9 DAYS:
9 WEEKS:
9 MONTHS:
9 DON’T KNOW

9 2 A LOT

DAYS

90
91

c.
9 1 A LITTLE

9 1 A LITTLE

NO
YES:
DAYS

90
91

How many days did
you NOT WORK
because of this
pain/discomfort?

9 2 A LOT

DAYS

90
91

How long did you
work with this
pain/discomfort?

9 1 A LITTLE

NO
YES:

9 NW
9 FW

6

90
91

How severe was
this
pain/discomfort?
[SHOW SCALE
BELOW]

9 2 A LOT

DAYS

9 NW
9 FW

5

NO
YES:

9 NW
9 FW

4

90
91

9 NW
9 FW

3

b.

9 NW
9 FW

2

Did you have this
pain/discomfort for
FIVE (5) or more
consecutive days?
[If “YES”, ask]: How
many DAYS?

9 3 UNBEARABLE
9 1 A LITTLE

NO

YES:

9 2 A LOT

DAYS

A LOT

9 3 UNBEARABLE

UNBEARABLE

20

REV.01/21/09

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NH – INDIVIDUAL PERSONAL HEALTH HISTORY (LIFETIME)
[INTERVIEWER: FIRST ASK ALL QUESTIONS IN FIRST COLUMN.]
c.
b.
Have you ever -- in your
In
the
last
12
months,
in
the U.S. and/or abroad,
Are
you
currently
whole life – been told by a
have you seen a doctor or nurse for (condition
a.
taking
medication
doctor or nurse that you
NH COLUMN)? [IF ANSWER IS “YES” FOR
for this condition? in
have the following
THE U.S. AND “AB” MARK BOTH]

conditions: ...
NH1
...ASTHMA?

9 0 NO

9 0 NO

9 1 YES

9 1 YES

NH2
...DIABETES?

9 0 NO

9 0 NO

9 1 YES

9 1 YES

NH3
...HIGH BLOOD PRESSURE?

9 0 NO

9 0 NO

9 1 YES

9 1 YES

9 0 NO

9 0 NO

9 1 YES

9 1 YES

9 0 NO

9 0 NO

9 1 YES

9 1 YES

9 0 NO

9 0 NO

9 1 YES

9 1 YES

9 0 NO

9 0 NO

9 1 YES

9 1 YES

NH4
...TUBERCULOSIS?

NH5
...HEART DISEASE?

NH6
...URINARY TRACT
INFECTIONS?
NH10
...OTHER?:

21

9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:

21 de enero de 2009

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NQ5

NQ – QUALITY OF AND ACCESS TO HEALTH

9 1 I PAID THE BILL OUT OF “MY OWN POCKET”
9 2 MEDICAID / MEDICARE

CARE SECTION

9 3 PUBLIC CLINIC DID NOT CHARGE
9 4 EMPLOYER PROVIDED HEALTH PLAN
9 5 SELF OR FAMILY BOUGHT INDIVIDUAL HEALTH

[INTERVIEWER]: I would like to ask you a few
final questions about health care in general. You
may have given me some of this information
already, but I would like to make sure it is correct.

NQ1

98
9 9 WORKER’S COMPENSATION
9 6 OTHER:

9 m.
9 l.

9 i.
9 j.

I do not know. I’ve never needed it
I’m “undocumented” / “no papers” (that’s
why they don’t treat me well)
No transportation, too far away
Don’t know where services are available
Health Center not open when needed
They don’t provide the services I need
They don’t speak my language
They don’t treat me with respect / I don’t
feel welcomed
They don’t understand my problems
I’ll lose my job
Too expensive/ no insurance
Other:

CHIROPRACTOR OR NATUROPATH’S

9

No difficulties / No problems

OFFICE

NQ1a.

NO [SKIP TO NQ10]
YES

...And the last time you used the health care
provider, where did you go (what kind of
place was it)?

91

COMMUNITY HEALTH CENTER/

92

PRIVATE MEDICAL DOCTOR’S
OFFICE/PRIVATE CLINIC

93

HEALER/ “CURANDERO”

94

HOSPITAL

95

EMERGENCY ROOM

96

MIGRANT HEALTH CLINIC

97
98

PLAN
BILLED, BUT DID NOT PAY

9 7 COMBINATION OF:
In the last TWO YEARS [SINCE
(FEBRUARY 2007), 2 YEARS AGO UNTIL
NOW (MONTH) 2009], in the U.S.A., have NQ10 [ASK ALL]: ...When you NEED to get health
you used any type of health care services
care in the USA what are the main
from doctors, nurses, dentists, clinics, or
difficulties you face? [CHECK ALL THAT APPLY]
hospitals?
90
91

NQ3

And, ...the last time you used the health care
provider, who paid the majority of the cost?

9 a.
9 b.
9 c.
9 d.
9 e.
9 f.
9 g.
9 h.

DENTIST

9 10 OTHER:

(How about) In a foreign country (e.g.
Mexico), Have you used any type of
health service IN THE LAST TWO
YEARS [IF “YES,” ASK AND ENTER
COUNTRY]

9 97 DON’T KNOW
90
91

NO
YES, IN:
[NAME OF COUNTRY]

22

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GENERAL HEALTH (MG)
MG1.

91
92
93
94
97
96

FAMILY WORRYING AND CONCERNS (MF)

In general, how would you describe your
health? Would you say...[READ OPTIONS]

How difficult is it for you to be separated
from your family? Would you say [READ

MF1.

OPTIONS]...

...EXCELLENT?
...GOOD?
...FAIR?
... POOR?
DON’T KNOW
REFUSED

9
9
9
9
9
9

0
1
2
3
7
6

...NOT AT ALL DIFFICULT?
...SOMEWHAT (MORE OR LESS)
...VERY DIFFICULT
NOT SEPARATED FROM FAMILY
DON’T KNOW
REFUSED

WORK LIMITATIONS (MW)
MW1.

90
91
97
96
95
MW2.

90
91
97
96
95

Do you have any PHYSICAL problem that
limits your work?

In the last 12 months, ABOUT how many
days have you MISSED WORK because of
a work-related illness or injury?

MW3.

NO
YES
DON’T KNOW
REFUSED
OTHER:

91
97
96
95

DAYS.
DON’T KNOW
REFUSED
OTHER:

MW4. ...And

in the last 12 months, ABOUT how
many days have you WORKED while
injured or ill because of a work-related
illness or injury?

Do you have any MENTAL or EMOTIONAL
problem that limits your work?
NO
YES
DON’T KNOW
REFUSED
OTHER:

91
97
96
95

DAYS.
DON’T KNOW
REFUSED
OTHER:

DECISIONS LATITUDE (MD)
0

“In your current FW...how often...

NEVER

1

2

3

7

6

5

DOESN’T
SOMETIMES VERY OFTEN ALWAYS DON’T KNOW REFUSED UNDERSTAND

1

... do you have a lot of say
about what happens on your
job?

9

9

9

9

9

9

9

2

... does your job require a high
level of skill?

9

9

9

9

9

9

9

3

... do you have the freedom to
decide how you do your
farmwork?

9

9

9

9

9

9

9

4

... does your job require you to
be creative?

9

9

9

9

9

9

9

3

7

6

5

JOB DEMANDS (MJ)
0

“In your current FW...how often...

NEVER

1

2

DOESN’T
SOMETIMES VERY OFTEN ALWAYS DON’T KNOW REFUSED UNDERSTAND

1

... does your job in farmwork
require you to work very hard?

9

9

9

9

9

9

9

2

... are you asked to do an
excessive amount of work?

9

9

9

9

9

9

9

23

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CESD - SHORT FORM (MC)
[FIRST READ INTRODUCTION AND ASK ALL QUESTIONS IN FIRST COLUMN. MARK RESPONSES IN SECOND COLUMN
"MC". THEN, ASK “MCDAYS” FOR EACH “YES” RESPONSE IN SECOND COLUMN “MC”]

The next set of items are about your
mood. Different people experience their
moods in different ways, so some of the
items may sound similar, but I need to ask
them. In the past seven (7) days, have
you felt...

MC

MCDAYS

[CHECK ALL
RESPONSES]

How many of the past 7 days did you
feel... [SYMPTOM IN CES1] for MOST of
the day?”
[IF RESPONDENT ASKS “WHAT DO YOU
MEAN BY MOST?”, ANSWER: “WHATEVER
“MOST” MEANS TO YOU]
[WRITE NUMBER OF DAYS]

...that

1

...that

everything you did was an effort?
...restless

4

...that

9 0 NO
9 1 YES
9 0 NO
9 1 YES

...sad?

people disliked you?

9 0 NO
9 1 YES

you could not get going?

9 0 NO
9 1 YES

...that

8

9

9 0 NO
9 1 YES

people were unfriendly?

7

...that

9 0 NO
9 1 YES

...depressed?

10

9 0 NO
9 1 YES
9 0 NO
9 1 YES

in your sleep?

...lonely?

5

6

9 0 NO
9 1 YES

...happy?

2

3

9 0 NO
9 1 YES

you enjoyed life?

JOB INSECURITY (MI)
MI1.

Are you afraid that you could be fired
from this farm job?

90
91
97
96

MI2.

NO
YES
DON’T KNOW
REFUSED

How easy would it be to find another job,
FW or NF were you would earn at least as
much as you earn now? ...Would you say...
91
92
93
97
96

24

...NOT AT ALL EASY? (DIFFICULT)
...SOMEWHAT EASY?
...VERY EASY?
DON’T KNOW
REFUSED

INTERVIEWER:

PLEASE CHECK
IF RESPONDENT QUALIFIES FOR
THE INJURY SUPPLEMENT!
CHECK PAGE 18 (SCREENING SECTION)

25

(REV.01/21/09)

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LEGAL STATUS

We are interested in knowing whether any of the following apply to you. Please be assured that no one
besides us will know your response.
L1

What is your current legal status in the U.S.? [READ
CHOICES IF NECESSARY]

9 1 I AM A U.S. CITIZEN BY BIRTH [SKIP TO NEXT PAGE]
9 2 I AM A NATURALIZED U.S. CITIZEN (FOREIGN BORN,
NATURALIZED). (ASK: “BEFORE BECOMING A
NATURALIZED U.S. CITIZEN, UNDER WHICH PROGRAM
DID YOU APPLY TO OBTAIN YOUR PERMANENT
RESIDENCE?”) [POSSIBLE ANSWERS IN L2: 1 - 9, 97).
THEN ASK: L4-1, L4-2, AND L4-3]

L2

OPTIONS]

91

AMNESTY UNDER 5 YEAR
PROGRAM [“TIME”]

92

AMNESTY UNDER SAW (90 DAY)
PROGRAM [“FW”]

93

CUBAN/HAITIAN ENTRANT

94

SPOUSAL PETITION
PROGRAM/FAMILY UNITY

9 3 PERMANENT RESIDENT/GREEN CARD (RIGHT TO
RESIDE AND WORK IN THE U.S.) (ASK L2: “UNDER WHICH 9 5
PROGRAM DID YOU APPLY?”) [POSSIBLE ANSWERS: 1
HASTA 9 Y 97). THEN ASK: L4-1 AND L4-2]

9 4 BORDER CROSSING CARD/COMMUTER CARD (RIGHT TO

96

CROSS THE BORDER AND WORK IN THE U.S.) (ASK L2:
97
“UNDER WHICH PROGRAM DID YOU APPLY?”) [POSSIBLE
ANSWERS: 9, 12, 13, Y 97. THEN ASK: L3, L4-1 AND L4-2]

98

9 5 PENDING STATUS (WITHOUT DOCUMENTS, APPLIED,

9
AWAITING OFFICIAL DECISION) (ASK L2: “UNDER WHICH 9
PROGRAM DID YOU APPLY?”) [POSSIBLE ANSWERS: 1- 9,
97. THEN ASK: L3, AND L41]

9 7 TEMPORARY RESIDENT - NON IMMIGRANT VISA (ONLY
FOR SPECIFIED TIME) [ASK L2: “UNDER WHICH
PROGRAM DID YOU APPLY?” POSSIBLE ANSWERS: 10 97. THEN ASK: L3 AND L41]

9 8 OTHER [IF RELEVANT AND APPROPRIATE ASK L2, L3,
L4-1, L4-2, AND L4-3. THEN SKIP TO NEXT PAGE]:

LABOR CERTIFICATION
PROGRAM
REGISTRY PROGRAM
POLITICAL ASYLUM
REFUGEE
PROTECTIVE STATUS
(TEMPORARY)

9 10

GUEST WORKER PROGRAM
[“BRACERO”]

9 11

STUDENT

9 12

TOURIST

9 6 UNDOCUMENTED (APPLICATION DENIED/DID NOT APPLY
TO ANY PROGRAMS) [POSSIBLE ANSWERS: “NONE”.
SKIP TO NEXT PAGE]

PROGRAMS [DO NOT READ

9 13 BORDER CROSSING CARD/
“PASSPORT”

9 97 OTHER:
9 99 NOT ANSWERED

L3 Do you have general work authorization?: 9 0 NO 9 1 YES 9 7 DON’T KNOW 9 9 NOT ANSWERED
L4
1 When did you apply to the

program (in L2)?

DATE STATUS BECAME EFFECTIVE:

2 [Only for those who responded

"2,3, or 4" in L1]: When did you
obtain your legal status?

/
(Month)

/

3 [Only for those who

responded "2" in L1]: When
did you obtain your
naturalization/ become a U.S.
citizen?

/
(Year)

(Month)

/

/

(Year)

26

(Month)

/

(Year)

INDIVIDUAL AGREEMENT TO BE A RESEARCH SUBJECT
OMB CONTROL NUMBER: 1205-0453

INTRODUCTION/PURPOSE
You are invited to participate in this survey for the National Institute for Occupational Safety and Health and the
Department of Labor because you are currently working on a farm. The purpose of the survey is to learn more about
the living conditions and health of farm workers.
PROCEDURES TO BE FOLLOWED
You will be asked to answer some questions about your work history and about your health. The interview will last
approximately 60 minutes.
RISKS
Since we will only be asking you questions, there is very little risk to you as a result of being in the survey. You
may refuse to answer any question at any time, with no penalty.
BENEFITS
There are no direct benefits to you from being in the survey. But, knowledge gained through this research may
help us learn how to prevent any harmful effects of farm work for workers like you.
CONFIDENTIALITY
Your answers to the interview will be kept private to the extent allowed by law. This means that the interview
record will be kept in a locked file, and only researchers on the survey will be allowed to see it. Your name will
not appear on any reports about the survey. (See back of page for details.)
ALTERNATIVES TO PARTICIPATION
Participating in this survey is voluntary and you can quit at any time. You can also choose not to participate in
any part of the interview at any time, with no penalty. Whether or not you participate in this survey will not affect
benefits and services to which you are normally entitled. You will be paid for the time you are spending in this
interview. However, if you choose not to participate in sections of the interview you may not receive the full
payment. At any time, you may ask the researchers to explain any part of the survey.
WHO TO CALL WITH QUESTIONS
If you have questions about the research survey, including questions about your rights as a research subject,
you may call Aguirre International (toll free) at 877- SAY-NAWS (or 877-729-6297). They will refer your
questions to Daniel Carroll at the Department of Labor, at (202) 693-2795.
I have read and understand the statement above. My questions about any unclear or confusing statements
have been answered clearly. I agree to participate in this survey as a research subject. I admit that I have
received a copy of this form and $20 for my participation.
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Signature of Subject

Date

(See reverse)

27

In accordance with the Privacy Act of 1974, as amended (5
U.S.C.552a), we are notifying you that this study is authorized by the
U.S. Department of Labor, Employment and Training Administration
(ETA). Your voluntary participation is important to the success of
this study and will enable the ETA to understand the labor market
and living experiences of U.S. farmworkers. Under written
agreement with research organizations, the ETA may release certain
information necessary for research but only after all identifying
information has been removed. Unless required by law, or necessary
for litigation or legal proceedings and except as indicated in this
statement, we will hold all personal identifiers (e.g. name, address,
and social security number) in total confidence and will not release
them.

Persons are not required to respond to this collection of information unless it displays a currently
valid OMB control number. Public reporting burden for this collection of information, which is
voluntary, is estimated to average 1 hour (or 60 minutes) per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate to the Office of Policy, Development and Evaluation, ETA, Department of
Labor, Room N5641, 200 Constitution Avenue, N.W., Washington, D.C. 20210.