Various Demographic Pretesting Activities
Generic Clearence for Questionnaire Pretesting Research
omb1107ASECenc1
Various Demographic Pretesting Activities
OMB: 0607-0725
Date:__________ Time:__________ Interviewer:_____________ Respondent ID:____________
ASEC Cognitive Interview Introduction
Thank you for joining me today. Let me tell you what this is about.
I work for Westat (in Rockville, MD), and we’re a research company that conducts research under contract to other organizations, on many different topics. This particular project is for the U.S. Census Bureau – you may know them as the agency that counts the number of people in the country every 10 years. But the Census Bureau actually collects a lot of other data. For example, one survey that do each year, called the Annual Social and Economic Supplement, is very important for measuring the economic status of people in America. It involves asking questions of thousands of people around the country about their family’s income and financial resources. .
Today we are helping the Census Bureau test and improve that survey. See, for the information gathered in any survey to be useful, it's important that the questions are ones that people can easily understand, and provide meaningful answers to, rather than having to take wild guesses. So by sharing some of your reactions to the questions with us, it will help make sure the questions are good questions, and collect accurate information.
Before we get into it, I should make you aware of a few things. First, I want to assure you that everything we cover in the interview will be treated as confidential - Only a very small number of people actually working on the project will have access to the information you share with us, and we won’t use your name in any reports. But if it’s OK with you, we would like to make a recording of our conversation, just so that we can review it later – it helps us analyze our results. (And finally, one of my friends from the Census Bureau that we’re working with is here today – behind the mirror - to observe and see for himself how the questions work.)
CONSENT FORM: Here is a form I must ask you to look over and sign - a standard procedure in these types of studies. It basically states the points I’ve just gone over with you and indicates you have agreed to take part. (MAKE SURE THEY INDICATE WHETHER THEY OR NOT THEY GIVE PERMISSION TO AUDIOTAPE. ONE COPY OF FORM IS FOR RESPONDENT, ONE COPY FOR US)
So the way this will work is - I’m going to be reading questions to you the way I would if it were the actual survey I was telling you about. I’d just like for you to answer the questions the best you can. And because we're trying to improve these questions, please let me know whenever you find a question to be confusing, or it bothers you for some reason, so that we can talk about it. And now and then we’ll pause so that I can ask you to tell me a little about why you answered the way you did, or I might ask you what a word in the question means to you, and things like that. Okay?
INTERVIEWER:
RESPONDENT PERMISSION TO AUDIOTAPE MUST BE ON THE TAPE, SO TURN ON RECORDER AND SAY:
Our conversation is now being recorded. Do I have your permission to record this interview? (I have to have you say “yes” on the recording)
IF RESPONDENT SAYS “NO” THEN TURN OFF RECORDER AND PROCEED WITH INTERVIEW
HOUSEHOLD ROSTER
The way the survey would work (if this were for real) is a Census Bureau interviewer would come to your home and ask you the questions while sitting with you there. The questions are about yourself and the people who live with you.
So starting with yourself, please tell me the names of all persons currently living with you (just their first names are okay).
Is there anyone else who usually lives here but is away at the time – traveling, at school, or in a hospital?
Have we missed any babies or small children?
What is (your/NAME’s) age?
Is NAME male or female?
INTERVIEWER: ASEC QUESTIONS ADDRESS THOSE 15 YEARS OF AGE AND OLDER
The next set of questions asks about your job and economic status last year.
WORK EXPERIENCE
Q29a
Did (name/you) work at a job or business at any time during 2010?
Yes No
Q29b
Did (you/he/she) do any temporary, part-time, or seasonal work even for a few days during 2010?
Yes No
Q30
Even though (name/you) did not work in 2010, did (you/he/she) spend any time trying to find a job or on layoff?
Yes No
Q31
How many different weeks (was/were) (name/you) looking for work or on layoff from a job?
________________
Q32
What was the main reason (you/he/she) did not work in 2010?
Q33
During
2010 in how many weeks did (name/you) work even for a few hours?
Include paid vacation and sick leave as work. Q35
Did
(name/you) lose any full weeks of work in 2010 because
(you/he/she) (were/was) on layoff from a job or lost a job? Yes
Q36
You
said (name/you) worked about (number) (week/weeks). How many OF
THE REMAINING (number) WEEKS (was/were) (you/he/she) looking for
work or on layoff from a job? ________________
Q37
Were the (number) weeks (name/you) (was/were) looking for work or on layoff all in one stretch?
Yes – one stretch No – two stretches No – 3 or more stretches
Q38
What was the main reason (name/you) (was/were) not working or looking for work in the remaining weeks of 2010?
Q39
For
how many employers did (name/you) work in 2010? One Two Three or more
Q41
In the (one week/weeks) that (name/you) worked, how many hours did (you/he/she) (work that week?/usually work per week?)
________________
Q46
What was (name's/your) longest job during 2010?
(occupation or employer name)_____________________________________
Q47E1
(Were/Was) (you/he/she) employed by government, by a PRIVATE company, a nonprofit organization, or (was/were) ( you/he/she) self-employed or working in a family business?
organizations
Q47E1c
(Were/Was) (you/name) the owner of the business?
|
Now I will ask whether you and others in your household received income from various sources during 2010. I’ll be asking about all of the things on this card (SOURCE SHOWCARD). We are interested in all sources of income, even if someone in the household received only a small amount of money from a source, or had income from a source for only a short period of time in 2010.
First….
|
UNEMPLOYMENT AND WORKERS COMPENSATION
Q51A1
At any time during 2010 did you receive any State or Federal unemployment compensation?
Yes No
How about [NAMES(S)]? (At any time during 2010 did [NAME(S)] receive any State or Federal unemployment compensation?)
Yes No
Who received State or Federal unemployment compensation?
Q51A2
At any time during 2010 did (name/you) receive any Supplemental Unemployment Benefits (SUB)?
Yes No
Q51A3
At any time during 2010 did (name/you) receive any Union Unemployment or Strike Benefits?
Yes No
Q52a
During 2010 did you receive any Worker’s Compensation payments or other payments as a result of a job related injury or illness?
Yes No
Q52b
What was the source of these payments?
How about [NAMES(S)]? During 2010 did [NAME(S)] receive any Worker’s Compensation payments or other payments as a result of a job related injury or illness?
Yes No Q52b
What was the source of these payments?
|
SOCIAL SECURITY
Q56a
During 2010 did you receive any Social Security payments from the U.S. Government?
Yes No
How about [NAMES(S)]? (During 2010 did [NAMES(S)] receive any Social Security payments from the U.S. Government?)
Yes No
Who received Social Security payments, either for themselves or as combined payments with other family members?
SOCIAL SECURITY FOR CHILDREN
Q56f
Did anyone in this household receive any Social Security income in 2010 that we have not already counted on behalf of children in this household?
Yes No
Q56g
Who
received these Social Security payments?
|
SUPPLEMENTAL SECURITY INCOME (SSI)
Q57a
During 2010 did (you/ anyone in this household) receive: any SSI payments, that is, Supplemental Security Income?
Yes No
Q57b
Who received SSI?
SUPPLEMENTAL SECURITY INCOME FOR CHILDREN
Q57d
Did anyone in this household receive any Supplemental Security Income in 2010 that we have not already counted on behalf of children in this household?
Yes No
Q57e
Who received these Supplemental Security Income payments?
|
PUBLIC ASSISTANCE
Q59A88
At any time during 2010, even for one month, did (you/ anyone in this household) receive any CASH assistance from a state or county welfare program such as (STATE PROGRAM NAME)?
welfare or welfare-to-work programs, (State Program Name and/or acronyms), Temporary Assistance for Needy Families program (TANF), Aid to Families with Dependent Children (AFDC), General Assistance/Emergency Assistance program, Diversion Payments, Refugee Cash and Medical Assistance program, General Assistance from Bureau of Indian Affairs, or
Tribal
Administered General Assistance. Do not include food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits, SSI, energy assistance, WIC, School meals, or transportation, childcare, rental, or education assistance.
Yes (SKIP TO ) No
Q59A89
Just to be sure, in 2010, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?
Yes No
Q59b_88
Who received this CASH assistance?
Q59C8
From what type of program did (name/you) receive the CASH assistance? Was it a welfare or welfare-to-work program such as (STATE PROGRAM NAME), General Assistance, Emergency Assistance, or some other program?
Q59C8s
What type of program? _________________________________________________
|
FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)
Q87
Did (you/ anyone in this household) get food stamps or a food stamp benefit card at any time during 2010?
Yes (SKIP TO Q88) No
Q87a
At any time during 2010, even for one month, did (you/ anyone in this household) receive any food assistance from (State Program name)?
Yes No (SKIP TO SWRWIC)
Q88
Which of the people now living here were covered by that food assistance during 2010?
SWRWIC
At any time during 2010, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?
Yes No
SWRW
Who received WIC for themselves or on behalf of a child?
NOTE: THE ASEC ITEMS BOOKLET DOES NOT CONTAIN AN ITEM ASKING FOR THE AMOUNT OF THE WIC BENEFIT – IS THIS CORRECT??
|
SCHOOL LUNCHES
Q80
During 2010 which of the children ages 5 to 18 in this household usually ate a complete lunch offered at school?
Q83
During 2010 which of the children in this household received free or reduced priced lunches because they qualified for the Federal School Lunch Program?
|
VETERANS PAYMENTS
Q60A88
At any time during 2010 did (you/ anyone in this household) receive: Any Veterans’ (VA) payments?
Yes No
Q60b_88
Who
received Veterans’ (VA) payments either for themselves
or as combined payments with other family members?
Q60C8
What type of Veterans' payment did (name/you) receive?
veterans)
Q60D88
(Are/Is) (name/you) required to fill out an annual income questionnaire for the Department of Veterans' Affairs?
Yes No
|
SURVIVOR BENEFITS
Q58A
Did (you/ anyone in this household) receive any survivor benefits in 2010 such as widow’s pensions, estates, trusts, insurance annuities, or any other survivor benefits (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits)?
Yes No
Q58b
Who received this income?
Q58C
What was the source of this income?
SHARING)
12 Other or don't know (SPECIFY) - ENTER LAST
________________________________________________
|
DISABILITY INCOME
Q59A
(Do you/Does anyone in the household) have a health problem or disability which prevents (you/them) from working or which limits the kind or amount of work (you/they) can do?
Yes No (SKIP TO Q60a)
Q59b
Who is that?
Q60a
(Did you/Is there anyone in this household who) ever (retire or leave/ retired or left) a job for health reasons?
Yes No (SKIP TO NEXT SECTION)
Q60b
Who is that?
Q61b
Did (name/you) receive any income in 2010 as a result of (your/his/her) health problem (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits)?
Yes No
Q61c
What was the source of this income?
_____________________________________________
|
*NEW*
DETERMINING HOLDERS OF RETIREMENT ACCOUNTS
At any time during 2010 did (you/ anyone in this household): Have any retirement accounts such as a 401(k), 403(b), KEOGH, or IRA?
Yes No
Which members of this household ages 15 and over had such a retirement account?
|
RETIREMENT AND PENSIONS
Q62A (revised)
During 2010 did (you/ anyone in this household) receive any pension or retirement income from a previous employer or union, (other than VA benefits)?
Yes No
Q62b-1
Who received (pension/ or retirement income?
*NEW* During 2010 did (you/ anyone in this household) receive any other type of retirement income (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits), including lump sum payments from a retirement account?
Yes No
Q62b-2
Who received this retirement income?
Q62C
What was the source of (name's/your) income?
_____________________________________________
|
INTEREST
Q63A1
At anytime during 2010 did (you/ anyone in this household): Have money in any kind of money market fund, interest earning checking account, or savings account?
Yes No
Q63A2
At anytime during 2010 did (you/ anyone in this household): Have any savings bonds?
Yes No
Q63A3 At anytime during 2010 did (you/ anyone in this household):
Have
any treasury notes, certificates of deposit, or any other
investments which pay interest? Yes No
Q63b
Which members of this household ages 15 and over had (interest earning accounts or money market funds/savings bonds/treasury notes, CDs, or any other investments which pay interest)?
*NEW* [IF RETIREMENT ACCOUNT] Did (you/NAME) have (this asset / any these assets) within a retirement account?
Yes No (SKIP TO NEXT PERSON OR SECTION)
*NEW* Did (you/NAME) also have (this asset / any these assets) outside of a retirement account?
Yes No
|
DIVIDENDS
Q64A
At anytime during 2010 did (anyone in this household ages 15 and over/you) own any shares of stock in corporations (PAUSE) or any mutual fund shares?
Yes No
Q64b
Which members of this household?
*NEW* [IF RETIREMENT ACCOUNT] Did (you/NAME) own any of these shares within a retirement account?
Yes No (SKIP TO NEXT PERSON OR SECTION)
*NEW* Did (you/NAME) also own shares of stock or mutual funds outside of a retirement account?
Yes No
|
PROPERTY INCOME
Q65A1
During 2010 did (you/ anyone in this household):
Own
any land, business property, apartments, or houses which were
rented to others? Yes No
Q65A2
At anytime during 2010 did (you/ anyone in this household): Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)
Yes No
Q65A3
At anytime during 2010 did (you/ anyone in this household): Receive income from estates or trusts? (exclude estates or trusts already reported)
Yes No
Q65b
Who received this (income/rent) ?
|
EDUCATION ASSISTANCE
Q66a
During 2010 did (you/ anyone in this household) attend school beyond the high school level including a college, university, or other schools? (include vocational, business, or trade schools)
Yes No
Q66b
Did (you/ anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2010?
Yes No
Q66c
Which member received assistance?
Q66d
What type of assistance did (name/you) receive?
|
CHILD SUPPORT
Q70a
During 2010 did (you/ anyone in this household) receive: Any child support payments?
Yes No
Q70b
Who received these payments?
|
ALIMONY PAYMENTS
Q71a
During 2010 did (you/ anyone in this household) receive: Any alimony payments?
Yes No
Q71b
Who received these payments during 2010?
|
*NEW* (REMOVED REFERENCE TO “REGULAR” FINANCIAL ASSISTANCE)
FINANCIAL ASSISTANCE
Q72a
During 2010 did (you/ anyone in this household) receive: (Any other/Any) financial assistance from friends or relatives not living in this household?
Yes No
Q72b
Who received this assistance?
|
WIC ASSISTANCE
SWRWIC
At any time during 2010, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?
Yes No
SWRW
Who received WIC for themselves or on behalf of a child?
|
************ ASK INCOME SOURCE PROBES HERE, BEFORE CONTINUING WITH THE COLLECTION OF AMOUNTS ************
|
*NEW*
Now I will ask you about the amount of money you and others in this household received from various sources in 2010. Let’s start with you.
You said that you received income or payments in 2010 from…. [LIST ALL SOURCES]
ASK ITEMS BELOW AS APPLICABLE. THEN CONTINUE WITH NEXT HH MEMBER AGED 15+
Now let’s talk about [NAME]. You said that [NAME] received income or payments in 2010 from…. [LIST ALL SOURCES]
|
EARNED INCOME - AMOUNTS
Q48aa
How much did (name/you) earn from (your/his/her) (longest) employer before taxes and other deductions during 2010?
________________
*NEW*
IF DON’T KNOW: Would you say it was more than $30,000, or less than that?
[IF MORE THAN $30,000] Was it more or less than $60,000?
[IF MORE THAN $60,000] Would you say it was less than $83,000, $83,000 to less than $110,000, or more than $110,000?
[IF LESS THAN $60,000] Would you say it was less than $38,000, $38,000 to less than $48,000, or more than $48,000?
[IF LESS THAN $30,000] Was it more or less than $12,000?
[IF MORE THAN $12,000] Would you say it was less than $18,000, $18,000 to less than $25,000, or more than $25,000?
[IF LESS THAN $12,000] Would you say it was less than $2,400, $2,400 to less than $5,000, or more than $5,000?
Q48aap
Is
this a weekly, every other week, twice a month, monthly, or
yearly amount?
7 Yearly
Q48a1
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q48aa) from this employer in 2010?
________________
Q48aV
According to my calculations (name/you) earned (total) altogether from this employer in 2010 before deductions. Does that sound about right?
Yes No
Q48a2
What is your best estimate of (name's/your) correct total amount of earnings from this employer during 2010 before deductions?
________________
Q48a3
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this employer in 2010?
Yes No
Q48aad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from this employer in 2010?
________________
Q48b
What were (name's/your) net earnings from this business/farm after expenses during 2010?
________________
If business lost money, collect annual amount lost, and skip to Q49A
Q48bp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?
6 Yearly
Q48b7
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this business in 2010?
Yes No
Q48bad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions in 2010?
________________
Q49a
Did
(name/you) earn money from any other work (you/he/she) did during
2010?
Q49b1d
How much did (name/you) earn from all other employers before taxes and other deductions during 2010?
________________
Q49b1p
Is
this a weekly, every other week, twice a month, monthly, or yearly
amount?
7 Yearly
Q49B11
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q49b1d) from all other employers in 2010?
________________
Q49B1V
According to my calculations (name/you) earned (total) altogether from all other employers in 2010. Does that sound about right?
Yes No
Q49B12
What is your best estimate of (name's/your) correct total amount of earnings from all other employers during 2010?
________________
Q49b13
Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from all other employers in 2010?
Yes No
Q49B1A
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from all other employers in 2010?
________________
Q49b2
How much did (name/you) earn from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?
________________ Enter annual amount only
|
UNEMPLOYMENT AND WORKERS COMPENSATION - AMOUNT
What
is the easiest way for you to tell us (name's/your) State or
Federal unemployment compensation; weekly, every other week, twice
a month, monthly, or yearly?
7 Yearly
Q51A11
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in State or Federal unemployment compensation during 2010?
________________
Q51A12
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive from State or Federal unemployment compensation during 2010?
________________
Q51A13
According to my calculations (name/you) received (total) altogether from State or Federal unemployment compensation during 2010. Does that sound about right?
Yes No
Q51A14
What is your best estimate of the correct total amount (name/you) received from State or Federal unemployment compensation during 2010?
________________
SUPPLEMENTAL UNEMPLOYMENT BENEFITS - AMOUNT
Q51A2p
What
is the easiest way for you to tell us (name's/your) Supplemental
Unemployment Benefits; weekly, every other week, twice a month,
monthly, or yearly?
7 Yearly
Q51A21
How
much did (name/you) receive (weekly/every other week/twice a
month/ monthly/ ) in Supplemental Unemployment Benefits during
2010? _____________
Q51A22
How many (weekly/every other week/twice a month/ monthly) payments did (name/you) receive from Supplemental Unemployment Benefits during 2010?
________________
Q51A23
According to my calculations (name/you) received (total) altogether from Supplemental Unemployment Benefits during 2010. Does that sound about right?
Yes (SKIP TO ) No
Q51A24
What is your best estimate of the correct total amount (name/you) received from Supplemental Unemployment Benefits during 2010?
________________
UNION EMPLOYMENT/STRIKE BENEFITS - AMOUNT
Q51A3p
What
is the easiest way for you to tell us (name's/your) Union
Unemployment or Strike Benefits; weekly, every other week, twice a
month, monthly, or yearly?
7 Yearly
Q51A31
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in Union Unemployment or Strike Benefits during 2010?
________________
Q51A32
How
many (weekly/every other week/ twice a month/ monthly) payments
did (name/you) receive from Union Unemployment or Strike Benefits
during 2010? ________________
Q51A33
According to my calculations (name/you) received (total) altogether from Union Unemployment or Strike Benefits during 2010. Does that sound about right?
Yes No
Q51A34
What is your best estimate of the correct total amount (name/you) received from Union Unemployment or Strike Benefits during 2010?
________________
WORKER’S COMPENSATION - AMOUNT
Q52cp
What
is the easiest way for you to tell us (name's/your)Worker’s
Compensation; weekly, every other week, twice a month, monthly, or
yearly?
7 Yearly
Q52c1
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in Worker’s Compensation during 2010?
________________
Q52c2
How
many (weekly/every other week/ twice a month/ monthly) payments
did (name/you) receive from Worker’s Compensation during
2010?
________________
Q52c3
Then (name/you) received (total) altogether from Worker’s Compensation during 2010. Does that sound about right?
Yes No
Q52c4
What
is your best estimate of the correct total amount
(name/you) ________________
|
SOCIAL SECURITY- AMOUNT
Q56dp
What is the easiest way for you to tell us (name's/your) Social Security payment; monthly, quarterly, or yearly?
4 Monthly 5 Quarterly 7 Yearly
Q56d
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments in 2010?
If already included in amount reported for another household member, indicate this
________________
*NEW*
[IF DON’T KNOW] Would you say it was more than $12,200 or less than that?
[IF MORE THAN $12,200] Was it more or less than $17,500?
[IF MORE THAN $17,500] Would you say it was less than $20,300, or more than that?
[IF LESS THAN $17,500] Would you say it was less than $13,900, $13,900 to less than $15,500, or more than $15,500?
[IF LESS THAN $12,200] Was it more or less than $7,800?
[IF MORE THAN $7,800] Would you say it was less than $9,300, $9,300 to less than $10,700, or more than $10,700?
[IF LESS THAN $7,800] Would you say it was less than $3,800, $3,800 to less than $6,000, or more than $6,000?
Q56d1
What is the amount of the Social Security payment (name/you) received last month?
________________
Q56d2
For
how many (months/quarters) did (name/you) receive Social Security
in 2010? ________________
Q56d3
Is this $(amount from Q56d/amount from Q56d1) before or after the $96.40 per month Medicare deduction?
Q56d4
Was the cost of living increase the only change which occurred in monthly payments?
Yes No
Q56d5
According to my calculations (name/you) received $(total) altogether from Social Security in 2010. Does that sound about right?
Yes No
Q56d6
What
is your best estimate of the correct amount (name/you) received in
Social Security during 2010? ________________
SSR
What were the reasons (name/you) (was/were) getting Social Security in 2010?
________________________________________________
SSC
Which children under age 15 were receiving Social Security in 2010?
SSCR
What were the reasons (Child's name/the children) (was/were) getting Social Security in 2010?
4 Other
|
SOCIAL SECURITY FOR CHILDREN - AMOUNT
Q56ip
What is the easiest way for you to tell us (name's/your) Social Security payment for children in this household; monthly, quarterly, or yearly?
4 Monthly 5 Quarterly 7 Yearly
Q56i
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments for children in this household in 2010?
________________
Q56i1
What
is the amount of the Social Security payment (name/you) received
for children in this household last month? ________________
Q56i2
For how many (months/quarters) did (name/you) receive Social Security in 2010?
________________
Q56i3
Was the cost of living increase the only change which occurred in monthly payments for children in this household?
Yes No
Q56i4
According to my calculations (name/you) received $(total) altogether for children in this household from Social Security in 2010. Does that sound about right?
Yes No
Q56i5
What
is your best estimate of the correct amount (name/you) received in
Social Security for children in this household during 2010?
________________
CSS
Which children under age 19 were receiving Social Security in 2010?
CRSS
What
were the reasons (Child’s name/the children) (was/were)
getting Social Security in 2010?
|
SUPPLEMENTAL SECURITY INCOME (SSI) - AMOUNT
Q57cp
What is the easiest way for you to tell us (name's/your) Supplemental Security Income payment; monthly, quarterly, or yearly?
4 Monthly 5 Quarterly 7 Yearly
Q57c
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income payments in 2010?
________________
*NEW*
[IF DON’T KNOW] Would you say it was more than $7,600 or less than that?
[IF MORE THAN $7,600] Was it more or less than $9,300?
[IF MORE THAN $9,300] Would you say it was less than $12,000, $12,000 to less than $15,400, or more than $15,400?
[IF LESS THAN $9,300] Would you say it was less than $8,000, $8,000 to less than $8,300, or more than $8,300?
[IF LESS THAN $7,600] Was it more or less than $3,000?
[IF MORE THAN $3,000] Would you say it was less than $4,800, $4,800 to less than $6,700, or more than $6,700?
[IF LESS THAN $3,000] Would you say it was less than $700, $700 to less than $1,300, or more than $1,300?
Q57c1
What is the amount of the Supplemental Security Income payment (name/you) received last month?
________________
Q57c2
For how many (months/quarters) did (name/you) receive Supplemental Security Income in 2010?
________________
Q57c3
Was the cost of living increase the only change which occurred in monthly payments?
Yes No
Q57c4
According to my calculations (name/you) received $(total) altogether from Supplemental Security Income in 2010. Does that sound about right?
Yes No
Q57c5
What is your best estimate of the correct amount (name/you) received in Supplemental Security Income during 2010?
________________
SSIR
What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2010?
SSIC
Which children under age 15 were receiving Supplemental Security Income in 2010?
|
SUPPLEMENTAL SECURITY INCOME (SSI) FOR CHILDREN - AMOUNT
Q57ip
What
is the easiest way for you to tell us the Supplemental Security
4 Monthly 5 Quarterly 7 Yearly
Q57i
How
much did (name/you) receive (monthly/ quarterly/ ) in Supplemental
Security Income on behalf of children in 2010? ________________
Q57i1
What
is the amount of the Supplemental Security Income payment
(name/you) received on behalf of children last month? ________________
Q57i2
For how many (months/quarters) did (name/you) receive Supplemental Security Income on behalf of children in 2010?
________________
Q57i3
Was the cost of living increase the only change which occurred in monthly payments?
Yes No
Q57i4
According to my calculations (name/you) received $(total) altogether from Supplemental Security Income on behalf of children in 2010. Does that sound about right?
Yes No
Q57i5
What is your best estimate of the correct amount (name/you) received in Supplemental Security Income on behalf of children during 2010?
________________
RSSI
What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2010?
CSSI
Which children under age 18 were receiving Supplemental Security Income in 2010?
|
PUBLIC ASSISTANCE (TANF) –AMOUNT
Q59ep
What is the easiest way for you to tell us (name's/your) CASH assistance payments; weekly, every other week, twice a month, monthly, or yearly?
7 Yearly
Q59e
During 2010, how much CASH assistance did (name/you) receive (per week/every other week/twice a month/ monthly/ )?
___________
*NEW*
[IF DON’T KNOW] Would you say it was more than $2,200 or less than that?
[IF MORE THAN $2,200] Was it more or less than $4,700?
[IF MORE THAN $4,700] Would you say it was less than $6,400, $6,400 to less than $8,000, or more than $8,000?
[IF LESS THAN $4,700] Would you say it was less than $2,600, $2,600 to less than $3,500, or more than $3,500?
[IF LESS THAN $2,200] Was it more or less than $600?
[IF MORE THAN $600] Would you say it was less than $1,000, $1,000 to less than $1,500 or more than $1,500?
[IF LESS THAN $600] Would you say it was less than $200, $200 to less than $300, or more than $300?
Q59e2
How many (weekly/every other week/ twice a month/ monthly) cash assistance payments did (name/you) receive in 2010?
________________
Q59e3
According to my calculations (name/you) received $(total) altogether in cash assistance from a state or county program in 2010. Does that sound about right?
Yes No
Q59e4
What
is your best estimate of the correct amount of cash
assistance ________________
Q59f
Was the cash assistance for adults AND children, or JUST children?
Q59g
(Who/Which children) in your household was the cash assistance for?
|
FOOD STAMPS (SNAP) BENEFITS - AMOUNTS
Q90p
What is the easiest way for you to tell us the value of the food assistance that covered [NAMES]: monthly or yearly?
Q90
What is the (monthly/ ) value of the food assistance received in 2010?
________________
*NEW*
[IF DON’T KNOW] Would you say it was more than $1,900 or less than that?
[IF MORE THAN $1,900] Was it more or less than $3,900?
[IF MORE THAN $3,900] Would you say it was less than $5,500, $5,500 to less than $6,600, or more than $6,600?
[IF LESS THAN $3,900] Would you say it was less than $2,400, $2,400 to less than $3,200, or more than $3,200?
[IF LESS THAN $1,900] Was it more or less than $650?
[IF MORE THAN $650] Would you say it was less than $1,000, $1,000 to less than $1,400 or more than $1,400?
[IF LESS THAN $650] Would you say it was less than $170, $170 to less than $300, or more than $300?
Q902
How many months was food assistance received in 2010?
________________
. Q903
According to my calculations (total) was received altogether from food assistance in 2010. Does that sound about right?
Yes No
Q904
What is your best estimate of the correct amount of food assistance received during 2010?
________________
|
VETERANS PAYMENTS - AMOUNTS
Ask this series for up to two types of Veteran’s Payments
Q60V1P
What is the easiest way for you to tell us (name's/your) (Service-connected disability compensation / Survivor Benefits / Veteran’s Pension / Veteran’s Educational Assistance (inc. for child) / Other Veterans’ payments) - weekly, every other week, twice a month, monthly, or yearly?
7 7 Yearly
Q60V1
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/) before deductions in (Service-connected disability compensation / Survivor Benefits / Veteran’s Pension / Veteran’s Educational Assistance (inc. for child) / Other Veterans’ payments) in 2010?
______________ _______________
Q60V12
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (Service-connected disability compensation / Survivor Benefits / Veteran’s Pension / Veteran’s Educational Assistance (inc. for child) / Other Veterans’ payments) in 2010?
______________ _______________
Q60V13
According to my calculations (name/you) received (total) dollars altogether from (Service-connected disability compensation / Survivor Benefits / Veteran’s Pension / Veteran’s Educational Assistance (inc. for child) / Other Veterans’ payments) in 2010. Does that sound about right?
Yes Yes No No
Q60V14
What is your best estimate of the correct amount (name/you) received in (Service-connected disability compensation / Survivor Benefits / Veteran’s Pension / Veteran’s Educational Assistance (inc. for child) / Other Veterans’ payments)during 2010?
______________ _______________
REPEAT SERIES FOR SECOND TYPE OF VETERAN’S PAYMENTS REPORTED
|
SURVIVOR BENEFITS -AMOUNTS
Ask this series for up to three types of Survivor Benefits
Q58E1P
What is the easiest way for you to tell us (name's/your) (SURVIVOR BENEFIT SOURCE); weekly, every other week, twice a month, monthly, or yearly?
7 7 7 Yearly
Q58E1
How much did (name/you) receive (weekly/every other week/twice a month/ monthly) in (SURVIVOR BENEFIT SOURCE) in 2010?
_______________ ________________ _______________
Q58E12
How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (SURVIVOR BENEFIT SOURCE) in 2010?
_______________ ________________ _______________
Q58E13
According to my calculations (name/you) received (total) altogether from (SURVIVOR
BENEFIT
SOURCE) in
2010. Does that sound about right? Yes Yes Yes No No No
Q58E14
What is your best estimate of the correct amount (name/you) received from (SURVIVOR BENEFIT SOURCE) during 2010?
_______________ ________________ _______________
REPEAT SERIES FOR SECOND/THIRD TYPE OF VETERAN’S PAYMENTS REPORTED
|
DISABILITY INCOME - AMOUNT
Ask this series for up to two types of Disability Benefits
Q61E1P
What is the easiest way for you to tell us (name's/your) (first answer from Q61c or Q61cs1) payments; weekly, every other week, twice a month, monthly, or yearly?
7 7 Yearly
Q61E1
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly) before deductions in (DISABILITY INCOME SOURCE) payments in 2010?
______________ _______________
Q61E12
How
many (weekly/ every other week/ twice a month/ monthly) payments
did (name/you) receive in (DISABILITY INCOME SOURCE) payments in
2010? ______________ _______________
Q61E13
According to my calculations (name/you) received (total) dollars altogether from (DISABILITY INCOME SOURCE) payments in 2010. Does that sound about right?
Yes Yes No No
Q61E14
What is your best estimate of the correct amount (name/you) received from (DISABILITY INCOME SOURCE) payments during 2010?
______________ _______________
REPEAT SERIES FOR SECOND/THIRD TYPE OF DISABILITY BENEFITS REPORTED
|
RETIREMENT AND PENSIONS - AMOUNT
Ask this series for up to three types of Retirement/Pension Sources
Q62E1P
What is the easiest way for you to tell us (name's/your) (RETIREMENT/PENSION SOURCE); weekly, every other week, twice a month, monthly, or yearly?
1 1 1 Weekly 2 2 2 Every other week 3 3 3 Twice a month 4 4 4 Monthly 7 7 7 Yearly
Q62E1
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) in (RETIREMENT/PENSION SOURCE) in 2010?
_______________ ________________ _______________
Q62E12
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (RETIREMENT/PENSION SOURCE) in 2010?
_______________ ________________ _______________
Q62E13
According to my calculations (name/you) received (total) dollars altogether from (RETIREMENT/PENSION SOURCE) in 2010. Does that sound about right?
Yes Yes Yes No No No
Q62E14
What is your best estimate of the correct amount (name/you) received in (RETIREMENT/PENSION SOURCE) during 2010?
_______________ ________________ _______________
*NEW*
PENSION FROM PRIVATE COMPANY
[ IF DON’T KNOW}Would you say it was more than $8,400 or less than that?
[IF MORE THAN $8,400] Was it more or less than $19,300?
[IF MORE THAN $19,300] Would you say it was less than $30,000, $30,000 to less than $40,000, or more than $40,400?
[IF LESS THAN $19,300] Would you say it was less than $11,800, $11,800 to less than $15,000, or more than $15,000?
[IF LESS THAN $8,400] Was it more or less than $2,600?
[IF MORE THAN $2,600] Would you say it was less than $4,200, $4,200 to less than $6,000, or more than $6,000?
[IF LESS THAN $2,600] Would you say it was less than $900, $900 to less than $1,400, or more than $1,400?
PENSION FROM STATE AND LOCAL GOVERNMENT
[IF DON’T KNOW] Would you say it was more than $19,000 or less than that?
[IF MORE THAN $19,000] Was it more or less than $36,000?
[IF MORE THAN $36,000] Would you say it was less than $36,000, $36,000 to less than $64,000, or more than $64,000?
[IF LESS THAN $36,000] Would you say it was less than $24,000, $24,000 to less than $28,800, or more than $28,800?
[IF LESS THAN $19,000] Was it more or less than $7,200?
[IF MORE THAN $7,200] Would you say it was less than $10,800, $10,800 to less than $14,000, or more than $14,000?
[IF LESS THAN $7,200] Would you say it was less than $2,000, $2,000 to less than $3,600, or more than $3,600?
DISTRIBUTIONS FROM RETIREMENT PLAN
[IF DON’T KNOW] Would you say it was more than $9,500 or less than that?
[IF MORE THAN $9,500] Was it more or less than $24,400?
[IF MORE THAN $24,400] Would you say it was less than $44,000, $44,000 to less than $64,000, or more than $64,000?
[IF LESS THAN $24,400] Would you say it was less than $12,000, $12,000 to less than $17,600, or more than $17,600?
[IF LESS THAN $9,500] Was it more or less than $3,600?
[IF MORE THAN $3,600] Would you say it was less than $4,900, $4,900 to less than $6,000, or more than $6,000?
[IF LESS THAN $3,600] Would you say it was less than $900, $900 to less than $1,200, or more than $3,600?
|
INTEREST - AMOUNT
*NEW*
IF ANY OF THESE ASSETS WERE IN A RETIREMENT ACCOUNT:
Within (your/ NAME’S) retirement account(s) what was the value of the (interest earning accounts or money market funds / savings bonds / treasury notes, CDs, or any other investments which pay interest) at the end of 2010?
Within
(your/ NAME’S) retirement account(s) how
much did (name/you) receive in interest from these sources during
2010, including even small amounts reinvested or credited to
accounts?
_______________
*NEW*
[IF DON’T KNOW] Would you say it was more than $160 or less than that?
[IF MORE THAN $160] Was it more or less than $1,400?
[IF MORE THAN $1,400] Would you say it was less than $4,000, $4,000 to less than $8,400, or more than $8,400?
[IF LESS THAN $1,400] Would you say it was less than $300, $300 to less than $570, or more than $570?
[IF LESS THAN $160] Was it more or less than $17?
[IF MORE THAN $17] Would you say it was less than $42, $42 to $84, or more than $84?
[IF LESS THAN $17] Would you say it was less than $3, $3 to less than $6, or more than $6?
Q63cp
Is
this a weekly, every other week, twice a month, monthly,
quarterly, every 6 months, or yearly amount?
Q63c2
Within the retirement account(s), how many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name/you) receive in interest income in 2010?
_______________
Q63c3
According to my calculations (name/you) received (total) dollars from interest income within (your/his/her) retirement account(s) in 2010. Does that sound about right?
Yes No
Q63c4
What is your best estimate of the correct amount (name/you) received from interest payments within the retirement account(s) during 2010?
_______________
*NEW*
IF ANY OF THESE ASSETS WERE OUTSIDE OF A RETIREMENT ACCOUNT:
(Outside of (your/ NAME’S) retirement account(s) what was the value of the (interest earning accounts or money market funds / savings bonds / treasury notes, CDs, or any other investments which pay interest) at the end of 2010?
(Outside
of the retirement account(s)) how
much did (name/you) receive in interest from these sources during
2010, including even small amounts reinvested or credited to
accounts?
_______________
*NEW*
[IF DON’T KNOW] Would you say it was more than $160 or less than that?
[IF MORE THAN $160] Was it more or less than $1,400?
[IF MORE THAN $1,400] Would you say it was less than $4,000, $4,000 to less than $8,400, or more than $8,400?
[IF LESS THAN $1,400] Would you say it was less than $300, $300 to less than $570, or more than $570?
[IF LESS THAN $160] Was it more or less than $17?
[IF MORE THAN $17] Would you say it was less than $42, $42 to $84, or more than $84?
[IF LESS THAN $17] Would you say it was less than $3, $3 to less than $6, or more than $6?
Q63cp
Is
this a weekly, every other week, twice a month, monthly,
quarterly,
Q63c2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name/you) receive in interest income in 2010 (outside of the retirement account(s))?
_______________
Q63c3
According to my calculations (name/you) received (total) dollars from interest income (outside of the retirement account(s)) in 2010. Does that sound about right?
Yes No
Q63c4
What is your best estimate of the correct amount (name/you) received from interest payments (outside of the retirement account(s)) during 2010?
_______________
|
DIVIDENDS - AMOUNT
*NEW*
IF ANY OF THE STOCK/MUTUAL FUND SHARES WERE IN A RETIREMENT ACCOUNT:
Within (your/ NAME’S) retirement account(s) what was the value of the shares of stock or mutual funds at the end of 2010?
Within (your/ NAME’S) retirement account(s), how much did (name/you) receive in dividends from stocks or mutual funds during 2010, including dividends that were reinvested?
_______________
*NEW*
[IF DON’T KNOW] Would you say it was more than $500 or less than that?
[IF MORE THAN $500] Was it more or less than $3,000?
[IF MORE THAN $3,000] Would you say it was less than $7,000, $7,000 to less than $13,500, or more than $13,500?
[IF LESS THAN $3,000] Would you say it was less than $1,000, $1,000 to less than $1,500, or more than $1,500?
[IF LESS THAN $500] Was it more or less than $96?
[IF MORE THAN $96] Would you say it was less than $175, $175 to $300, or more than $300?
[IF LESS THAN $96] Would you say it was less than $10, $10 to less than $25, or more than $25?
Q64cp
Is
this a weekly, every other week, twice a month, monthly,
quarterly,
Q64c2
Within the retirement account(s), how many (weekly/every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name's/your) receive in dividends from stocks (or mutual funds) in 2010?
_______________
Q64c3
According to my calculations (name/you) received (total) dollars altogether from dividend payments within (your/his/her) retirement account(s) in 2010. Does that sound about right?
Yes No
Q64c4
What is your best estimate of the correct amount (name/you) received from dividend payments within the retirement account(s) during 2010?
_______________
*NEW*
IF ANY OF THE STOCK/MUTUAL FUND SHARES WERE IN A RETIREMENT ACCOUNT:
(Outside of the retirement account(s)) what was the value of the shares of stock or mutual funds at the end of 2010?
(Outside of the retirement account(s),) how much did (name/you) receive in dividends from stocks or mutual funds during 2010, including dividends that were reinvested?
_______________
Q64cp
Is
this a weekly, every other week, twice a month, monthly,
quarterly,
Q64c2
(Outside of the retirement account(s)), how many (weekly/every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name's/your) receive in dividends from stocks or mutual funds in 2010?
_______________
*NEW*
[IF DON’T KNOW] Would you say it was more than $500 or less than that?
[IF MORE THAN $500] Was it more or less than $3,000?
[IF MORE THAN $3,000] Would you say it was less than $7,000, $7,000 to less than $13,500, or more than $13,500?
[IF LESS THAN $3,000] Would you say it was less than $1,000, $1,000 to less than $1,500, or more than $1,500?
[IF LESS THAN $500] Was it more or less than $96?
[IF MORE THAN $96] Would you say it was less than $175, $175 to $300, or more than $300?
[IF LESS THAN $96] Would you say it was less than $10, $10 to less than $25, or more than $25?
Q64c3
According to my calculations (name/you) received (total) dollars altogether from dividend payments (outside of the retirement account(s)) in 2010. Does that sound about right?
Yes No
Q64c4
What is your best estimate of the correct amount (name/you) received from dividend payments (outside of the retirement account(s)) during 2010?
_______________
|
PROPERTY INCOME - AMOUNT
Q65c
How much did (name/you) receive in income from rent (blank /, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES during 2010?
Q65cp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?
7 Yearly
Q65c2
What is your best estimate of (name's/your) ANNUAL net income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2010?
_______________
*NEW*
[IF DON’T KNOW] Would you say it was more than $3,600 or less than that?
[IF MORE THAN $3,600] Was it more or less than $10,000?
[IF MORE THAN $10,000] Would you say it was less than $20,000, $20,000 to less than $70,000, or more than $70,000?
[IF LESS THAN $10,000] Would you say it was less than $6,000, or more than that?
[IF LESS THAN $3,600] Was it more or less than $1,000?
[IF MORE THAN $1,000] Would you say it was less than $2,000 or more than that?
[IF LESS THAN $1,000] Would you say it was less than $215, or more than that?
Q65c2L
What is your best estimate of (name’s/your) ANNUAL LOSS from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2010?
_______________
|
EDUCATION ASSISTANCE - AMOUNT
Q69F88
[IF PELL GRANT RECEIVED] How much did (name/you) receive in Pell Grants during 2010?
________________
IF NO OTHER EDUCATION ASSISTANCE SOURCE, SKIP REMAINING ITEMS IN THIS SECTION
Q66HP
What is the easiest way for you to tell us (name's/your) (other/blank ) educational assistance during 2010; weekly, every other week, twice a month, monthly, or yearly?
7 Yearly
Q66H
(blank/Aside from the Pell Grant assistance,) (How/how) much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in educational assistance during 2010?
________________
Q66H2
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in educational assistance in 2010?
________________
Q66H3
According to my calculations (name/you) received (total) altogether from educational assistance in 2010. Does that sound about right?
Q66H4
What is your best estimate of the correct amount (name/you) received from educational assistance during 2010?
________________
|
CHILD SUPPORT - AMOUNT
Q70cp
What is the easiest way for you to tell us (name's/your) child support payments;
weekly,
every other week, twice a month, monthly, or yearly?
7 Yearly
Q70c
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in child support payments in 2010?
________________
Q70c2
How many (weekly/every other week/ twice a month/ monthly) child support payments did (name/you) receive in 2010?
________________
Q70c3
According to my calculations (name/you) received (total) altogether from child support payments in 2010. Does that sound about right?
Yes No
Q70c4
What is your best estimate of the correct amount (name/you) received from child support payments during 2010?
________________
|
ALIMONY – AMOUNT
Q71cp
What
is the easiest way for you to tell us (name's/your) alimony
payments;
weekly,
every other week, twice a month, monthly, or yearly?
7 Yearly
Q71c
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in alimony payments in 2010?
________________
Q71c2
How many (weekly/every other week/ twice a month/ monthly) alimony payments did (name/you) receive in 2010?
________________
Q71c3
According to my calculations (name/you) received (total) altogether from alimony payments in 2010. Does that sound about right?
Yes No
Q71c4
What is your best estimate of the correct amount (name/you) received from alimony payments during 2010?
________________
|
*NEW* (REMOVED REFERENCE TO “REGULAR” FINANCIAL ASSISTANCE)
FINANCIAL ASSISTANCE
Q72cp
What is the easiest way for you to tell us (name's/your) financial assistance; weekly, every other week, twice a month, monthly, or yearly?
7 Yearly
Q72c
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in financial assistance in 2010?
________________
Q72c2
How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2010?
_______________
Q72c3
According to my calculations (name/you) received (total) altogether from financial assistance in 2010. Does that sound about right?
Yes No
Q72c4
What is your best estimate of the correct amount (name/you) received from financial assistance during 2010?
________________
|
OTHER MONEY INCOME 1 (BOTH SOURCES AND AMOUNTS)
Q73A1
During 2010 did (you/ anyone in this household) receive income from: Hobbies, home businesses, farms, or business interests not already covered?
Yes No
Q73A1b
Who received this income?
Q73A1c
What was the source of this income?
_________________________________________________
_________________________________________________
Q731P
What is the easiest way for you to tell us (name's/your) income from hobbies, home businesses, farms, or business interests not already covered during 2010; weekly, every other week, twice a month, monthly, or yearly?
7 Yearly Q731
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income from hobbies, home businesses, farms, or business interests not already covered during 2010?
________________
Q7312
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in income from hobbies, home businesses, farms, or business interests not already covered in 2010?
________________
Q7313
According to my calculations (name/you) received (total) altogether from hobbies, home businesses, farms, or business interests not already covered in 2010.
Does that sound about right?
Q7314
What is your best estimate of the correct amount (name/you) received in income from hobbies, home businesses, farms, or business interests not already covered during 2010?
________________
|
OTHER MONEY INCOME 2 (BOTH SOURCES AND AMOUNTS)
Q73A2
During 2010 did (you/ anyone in this household) receive income from: Any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered?
Yes No
Q73A2b
Who received this income?
Q73A2c
What was the source of this income?
_________________________________________________
_________________________________________________
Q732P
What
is the easiest way for you to tell us (name's/your) income from
any severance pay, welfare, emergency assistance, other short-term
cash assistance, foster child care payments, or any other money
income not already covered during 2010; weekly,
every other week, twice a month, monthly, or yearly?
7 Yearly
Q732
How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income from any severance pay, welfare, emergency assistance,
other
short-term cash assistance, foster child care payments, or any
other money I income not already covered during 2010?
________________
Q7322
How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010?
________________
Q7323
According to my calculations (name/you) received (total) altogether from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010. Does that sound about right?
Yes No
Q7324
What is your best estimate of the correct amount (name/you) received in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2010?
________________
|
PUBLIC HOUSING
Q85
Is this public housing, that is, is it owned by a local housing authority or other public agency?
Yes No
Q86
Are you paying lower rent because the Federal, State, or local government is paying part of the cost?
SPHS8
Is this through Section 8 or through some other government program?
|
ENERGY ASSISTANCE
Q93
The government has an energy assistance program which helps pay heating or cooling costs. This assistance can be received directly by the household or it can be paid directly to the electric company, gas company, or fuel dealer.
In 2010, did you receive assistance of this type from the federal, state, or local government?
Yes No
Q93pr1
Do you remember receiving an additional or unexpected check that was sent during the winter to help pay heating costs?
Yes No
Q93pr2
Was it used to pay heating costs?
Yes No
Q94
Altogether, how much energy assistance has been received in 2010?
________________
|
|
|
|
|
|
|
Read
categories if necessary
If
response is "Broke Even" then enter 1.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kerwin_j |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |
© 2024 OMB.report | Privacy Policy