Download:
pdf |
pdfItems Booklet for
Specification:
Section: Front
Mark One Only
[fill TEMP2]
Some of the questions have already been answered.
Let me see where we should begin.
Item to begin:
INTRO_D
[fill loq]
PRESS "ENTER" TO CONTINUE
@
Mark One Only
"Hello. I'm ... from the United States Census Bureau.
Here is my identification card (show ID card). We are
conducting a survey on the economic situation of people who
live in the United States. I have some questions to ask you."
INTRO
o ASK RESPONDENT IF HE/SHE RECEIVED ADVANCE LETTER;
IF NOT, GIVE LETTER TO RESPONDENT BEFORE PROCEEDING.
o IS THE RESPONDENT READY TO COMPLETE THE INTERVIEW?
(1)
(2)
(3)
Inconvenient time. Try again later
Reluctant Respondent - Hold for refusal followup
Noninterview
(P)
Proceed
@
Mark One Only
ENTER NONINTERVIEW CODE
TYPE A
(1) No one home
(2) Temporarily absent
(3) Refused
(4) Unable to locate
(5) Language problem
(6) Other Type A
TYPEABC
TYPE B
(10) Vacant regular (REG)
(11) Vacant - storage of household furniture
(12) Unfit or to be demolished
(13) Under construction, not ready
(14) Converted to temp. business or storage
(15) Unoccupied tent or trailer site
(16) Permit granted, construction not started
(17) Temp. occupied by persons with URE
(18) Occupied by persons under 15 years of age
(19) Other Type B
TYPE C
(21) Demolished
(22) House or trailer moved
(23) Address outside segment
(24) Converted to permanent business or storage
(25) Merged
(26) Condemned
(27) Unused Serial #/Listing sheet line
(28) Removed during subsampling
(29) Unit already had a chance of selection
(30) Other Type C
@
Mark One Only
Specify the kind of "Other" Noninterview
SPCIFY
@
Wednesday, August 22, 2007
Page 1 of 314
Survey:
Section: Front
Items Booklet
Mark All That Apply
Enter your best guess as to the Race of the reference person.
NI_RACE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(D)
White
Black/African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other
Don't Know
@
Mark One Only
Enter your best guess as to the sex of the reference person.
NI_SEX
[fill ENTERFIL]
(1)
(2)
Male
Female
@
Mark One Only
ASK OR VERIFY WITH SOME KNOWLEDGEABLE INDIVIDUAL
NI_SIZE
Enter your best guess as to the total number of people in the household.
Count all children and adults.
[fill ENTERFIL]
@
Mark One Only
ASK OR VERIFY WITH A KNOWLEDGEABLE INDIVIDUAL,
OR ENTER YOUR BEST GUESS.
NI_TENUR
Are the living quarters -(1)
(2)
(3)
Owned or being bought by the occupant(s)?
Rented?
Or occupied without payment of rent?
@
Mark One Only
TYPEADIS
YOU MUST DISCUSS THIS CASE WITH YOUR SUPERVISOR
BEFORE TRANSMITTING IT AS A TYPE A NONINTERVIEW.
PRESS "ENTER" TO CONTINUE
@
Page 2 of 314
Wednesday, August 22, 2007
Items Booklet
Wednesday, August 22, 2007
Survey:
Section: Coverage
Page 3 of 314
Survey:
Section: Coverage
Items Booklet
Mark One Only
We will begin the interview with questions about
who lives here, their ages, how they're related to each
other, and any other information. Then, I will ask you
questions about your jobs and any other sources of income.
Then I'll have questions about anyone else who's
at least 15 years old.
BEGINT
PRESS "ENTER" TO CONTINUE
@
Mark One Only
I have your address listed as:
ADDRESS: [fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
VERADD
HNO] [fill HNOSUF] [fill STRNAME]
UDESIG]
GQUNITINFO]
NONCITYADD]
PO], [fill ST] [fill ZIP5:0]-[fill ZIP4:0]
DESCTEMP1]
DESCTEMP2]
BLDGNAME]
Is that your exact address?
(1)
(2)
(3)
H
Yes, address is EXACTLY CORRECT as listed
Address is MOSTLY CORRECT, but needs some minor changes
INCORRECT ADDRESS - terminate interview, find correct address
@
Multiple Entry
ENTER ADDRESS OR (S) FOR SAME, IF NO CHANGE NEEDED
ENTER (X) TO BLANK-OUT THE CURRENT INFORMATION
CHNGADD
HOUSE NUMBER:
SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF]
[fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
[fill GQ UNIT DESIG:]
[fill UDESIG]
[fill GQUNITINFO]
@UNITDES
[fill @GQUINFO]
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME:
Page 4 of 314
[fill BLDGNAME]
@BLDGNAME
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Coverage
MAILADDR
Mark One Only
Is this also your mailing address?
H
ADDRESS: [fill
[fill
[fill
[fill
[fill
(1)
(2)
HNO] [fill HNOSUF] [fill STRNAME]
UDESIG]
GQUNITINFO]
NONCITYADD]
PO], [fill ST] [fill ZIP5:0]-[fill ZIP4:0]?
Yes
No
@
CHNGMAIL
Multiple Entry
ENTER CORRECTED MAILING ADDRESS OR (S) FOR SAME IF CORRECT
ENTER (X) TO BLANK OUT THE CURRENT INFORMATION
H
HOUSE NUMBER:
SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF]
[fill STRNAME]
@MHHNO
@MHHNOSUF
@MSTRNAME
UNIT DESIG:
[fill GQ UNIT DESIG:]
[fill UDESIG]
[fill GQUNITINFO]
@MUNITDES
[fill @MGQUINFO]
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@MNOCITY
CITY: [fill PO]
@MPO
STATE:[fill ST]
ZIP CODE: [fill ZIP5] [fill ZIP4]
@MST
@MZIP5 @MZIP4
Mark One Only
OLDCON
IF THIS ADDRESS IS A
- GROUP QUARTERS,
- MOBILE HOME,
- TRAILER, TENT, BOAT, OR
- A UNIT NOT LOCATED IN A STRUCTURE,
ENTER (N) WITHOUT ASKING THE FOLLOWING QUESTION.
Was this structure originally built before April of 2000?
(1)
(2)
(N)
Yes
No
Not Asked
@
Mark One Only
Are there any other living quarters
- either occupied or vacant - at this address?
(1)
(2)
ATADR
Yes
No
@
Wednesday, August 22, 2007
Page 5 of 314
Survey:
Section: Coverage
Items Booklet
WARNING3
Mark One Only
YOU ARE ABOUT TO BEGIN ASKING QUESTIONS ABOUT ONE OR MORE
ADDITIONAL LIVING ARRANGEMENTS AT THIS LOCATION TO
DETERMINE IF THEY QUALIFY AS EXTRA UNITS!!!
IF YOU HAVE ACCIDENTALLY REACHED THIS SCREEN, PRESS "F1"
TO BACKUP TO THE PREVIOUS SCREEN AND CORRECT AN EARLIER ENTRY.
TO BEGIN COLLECTING INFORMATION FOR ADDITIONAL LIVING
ARRANGEMENTS AT THIS LOCATION, ENTER (P) TO PROCEED.
@
OTHADD
Multiple Entry
What is the exact address of this other living quarters?
ENTER (S) FOR SAME
HOUSE NUMBER:
SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF]
[fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
GQ UNIT DESIG:
[fill UDESIG]
[fill GQUNITINFO]
@UNITDES
@GQUINFO
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME:
[fill BLDGNAME]
@BLDGNAME
BNDARY
Mark One Only
ARE THE ADDITIONAL LIVING QUARTERS IN THE
SAME STRUCTURE AS THE SAMPLE UNIT?
(1)
(2)
Address is within same structure
Address is outside of the same structure
@
GRPQTR
Mark One Only
ARE THE ADDITIONAL LIVING QUARTERS IN A GROUP QUARTERS?
H
(1)
(2)
Yes
No
@
Mark One Only
LVEAT1
Do the occupants or intended occupants of the
additional living quarters live separately
from all other persons on the property?
(1)
(2)
Yes
No
@
Page 6 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Coverage
Mark One Only
Do the occupants or intended occupants of the
additional living quarters have direct access from
the outside or through a common hall?
(1)
(2)
ACCES1
Yes
No
@
Mark One Only
NOINCL
THIS ADDITIONAL LIVING QUARTERS IS NOT AN EXTRA UNIT,
DO NOT INCLUDE MEMBERS OF THIS OTHER LIVING QUARTERS
AS MEMBERS OF THE CURRENT HOUSEHOLD.
(P)
Proceed
@
Mark One Only
INCLUD
THE OTHER LIVING QUARTERS IS NOT CONSIDERED TO BE
AN EXTRA UNIT. INCLUDE THE PERSONS WHO OCCUPY THAT LIVING
ARRANGEMENT AS MEMBERS OF THE ASSIGNED HOUSEHOLD.
(P)
Proceed
@
Mark One Only
XTRA
THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT.
DO NOT INCLUDE MEMBERS OF THIS EXTRA UNIT AS MEMBERS
OF THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY.
ADD THE EXTRA UNIT TO YOUR LISTING SHEET ACCORDING TO
THE INSTRUCTIONS IN YOUR LISTING AND COVERAGE MANUAL.
(P)
Proceed
@
Mark One Only
GQSEG
IF YOU NOTICE MORE UNITS IN THE GQ THAN ARE LISTED,
ENTER THE FOLLOWING NOTE IN THE FOOTNOTE SECTION OF
THE LISTING SHEET:
"FOUND MORE UNITS AT INTERVIEW ADD TO LISTING SHEET WHEN UPDATING"
(P)
Proceed
@
Wednesday, August 22, 2007
Page 7 of 314
Survey:
Section: Coverage
Items Booklet
OTHAD2
Multiple Entry
What is the exact address of this other living quarters?
ENTER (S) FOR SAME
HOUSE NUMBER:
SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF]
[fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
GQ UNIT DESIG:
[fill UDESIG]
[fill GQUNITINFO]
@UNITDES
@GQUINFO
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME:
[fill BLDGNAME]
@BLDGNAME
ONLIST
Mark One Only
IS THIS ADDRESS ALREADY LISTED ON YOUR LISTING SHEET?
(1)
(2)
Other Address on listing sheet
Other Address NOT on listing sheet
@
INSPACE
Mark One Only
ARE THE ADDITIONAL LIVING QUARTERS WITHIN THE SAME STRUCTURE AND
WITHIN THE SAME SPACE AS THE SAMPLE UNIT?
(1)
(2)
Yes
No
@
LVEAT2
Mark One Only
Do the occupants or intended occupants of the
additional living quarters live separately
from all other persons on the property?
(1)
(2)
Yes
No
@
ACCES2
Mark One Only
Do the occupants or intended occupants of the
other living quarters have direct access from
the outside or through a common hall?
H
(1)
(2)
Yes
No
@
Page 8 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Coverage
Mark One Only
NOINCL2
THIS ADDITIONAL LIVING QUARTERS IS NOT CONSIDERED TO BA AN EXTRA UNIT.
INCLUDE THE PERSONS WHO OCCUPY THAT LIVING ARRANGEMENT AS MEMBERS OF
THE ASSIGNED HOUSEHOLD.
(P)
Proceed
@
Mark One Only
INCLD2
THE ADDITIONAL LIVING QUARTERS IS NOT CONSIDERED TO BE
AN EXTRA UNIT. INCLUDE THE PERSONS WHO OCCUPY THAT
LIVING ARRANGEMENT AS MEMBERS OF THE ASSIGNED HOUSEHOLD.
(P)
Proceed
@
Mark One Only
XTRA2
THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT.
DO NOT INCLUDE MEMBERS OF THIS EXTRA UNIT AS MEMBERS
OF THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY.
ADD THE EXTRA UNIT TO YOUR LISTING SHEET ACCORDING TO
THE INSTRUCTIONS IN YOUR LISTING AND COVERAGE MANUAL.
(P)
Proceed
@
Multiple Entry
What is the exact address of this other living quarters?
ENTER (S) FOR SAME
OTHAD3
HOUSE NUMBER:
SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF]
[fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
GQ UNIT DESIG:
[fill UDESIG]
[fill GQUNITINFO]
@UNITDES
@GQUINFO
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME:
[fill BLDGNAME]
@BLDGNAME
Mark One Only
INADD
ARE THE ADDITIONAL LIVING QUARTERS WITHIN THE BASIC ADDRESS
OF THE ORIGINAL SAMPLE UNIT?
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 9 of 314
Survey:
Section: Coverage
Items Booklet
LVEAT3
Mark One Only
Do the occupants or intended occupants of the
additional living quarters live separately
from all other persons on the property?
(1)
(2)
Yes
No
@
ACCES3
Mark One Only
Do the occupants or intended occupants of the
additional living quarters have direct access from
the outside or through a common hall?
H
(1)
(2)
Yes
No
@
Mark One Only
NOINCL3
THIS ADDITIONAL LIVING QUARTERS IS NOT AN EXTRA UNIT,
DO NOT INCLUDE MEMBERS OF THIS ADDITIONAL LIVING QUARTERS
AS MEMBERS OF THE CURRENT HOUSEHOLD.
(P)
Proceed
@
Mark One Only
INCLD3
THE ADDITIONAL LIVING QUARTERS IS NOT CONSIDERED TO BE
AN EXTRA UNIT. INCLUDE THE PERSONS WHO OCCUPY THAT LIVING
ARRANGEMENT AS MEMBERS OF THE ASSIGNED HOUSEHOLD.
(P)
Proceed
@
Mark One Only
XTRA3
THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT.
DO NOT INCLUDE MEMBERS OF THIS EXTRA UNIT AS MEMBERS
OF THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY.
ADD THE EXTRA UNIT TO YOUR LISTING SHEET ACCORDING TO
THE INSTRUCTIONS IN YOUR LISTING AND COVERAGE MANUAL.
(P)
Proceed
@
Page 10 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Coverage
BCINFO
Mark One Only
FOR TYPE B and C NONINTERVIEWS, COLLECT THE
FOLLOWING INFOMATION.
Was the noninterview status determined by observation only
or did someone provide you with information about the
housing unit?
(1) By observation only
(2) Information provided by someone else
@
Multiple Entry
ENTER (R) FOR SPECIFIC ITEMS BELOW IF THEY ARE REFUSED
BCINFO2
Name of person providing noninterview status:
Firstname: @FN Lastname: @LN
Title of contact person (relative, neighbor, etc.): @CPRELA
Contact person's address:
Street name: @R1
Street name: @R2
City: @PO
State: @ST
Telephone Number: Area: @AR
Zip Code: @ZP5 @ZP4
Number: @NUM
Extension: @EXT
ACCESS
Mark One Only
ASK IF NOT APPARENT
[fill ORIGUNITFIL]
Do you have direct access to your home, either from the outside
or through a common hall?
H
(1)
(2)
Yes
No
@
Mark One Only
This household must be merged with the household through
which access is gained. Refer to Interviewer's manual
to determine if the merged household is in or out of
the SIPP sample.
(1)
(2)
MERGE
Merged -- in SIPP sample
Merged -- NOT in SIPP sample
@
Wednesday, August 22, 2007
Page 11 of 314
Survey:
Section: Coverage
Items Booklet
Mark One Only
ENTER TYPE OF LIVING QUARTERS:
LIVQRT
HOUSING UNIT
(1) House, apartment, flat
(2) HU in nontransient hotel, motel, etc.
(3) HU permanent, in transient hotel, motel, etc.
(4) HU in rooming house
(5) Mobile home or trailer with no permanent room added
(6) Mobile home or trailer with one or more permanent
rooms added
(7) HU not specified above
GROUP QUARTERS UNIT
(8) Quarters not HU in rooming or boarding house
(9) Unit not permanent in transient hotel, motel, etc.
(10) Unoccupied tent or trailer site
(11) Student quarters in college dormitory
(12) GROUP QUARTERS UNIT not specified above
@
Mark One Only
ASK IF NOT APPARENT
UNITS
How many housing units, both occupied and vacant,
are there in this structure?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
One, detached
One, attached
Two
3-4
5-9
10-19
20-49
50 or more
@
Mark One Only
Are your living quarters --
TENURE
READ ANSWER CATEGORIES
(1)
Owned or being bought by you or someone
in your household,
(2)
Rented, or
(3)
Occupied without payment of rent?
@
Page 12 of 314
Wednesday, August 22, 2007
Items Booklet
Wednesday, August 22, 2007
Survey:
Section: Demographics
Page 13 of 314
Survey:
Section: Demographics
Mark One Only
First I need to make a list of all the people who live or
stay here at this address.
Items Booklet
PREROST
Be sure to include:
- People who stay here only some of the time,
- non-relatives who live here,
- and of course any babies and small children.
Please mention someone even if you're not sure they should be
included.
PRESS "ENTER" TO CONTINUE
@
Multiple Entry
Let's start with you. What is your name? Please give
me the names of everyone else who lives or stays here
most of the time. Anyone else?
ENTER (N) FOR NO MORE
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED
ROST
|SEX
|(M) Male
|(F) Female
|
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other
Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX
@1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX
@2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX
@3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX
@4REL
|(7) Other Relative
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX
@5REL
|(Include in-laws)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX
@6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX
@7REL
|(9) House/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX
@8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX
@9REL
|(11)Other
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX
@10REL
|
non-relative
Multiple Entry
Please give me the names of everyone else who
lives or stays here most of the time. Anyone else?
ROST2
|SEX
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other
Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX
@1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX
@2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX
@3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX
@4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX
@5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX
@6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX
@7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX
@8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX
@9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX
@10REL
|
Page 14 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Multiple Entry
Please give me the names of everyone else who
lives or stays here most of the time. Anyone else?
ROST3
|SEX
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other
Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX
@1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX
@2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX
@3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX
@4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX
@5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX
@6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX
@7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX
@8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX
@9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX
@10REL
|
USUAL
Mark One Only
I need to be sure I'm including the
correct people in this survey. You have
mentioned ***READ NAMES***.
H
Is this the address where
[fill YOUALLFIL] live and sleep
most of the time?
(1)
(2)
Yes
No
@1
|NAME
|Display ROST, ROST2, & ROST3
|
|
|
|
|
|
|
|
|
|
|
NOTHERE
Mark All That Apply
Who doesn't live or sleep here
most of the time? Anyone else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@DEL [fill ERRROFIL]
|LN NAME
|Display ROST, ROST2, & ROST3
|
|
|
|
|
|
|
Multiple Entry
First time asked:
During a typical week over the last month or so, how many
nights did [fill NAMEFIL] stay here overnight,
or was there no usual pattern?
NITESTAY
Subsequent times asked:
(How about/And) [ADROSTNAME]...?
(During a typical week over the last month or so, how many
nights did [fill ADROSTNAME] stay here overnight,
or was there no usual pattern?)
(11)
(12)
(13)
(14)
Three or fewer
Four or more
No usual pattern
Other {pop-up SPECIFY: @SP}
@1
Wednesday, August 22, 2007
Page 15 of 314
Survey:
Section: Demographics
Mark One Only
Is there another place where [fill NAMEFIL] lives and
sleeps most of the time?
(1)
(2)
Items Booklet
ASKURE
Yes
No
@
Mark One Only
ASK IF NECESSARY:
AWAYSCH
Is [fill ADROSTNAME]. . .
. . . a student away attending school,
. . . non-married,
. . . whose permanent residence is HERE2FIL?
(1)
(2)
Yes to all 3
No
@
Mark One Only
ASK IF NECESSARY:
AWAYTRV
Does [fill ADROSTNAME] usually live here but is away
traveling for work, or on vacation, or in a hospital?
(1)
(2)
Yes
No
@
Mark One Only
Sometimes we miss people when
it's not totally clear where they
live. Just to make sure,
[fill OTHERTHANFIL] have I missed…
MSNGSTAY
|NAME
|Display verified roster
|
|
H
|
(1) Yes
(2) No
|
|
…Anyone who is staying here until
|
they find a place to live?
@STAY|
|
…(Have I missed) Any lodgers,
|
boarders or persons you employ who
|
live here?
@LODGE|
|
…(Have I missed) Anyone who
|
may have another place to live, but who
|
stays here often or has some space or a
|
room here?
@OTH |
Page 16 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Multiple Entry
ADSTAY
|SEX
Who is that? Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other
Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX
@1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX
@2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX
@3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX
@4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX
@5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX
@6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX
@7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX
@8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX
@9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX
@10REL
|
Mark One Only
Sometimes we miss people when
it's not totally clear where they
live or stay. Just to make sure,
[fill OTHERTHANFIL] have I missed…
MSNGLODGE
|NAME
|Display verified roster
|
|
H
|
(1) Yes
(2) No
|
|
…Anyone who is staying here until
|
they find a place to live?
fill<@STAY>|
|
…(Have I missed) Any lodgers,
|
boarders or persons you employ who
|
live here?
@LODG |
|
…(Have I missed) Anyone who
|
may have another place to live, but who
|
stays here often or has some space or a
|
room here?
@OTH |
Multiple Entry
ADLODGE
|SEX
Who is that? Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other
Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX
@1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX
@2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX
@3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX
@4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX
@5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX
@6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX
@7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX
@8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX
@9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX
@10REL
|
Wednesday, August 22, 2007
Page 17 of 314
Survey:
Section: Demographics
Items Booklet
Mark One Only
Sometimes we miss people when
it's not totally clear where they
live or stay. Just to make sure,
[fill OTHERTHANFIL] have I missed…
MSNGOTH
|NAME
|Display verified roster
|
|
H
|
(1) Yes
|
(2) No
|
|
…Anyone who is staying HEREFIL until
|
they find a place to live?
fill<@STAY>|
|
…(Have I missed) Any lodgers,
|
boarders or persons you employ who
|
live HEREFIL?
Fill<@LODGE>|
|
…(Have I missed) Anyone who
|
may have another place to live, but who
|
stays HERE2FIL often or has some space or a|
room HEREFIL?
@OTH |
Multiple Entry
ADOTH
|SEX
Who is that? Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other
Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX
@1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX
@2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX
@3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX
@4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX
@5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX
@6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX
@7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX
@8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX
@9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX
@10REL
|
Mark One Only
First time asked:
USUAL1
Is this the address where [fill ADROSTNAME] lives
and sleeps most of the time?
Subsequent times asked:
(How about/And) [ADROSTNAME]...?
(Is this the address where [fill ADROSTNAME] lives
and sleeps most of the time?)
(1)
(2)
Yes
No
@
Page 18 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Multiple Entry
NITESTA1
During a typical week over the last month or so, how many
nights did [fill ADROST2NAME] stay here overnight, or was there
no usual pattern?
(11)
(12)
(13)
(14)
Three or fewer
Four or more
No usual pattern
Other {pop-up: SPECIFY: @SP}
@1
Mark One Only
ASKURE1
Is there another place where [fill ADROSTNAME] lives and
sleeps most of the time?
(1)
(2)
Yes
No
@
Mark One Only
ASK IF NECESSARY:
AWAYSCH1
Is [fill ADROST2NAME]...
... a student away attending school,
... non-married,
... whose permanent residence is HERE2FIL?
(1)
(2)
Yes to all 3
No
@
Mark One Only
ASK IF NECESSARY:
AWAYTRV1
Does [fill ADROSTNAME] usually live here but is away
traveling for work, or on vacation, or in a hospital?
(1)
(2)
Yes
No
@
Mark All That Apply
STUDCK
|LN NAME
|Display ADROST1 where AD1FLAG eq <1>
TO THE BEST OF YOUR KNOWLEDGE, DOES
|& (AWAYSCH ne <1> or AWAYTRV ne <1>)
ANYONE NOW ON THIS LIST MEET ALL 3
|
OF THESE CRITERIA?
|Display ADROST2 where AD2FLAG2 eq <1>
|& (AWAYSCH1 ne <1> or AWAYTRV1 ne<1>)
- NON-MARRIED STUDENT,
|
- LIVING HERE TEMPORARILY WHILE
|
ATTENDING SCHOOL,
|
- WITH A PERMANENT RESIDENCE
|
ELSEWHERE?
|
|
IF YES TO ALL 3, ENTER LINE NUMBER(S) |
ENTER (N) FOR NONE OR NO MORE
|
|
@KEY
|
|
Wednesday, August 22, 2007
Page 19 of 314
Survey:
Section: Demographics
Items Booklet
CHECKPT
Mark One Only
According to the rules of this survey,
***READ ALL NAMES*** will be
included in this interview.
PRESS (P) TO PROCEED
TO THE NEXT SCREEN
@
Mark One Only
Since you do not stay or live here most
of the time, who can answer the remaining
household questions?
***READ NAMES***?
@
|
|
|
|
|
|
|
|
|
NOHHRESP
|Display T_NOHHRESP
|
|
|
|
|
Mark One Only
A MAXIMUM OF 30 PEOPLE MAY BE INTERVIEWED IN
ANY HOUSEHOLD. THE LIMIT HAS BEEN REACHED.
NO QUESTIONS WILL BE ASKED FOR ANY ADDITIONAL PEOPLE.
MAXPER
PRESS ENTER TO CONTINUE
@
Mark One Only
ALL PEOPLE LISTED HAVE ANOTHER RESIDENCE WHERE THEY DO
USUALLY LIVE. THEY WILL NOT BE INCLUDED IN THIS
INTERVIEW. TAKE ONE OF THE FOLLOWING ACTIONS --
OTHRRP
PRESS F1 TO BACK UP AND CORRECT
ENTER (B) IF NO OTHER ADULT MAINTAINS THIS ADDRESS
AS HIS/HER USUAL PLACE OF RESIDENCE. -- THIS DESIGNATES
THIS ADDRESS AS A TYPE B NONINT.
@
Mark One Only
ASK IF NOT APPARENT:
SEX
[if INDEX eq <1>]
(How about/And) [fill TEMPNAME]...?
([fill C_AREIS] [fill TEMPNAME] Male or Female?)
[else]
[fill C_AREIS] [fill TEMPNAME] Male or Female?
(1)
(2)
Male
Female
@
Page 20 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
REFPER2
Mark All That Apply
Who [fill OWNRENTFIL] this home that is, what name or names are on the
[fill DEEDLEASEFIL]?
|LN
NAME
|Display HH Roster
|
|
IF RESPONDENT CAN'T IDENTIFY OWNER/RENTER,|
ENTER LINE NUMBER OF HEAD OF HOUSEHOLD.
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
|
@KEY
|
|
RELRP
Mark One Only
SHOW FLASHCARD A
First time asked:
What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?)
H
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Spouse(Husband/Wife)
Unmarried Partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative (Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative
@
Mark One Only
PLEASE VERIFY THE INFORMATION DISPLAYED IS CORRECT
[PRESS "SHIFT-F6" TO DISPLAY FULL ROSTER IF NEEDED]
**THIS INFORMATION CANNOT BE CHANGED AFTER THIS POINT IN THE INTERVIEW**
CHANGE
ENTER (P) TO PROCEED IF ALL APPEARS CORRECT
OTHERWISE, ENTER LINE NUMBER WHERE A CHANGE IS NEEDED. @
IF NECESSARY, SAY: I need to verify some of the information
I have collected for: ***READ ROSTER NAME(S)***
H
Display CHNG template
REL TO
LN NAME
SEX
REF PERSON
1
2
JOSEPH
HELEN
C
M
Wednesday, August 22, 2007
JONES
JONES
M
F
REF
SPOUSE
Page 21 of 314
Survey:
Section: Demographics
Items Booklet
CHG_WHAT
Mark One Only
What change is needed for: [fill NAMEFIL]
PRESS "SHIFT-F6" TO DISPLAY FULL ROSTER IF NEEDED
(M)
(2)
(3)
(4)
Mistake -- no changes needed
Name
Sex
Relationship to Reference Person
@
Display CHNG template
LN NAME
1
2
SEX
JOSEPH
HELEN
JONES
JONES
M
F
REL TO
REF PERSON
REF
SPOUSE
FIXNAME
Multiple Entry
What is the name of the person living or staying
here? Please include middle initial and maiden or other name.
PRESS "ENTER" IF NO MIDDLE OR MAIDEN NAME
FIRST NAME
MIDDLE INITIAL
LAST NAME
MAIDEN/OTHER NAME
@FNAME
@MNAME
@LNAME
@OTNAME
FIXRELRP
Mark One Only
SHOW FLASHCARD A
First time asked:
What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Spouse(Husband/Wife)
Unmarried Partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person(Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
@
Mark One Only
Are any more changes needed for:
CHG_MORE
[fill CHGNAMEFIL]
H
(1)
(2)
Yes
No
@
Page 22 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
SPOUSE1
Mark One Only
DO NOT READ TO RESPONDENT UNLESS NECESSARY
Is one of the following SEX entries incorrect?
LINE
NAME
Display reference person and sex
Display spouse and sex
(1)
(2)
(3)
SEX
To correct LINE [fill REFPER]'s SEX entry
To correct LINE [fill L_NO]'s SEX entry
Neither sex entry is incorrect
@
SPOUSE2
Mark One Only
ASK IF NECESSARY:
You said [fill TEMPNAME]
[fill AREIS] [fill PNAME(REFPER)] spouse.
Is that correct?
H
(1)
(2)
Yes
No
@
Mark One Only
DO NOT READ TO RESPONDENT UNLESS NECESSARY
SPOUSE3
Earlier I recorded
[fill TEMPNAME] [fill WASWERE]
[fill PNAME(REFPER)] spouse.
You have just reported
[fill NAME(SPIX)] [fill AREIS] also
[fill PNAME(REFPER)] spouse.
Which is correct?
(1)
(2)
H
[fill TEMPNAME] is the correct spouse.
Change relationship entry of [fill NAME SPIX)]
[fill NAME SPIX)] is the correct spouse.
Change relationship entry of [fill NAME L_NO)]
@
Mark One Only
SPOUSE4
SHOW FLASHCARD A
What is [fill PNAME(INDEX4)]
relationship to [fill NAME(REFPER)]?
H
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person(Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
(3)
(4)
(5)
(6)
(7)
@
Wednesday, August 22, 2007
Page 23 of 314
Survey:
Section: Demographics
Items Booklet
Mark One Only
You have reported both
[fill NAME(DADIX)]
and
[fill NAME(L_NO)]
are parents of
[fill NAME(REFPER)]
DAD1
Is that correct?
(1)
(2)
(3)
H
No, change relationship to reference person code for
[fill NAME(L_NO)]
No, change relationship to reference person code for
[fill NAME(DADIX)]
Yes, this is correct.
(One is natural father, one is step-father, for example)
@
Mark One Only
DAD2
SHOW FLASHCARD A
What is [fill PNAME(INDEX2)]
relationship to [fill NAME(REFPER)]?
H
Unmarried partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person (Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
(2)
(3)
(4)
(5)
(6)
(7)
@
Mark One Only
You have reported both
[fill NAME(MOMIX)]
and
[fill NAME(L_NO)]
are parents of
[fill NAME(REFPER)]
MOM1
Is that correct?
(1)
(2)
(3)
H
No, change relationship to reference person code for
[fill NAME(L_NO)]
No, change relationship to reference person code for
[fill NAME(MOMIX)]
Yes, this is correct.
(One is natural mother, one is step-mother, for example)
@
Page 24 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Mark One Only
MOM2
SHOW FLASHCARD A
What is [fill PNAME(INDEX2)]
relationship to [fill NAME(REFPER)]?
H
Unmarried partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person (Uncle, cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
(2)
(3)
(4)
(5)
(6)
(7)
@
Mark One Only
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1)
(2)
(3)
RPDAD
Biological or natural child
Stepchild
Adopted child
@
Mark One Only
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1)
(2)
(3)
RPDAD2
Biological or natural child
Stepchild
Adopted child
2
[if RPDAD@1 eq <2>]
[fill ISREFPERFIL] also [if L_NO eq <1>]your[else]his[endif] adopted child?
(1)
(2)
Yes
No
@
Mark One Only
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1)
(2)
(3)
RPMOM
Biological or natural child
Stepchild
Adopted child
@
Wednesday, August 22, 2007
Page 25 of 314
Survey:
Section: Demographics
Items Booklet
RPMOM2
Mark One Only
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1)
(2)
(3)
Biological or natural child
Stepchild
Adopted child
2
[fill ISREFPERFIL] also <1>]your[else]her[endif] adopted child?
(1)
(2)
Yes
No
@
DOB
Multiple Entry
What is [fill PTEMPNAME] date of birth?
(1)
(2)
(3)
(4)
January
February
March
April
(5)
(6)
(7)
(8)
ENTER MONTH:
@BMONTH
ENTER DAY:
@BDAY
ENTER 4 DIGIT YEAR:
@BYEAR
May
June
July
August
(9)
(10)
(11)
(12)
September
October
November
December
VERAGE
Mark One Only
That would make [fill TEMPNAME] [fill TEMP_P].
Is that correct?
H
(1)
(2)
Yes
No
@
FIXDOB
Multiple Entry
What is [fill PTEMPNAME] date of birth?
(1)
(2)
(3)
(4)
January
February
March
April
(5)
(6)
(7)
(8)
ENTER MONTH:
@MO
ENTER DAY:
@DAY
ENTER 4 DIGIT YEAR:
@YR
May
June
July
August
Mark One Only
[fill C_AREIS] [fill TEMPNAME] now:
(1)
(2)
(N)
(9)
(10)
(11)
(12)
September
October
November
December
DOBA
[fill AGE1] or
[fill AGE2] years old?
Neither is correct
@
Page 26 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
AGEGES
Mark One Only
About how old would you say [fill TEMPNAME] [fill AREIS]?
H
ENTER BEST ESTIMATE OF AGE:
@
FRGES
Mark One Only
ENTER YOUR BEST ESTIMATE OF
[fill F_NAME] [fill L_NAME]'s AGE:
H
@
UNDERAGE
Mark One Only
YOU MUST RESTART THIS INTERVIEW
BOTH THE HOUSEHOLD REFERENCE PERSON AND
THE HOUSEHOLD RESPONDENT MUST BE 15 YEARS OF
AGE OR OLDER.
YOU REPORTED THAT THE [fill TEMP2] IS UNDER 15.
IF NO ONE IN THE HOUSEHOLD IS 15 YEARS OF AGE OR
OLDER, THE HOUSEHOLD IS A TYPE B (CODE 18)
NONINTERVIEW.
PRESS ENTER TO TERMINATE THIS INTERVIEW AND RESTART.
@
ZEROCHK
Mark One Only
[fill READFIL]
YOUR ENTRY OF 0 ON THE [fill AGEFRGES] SCREEN INDICATES THAT
YOUR BEST ESTIMATE OF THIS PERSON'S AGE IS -UNDER THE AGE OF 1 YEAR.
IF THIS IS NOT CORRECT, PRESS F1 TO BACK UP AND
ENTER A NEW ESTIMATE.
IF THIS IS CORRECT, PRESS ENTER TO PROCEED.
@
MARRIED
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME] currently married, widowed,
divorced, separated or [fill HAVHAS] [fill HESHE] never married?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_AREIS] [fill TEMPNAME] currently married, widowed,
divorced, separated or [fill HAVHAS] [fill HESHE] never married?)
H
(1)
(2)
(3)
(4)
(5)
Married
Widowed
Divorced
Separated
Never Married
@
Wednesday, August 22, 2007
Page 27 of 314
Survey:
Section: Demographics
Items Booklet
LNSP
Mark One Only
ASK IF NECESSARY:
Is [fill PTEMPNAME] spouse a
member of this household?
IF NO, ENTER (N)
IF YES, ENTER THE SPOUSE'S LINE NUMBER
ENTER (M) FOR MORE
@
|LIST OF OTHER ADULTS
|LINE NAME
|Display >SPLN< template
|
|
|
|
|
|
|
|
MSCHECK
Mark One Only
ASK IF NECESSARY
We have recorded that [fill TEMPNAME] is married but [fill HISHER]
spouse does not live here (four or more nights per week).
Is that correct?
(1)
(2)
Correct, married spouse absent
Incorrect marital status entered
MARRIED2
Mark One Only
[fill C_AREIS] [fill TEMPNAME] currently married, widowed,
divorced, separated or [fill HAVHAS] [fill HESHE] never married?
H
(2)
(3)
(4)
(5)
Widowed
Divorced
Separated
Never Married
@
SPSSX1
Mark One Only
DO NOT READ TO RESPONDENT UNLESS NECESSARY
Is one of the following SEX entries incorrect?
LN
NAME
SEX
[fill <[L_NO] [F_NAME]
[LNSP] [NAME(LNSP)]
(1)
(2)
(3)
H
[SX]
[SEXFIL]>
To correct Line [fill L_NO]'s SEX entry
To correct Line [fill LNSP]'s SEX entry
Neither SEX entry is incorrect
@
Mark One Only
ASK IF NECESSARY:
SPSSX2
You said [fill NAME(LNSP)]
is [fill PTEMPNAME] spouse.
Is that correct?
(1)
(2)
Yes
No
@
Page 28 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
EVRDIV
Mark One Only
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] ever been divorced?
H
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_HAVHAS] [fill TEMPNAME] ever been divorced?)
(1)
(2)
Yes
No
@
Mark One Only
ASK IF NECESSARY:
Is [fill PTEMPNAME] mother
a member of this household?
H
IF NO, ENTER (N)
IF YES, ENTER THE MOTHER'S LINE NUMBER
ENTER (M) FOR MORE
@
LNMOM
|LISTING OF ELIGIBLE FEMALES
|LINE NAME
|Display >MOMS< template
|
|
|
|
|
|
|
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME]
[fill MOMSFIL] biological, step, adopted or foster child?
TYPMOM
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME]
[fill MOMSFIL] biological, step, adopted or foster child?)
(1)
(2)
(3)
(4)
Biological or natural child
Stepchild
Adopted child
Foster child
@
Wednesday, August 22, 2007
Page 29 of 314
Survey:
Section: Demographics
Items Booklet
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME]
[fill MOMSFIL] biological, step, adopted or foster child?
TYPMOM2
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME]
[fill MOMSFIL] biological, step, adopted or foster child?)
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
(4) Foster child
2
[fill C_AREIS] [fill TEMPNAME] also
[fill MOMSFIL] adopted child?
(1)
(2)
Yes
No
@
Multiple Entry
What month and year did [fill MOMFIL] adopt
[fill TEMPNAME]?
MONTH:
YEAR:
ADDMMYYM
@MO
@YR
LNDAD
Mark One Only
ASK IF NECESSARY:
Is [fill PTEMPNAME] father
a member of this household?
H
IF NO, ENTER (N)
IF YES, ENTER THE FATHER'S LINE NUMBER
ENTER (M) FOR MORE
@
|LISTING OF ELIGIBLE MALES
|LINE NAME
|Display >DADS< template
|
|
|
|
|
|
|
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME]
[fill DADSFIL] biological, step, adopted or foster child?
TYPDAD
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME]
[fill DADSFIL] biological, step, adopted or foster child?)
(1)
(2)
(3)
(4)
Biological or natural child
Stepchild
Adopted child
Foster child
@
Page 30 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME]
[fill DADSFIL] biological, step, adopted or foster child?
TYPDAD2
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME]
[fill DADSFIL] biological, step, adopted or foster child?)
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
(4) Foster child
2
[fill C_AREIS] [fill TEMPNAME] also
[fill DADSFIL] adopted child?
(1)
(2)
Yes
No
@
ADDMMYYD
Multiple Entry
What month and year did [fill DADFIL] adopt
[fill TEMPNAME]?
MONTH:
YEAR:
@MO
@YR
LNGD
Mark One Only
[fill OTHERTHANFIL]
Who in this household is responsible for
[fill TEMPNAME]?
H
ENTER (N) IF NOT LISTED
@
Mark One Only
Did [fill / ever serve on active duty
in the U.S. Armed Forces?
(1)
(2)
AF_HH
Yes
No
@
AF_WHO1
Mark All That Apply
Who?
ENTER ALL THAT APPLY
ENTER (N)FOR NONE OR NO MORE
RE-ENTER PRECODE TO DELETE
@PER
[fill TEMPNAME]
Wednesday, August 22, 2007
| LINE
|
|
|
|
|
|
|
NAME
Page 31 of 314
Survey:
Section: Demographics
Items Booklet
Mark One Only
First time asked:
Did [fill TEMPNAME]] ever serve on active duty in the U.S. Armed Forces?
AFEVER
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
(Did [fill TEMPNAME]] ever serve on active duty in the U.S. Armed Forces?)
(1)
(2)
Yes
No
@
Mark All That Apply
If if FIRST_TIME eq <1> and AFEVER offpath display:
[Earlier I recorded that [fill TEMPNAME] [fill WASWERE] in the military.]
AFWHEN
First time asked:
When did [fill TEMPNAME] serve on active duty?
AFTER EACH RESPONSE ASK:
Any other times?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
(When did [fill TEMPNAME] serve on active duty?
AFTER EACH RESPONSE ASK:
Any other times?)
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
[fill
[fill
[fill
[fill
[fill
<@AFSRV1
<@AFSRV2
<@AFSRV3
<@AFSRV4
<@AFSRV5
[fill
[fill
[fill
[fill
[fill
TEMP2]>]
TEMP3]>]
TEMP4]>]
TEMP5]>]
TEMP6]>]
@KEY
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME] now on active duty?
AFNOW
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME] now on active duty?)
(1)
(2)
Yes
No
@
Page 32 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Mark One Only
First time asked:
SHOW FLASHCARD B
What is the highest level of school
[fill TEMPNAME] [fill HAVHAS] completed or the highest degree
[fill HESHE] [fill HAVHAS] received?
Subsequent times asked:
SHOW FLASHCARD B (How about/And) [fill TEMPNAME]...?
([fill OTHTHANVOCFIL] is the highest level of school
[fill TEMPNAME] [fill HAVEHAS] completed or the highest degree
[fill HESHE] [fill HAVHAS] received?)
(31)
(32)
(33)
(34)
(39)
(40)
(41)
(43)
(44)
(45)
(46)
(47)
EDUC
H
Less than 1st grade
(35) 9th grade
1st, 2nd, 3rd or 4th grade
(36) 10th grade
5th or 6th grade
(37) 11th grade
7th or 8th grade
(38) 12th grade, no diploma
HIGH SCHOOL GRADUATE (diploma or GED or equivalent)
Some college credit, but less than 1 year
1 or more years of college, no degree (regular Jr.coll./coll./univ.)
Associate (2-yr) college degree (include academic/occupational degree)
Bachelor's degree (for example: BA, AB, BS)
Master's degree (for example: MA, MS, MENG, Med, MSW, MBA)
Professional School degree (for example: MD(doctor),DDS(dentist),JD(lawyer))
Doctorate degree (for example: Ph.D., Ed.D.)
@1
Mark One Only
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] completed high school by means of
a GED or other equivalency test or program?
EDUCB
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
[fill C_HAVHAS] [fill TEMPNAME] completed high school by means of a GED
or other equivalency test or program?
(1)
(2)
Yes
No
@
Mark One Only
ASK OR VERIFY:
Did [you/NAME] get [YOUR/HISHER] high school diploma by graduating
from high school, or by passing a GED exam (or other equivalent)?
EDUCB2
Subsequent times asked:
How about [YOU/NAME]?
(Did [you/NAME] get [YOUR/HISHER] high school diploma by graduating
from high school, or by passing a GED exam (or other equivalent)?)
(1) Graduated from high school
(2) GED or other test
@
Wednesday, August 22, 2007
Page 33 of 314
Survey:
Section: Demographics
Mark One Only
First time asked:
[fill HAVHAS] [fill TEMPNAME] ever attended a
vocational, technical, trade, or business school
beyond high school?
Items Booklet
VOCAT
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill HAVHAS] [fill TEMPNAME] ever attended a
vocational, technical, trade, or business school
beyond high school?)
"BUSINESS SCHOOLS" TEACH SKILLS OR TRADES SUCH AS SECRETARIAL TRAINING,
BOOKKEEPING, COMPUTER PROGRAMMING, ETC. DO *NOT* INCLUDE BUSINESS PROGRAMS
IN COLLEGES AND UNIVERSITIES LEADING TO ACADEMIC DEGREES.
(1)
(2)
Yes
No
@
Mark One Only
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] received a diploma or
certificate from a vocational, technical, trade, or business
school?
YESVOC
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_HAVHAS] [fill TEMPNAME] received a diploma or
certificate from a vocational, technical, trade, or business
school?)
(1)
(2)
Yes
No
@
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME] Spanish, Hispanic or Latino?
ORIGIN
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_AREIS] [fill TEMPNAME] Spanish, Hispanic or Latino?)
READ IF NECESSARY: such as Mexican, Mexican-American, Chicano, Puerto Rican,
Cuban, or some other Spanish, Hispanic, or Latino group.
(1)
(2)
Yes
No
@
Page 34 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Mark One Only
First time asked:
[fill C_AREIS] [fill TEMPNAME] Mexican, Mexican American, Chicano,
Puerto Rican, Cuban, Cuban American, or some other Spanish, Hispanic,
or Latino group?
HISPAN
Subsequent times asked:
(How about/And) [fill TEMPNAME]...
([fill C_AREIS] [fill TEMPNAME] Mexican, Mexican American, Chicano,
Puerto Rican, Cuban, Cuban American, or some other Spanish, Hispanic,
or Latino group?)
IF MULTIPLE ANSWER, PROBE: Which group [fill DODOES] [fill HESHE]
most closely identify with?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Mexican
Mexican American
Chicano
Puerto Rican
Cuban
Cuban American
Other Spanish, Hispanic, or Latino group
@
Mark One Only
What is the name of [fill PTEMPNAME] other Spanish, Hispanic, or Latino group?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
@
Argentinean
Baleric Islander
Basque
Belize, British,
Honduran or Belice
Bolivian
Brazilian
Canary Islander
Castilian
Catalan
Central American
Central American
Indian
Chilean
Colombian
Costa Rican
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
(28)
Dominican
Ecuadorian
Filipino
Guatemalan
Guamanian or
Chamorro
Haitian
Hispanic
Honduran
Latin American
Latino
Nicaraguan
Panamanian
Paraguayan
Peruvian
(29) Portuguese
(30) Salvadoran
(31) Sephardic
(32) South American
(33)South American Indian
(34) Spanish
(36) Spanish American
Indian
(37) Spanish Basque
(38) Spaniard
(39) Uruguayan
(40) Venezuelan
(41) Both Spanish,
Hispanic, or Latino
(42) Other
Mark One Only
What is the name of [fill PTEMPNAME] other Spanish, Hispanic, or Latino group?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
42
Argentinean
Baleric Islands
Basque
Belize, British,
Honduras or Belice
Bolivian
Brazilian
Canary Islands
Castilian
Catalan
Central American
Central American
Indian
Chilean
Colombian
Costa Rican
SPECIFY: @SP
Wednesday, August 22, 2007
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
(26)
(27)
(28)
Dominican
Ecuadorian
Filipino
Guatemalan
Guamanian or
Chamorro
Haitian
Hispanic
Honduran
Latin American
Latino
Nicaraguan
Panamanian
Paraguayan
Peruvian
OROTSP
(29)
(30)
(31)
(32)
(33)
(34)
(36)
(37)
(38)
(39)
(40)
(41)
(42)
OROTSS
Portuguese
Salvadoran
Sephardic
South American
South American Indian
Spanish
Spanish American
Indian
Spanish Basque
Spaniard
Uruguayan
Venezuelan
Both Spanish,
Hispanic, or Latino
Other
Page 35 of 314
Survey:
Section: Demographics
Items Booklet
Mark All That Apply
RACE
SHOW FLASHCARD C
First time asked:
Please choose one or more races (from this card) that [fill NAME1FIL]
[fill NAME2FIL] to be.
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(What race(s) [fill DODOES] [fill NAME3FIL] [fill NAME2FIL]
to be?)
PROBE IF RESPONSE IS "HISPANIC" OR "LATINO", OR A SPECIFIC HISPANIC ORIGIN
(E.G. "MEXICAN", "CUBAN")
ENTER ALL THAT APPLY/ENTER (N) FOR NO MORE/RE-ENTER PRECODE TO DELETE
H
(1) White
(2) Black or African American
(3) American Indian or Alaska Native
(4) Asian
(5) Native Hawaiian or Other Pacific Islander
(6) Other - DO NOT READ
@KEY
[fill ERRORFIL]
Mark All That Apply
Which of the following Asian groups [fill CONSIDERFIL]?
RACEAS
READ EACH ITEM
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian - DO NOT READ
@
Mark All That Apply
Which of the following Native Hawaiian or Other Pacific Islander
groups [fill CONSIDERFIL]?
RACEPI
READ EACH ITEM
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
(1)
(2)
(3)
(4)
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander - DO NOT READ
@
Page 36 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
RACEOT
Mark One Only
READ ONLY IF NECESSARY:
What is [fill PTEMPNAME] other race?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
Aleut
African American
American Nation,
Ethnic Group or Tribe
American
American Indian
or Alaska Native
Anglo-Saxon
Arab
Asian
Asian Indian
Black
Brazilian
Caucasian
Chicano
Chinese
Creole
(16) Cuban or Cuban
American
(17) Eskimo
(18) European
(19) Filipino
(20) German
(21) Guamanian or
Chamorro
(22) Hispanic
(23) Jamaican
(24) Japanese
(25) Korean
(26) Latin American
(27) Latino
(28) Mexican or
Mexican American
(29) Native American
(30) Native Hawaiian
or Other Pacific
Islander
(31) Negro
(32) Puerto Rican
(33) Samoan
(34) Scotch-Irish
(35) Spanish
(36) Vietnamese
(37) West Indian
(38) White
(39) No race given
(40) Other - DO NOT READ
@
RACEOS
Mark One Only
READ ONLY IF NECESSARY:
What is [fill PTEMPNAME] race?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
Aleut
African American
American Nation,
Ethnic Group or Tribe
American
American Indian
or Alaska Native
Anglo-Saxon
Arab
Asian
Asian Indian
Black
Brazilian
Caucasian
Chicano
Chinese
Creole
(16) Cuban or Cuban
American
(17) Eskimo
(18) European
(19) Filipino
(20) German
(21) Guamanian or
Chamorro
(22) Hispanic
(23) Jamaican
(24) Japanese
(25) Korean
(26) Latin American
(27) Latino
(28) Mexican or
Mexican American
SPECIFY: @SP
(29) Native American
(30) Native Hawaiian
or Other Pacific
Islander
(31) Negro
(32) Puerto Rican
(33) Samoan
(34) Scotch-Irish
(35) Spanish
(36) Vietnamese
(37) West Indian
(38) White
(39) No race given
(40) Other - DO NOT READ
[40]
BORNUS
Mark One Only
[fill WASEVERYONEFIL] born in the United States?
H
READ IF NECESSARY: Consider persons born in a U.S. Island
area -- such as Puerto Rico, Guam, the U.S. Virgin Islands, or
Northern Marianas -- to have been born in the United States.
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 37 of 314
Survey:
Section: Demographics
Items Booklet
BORNOUT
Mark All That Apply
|LN NAME
Who was born outside the United States?
|Display HH Roster
Anyone else?
|
H |
READ IF NECESSARY: Consider persons
|
born in a U.S. Island area, such as
|
Puerto Rico, Guam, the U.S. Virgin
|
Islands, or Northern Marianas to have
|
been born in the United States.
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
CITIZEN
Mark One Only
First time asked:
[fill AREIS] [fill TEMPNAME] a citizen of the United States?
(1)
(2)
Yes
No
@
Subsequent times asked:
(How about/And) [fill TEMPNAME]. . . ?
([fill AREIS] [fill TEMPNAME] a citizen of the United States?)
(1)
(2)
Yes
No
@
NATCIT
Multiple Entry
First time asked:
How did [fill TEMPNAME] become a U.S. citizen?
H
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(How did [fill TEMPNAME] become a U.S. citizen?)
(1)
(2)
Naturalized
Through [fill HISHER] (or spouse's) military service
in U.S. Armed Forces
(3) Adopted by U.S. citizen parent or parents
(4) Born in a U.S. Island Area or born in the United States
(5) Born abroad of U.S. citizen parent or parents
(6) Other
{pop-up} SPECIFY @SP
@1
Page 38 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
CITPAR
Mark One Only
First time asked:
At the time of [fill PTEMPNAME] birth, was either of
[fill HISHER] parents a U.S. citizen?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(At the time of [fill PTEMPNAME] birth, was either of
[fill HISHER] parents a U.S. citizen?)
(1)
(2)
Yes
No
@
HHSPEAK1
Mark One Only
DO NOT READ TO RESPONDENT: SO FAR, HAS ANY PART OF THIS INTERVIEW
BEEN CONDUCTED IN A LANGUAGE OTHER THAN ENGLISH?
(DO NOT COUNT AMERICAN SIGN LANGUAGE AS NON-ENGLISH LANGUAGE)
(1) Yes
(2) No, all in English
@
HHSPEAK2
Mark One Only
[fill INTROFIL]
speak a language other than English at home?
DO NOT COUNT AMERICAN SIGN LANGUAGE AS NON-ENGLISH LANGUAGE
H
[fill UNDER5FIL]
(1) Yes
(2) No, only English
@
HHSPEAK3
Mark One Only
[fill C_DODOES] [fill TEMPNAME] speak a language other than
English at home?
DO NOT COUNT AMERICAN SIGN LANGUAGE AS NON-ENGLISH LANGUAGE
H
(1)
(2)
Yes
No
@
Mark All That Apply
WHOSPEAK
Who is that?
|LNO
NAME
|{list all hh members age 5+}
(Who[fill OTHERTHANFIL] speaks a language |{if HHSPEAK1 eq <1>, do not display
other than English at home?)
|the respondent, and do not allow
Anyone else?
|respondent's line # to be entered.}
H |
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL PEOPLE LISTED
|
ENTER (N) AFTER LAST ENTRY
|
RE-ENTER PRECODE TO DELETE
|
|
@
Wednesday, August 22, 2007
Page 39 of 314
Survey:
Section: Demographics
Multiple Entry
{first time asked:}
[fill ASKFIL]
What language [fill DODOES] [TEMPNAME] speak at home?
{subsequent times asked}
[fill ASKFIL]
How about/And [TEMPNAME]...? (What language does [TEMPNAME] speak at home?)
IF MORE THAN ONE, MARK THE "MAIN" OTHER LANGUAGE
H
ASIAN AND PACIFIC ISLAND LANGUAGES:
(1) Spanish
(10) Chinese (e.g. Cantonese, Mandarin)
OTHER EUROPEAN LANAGUAGES:
(11) Japanese
(2) French (include Creole)
(12) Korean
(3) German
(13) Tagalog, Pilippino
(4) Greek
(14) Vietnamese
(5) Italian
OTHER LANGUAGES:
(6) Polish
(15) Arabic
(7) Portuguese
(16) Hindi, Urdu
(8) Russian
(17) African lang.(e.g. Swahili, Yoruba)
(9) Serbo-Croatian (include
(18) American Indian, Alaska Native lang.
Bosnian, Yugoslavian)
(e.g. Cherokee, Navajo, Yupik)
(19) All other non-English languages (specify)
@
@SP
Mark One Only
First time asked:
[fill INTROFIL]
Items Booklet
LANG1
HOWWELL
How well [fill DODOES] [TEMPNAME] speak English –
would you say very well, well, not well, or not at all?
Subsequent times asked:
How about/And [TEMPNAME]...?
(How well [fill DODOES] [TEMPNAME] speak English –
would you say very well, well, not well, or not at all?)
(1)
(2)
(3)
(4)
Very well
Well
Not well
Not at all
@
Mark One Only
DO NOT READ TO RESPONDENT
AFHHLD
ALL OF THE ADULTS IN THIS HOUSEHOLD ARE MEMBERS OF THE
ARMED FORCES.
THE HOUSEHOLD IS CLASSIFIED AS A TYPE B NONINTERVIEW.
PRESS "ENTER" TO FINISH THE CASE.
@
Mark One Only
In order to make the interview as efficient as possible,
I am going to ask a question about household income. Is
[fill YOURCOMBINEFIL] total annual income
[fill [<>/] below
$[fill INCFILL] or above $[fill INCFILL]?
(1)
(2)
INCSCRN1A
Below ($0 - $[fill INCFILL])
Above ($[fill INCFILL2] or more)
@
Page 40 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Demographics
Mark One Only
Even though your income was above that amount, at any time
since [fill MONTH1] 1st, did [fill YOUANYONEFIL] receive
any kind of welfare or public assistance benefits from a
federal, state, or county program?
H
(1) Yes
(2) No
INCSCRN2
@
Wednesday, August 22, 2007
Page 41 of 314
Survey:
Section: Labor Force 1
Items Booklet
LFINTRO
Mark One Only
BEGINNING INTERVIEW FOR: [fill NAME]
if PELIG(L_NO) eq <5> or PELIG(L_NO) eq <9>
SOME OF THESE QUESTIONS HAVE BEEN ANSWERED. PRESS F3
TO RESUME INTERVIEW AT THE NEXT UNANSWERED QUESTION.
else if LNORESP ne <1>
IF NEW RESPONDENT, BRIEFLY EXPLAIN INTERVIEW TO THE NEW
RESPONDENT.
If HHSTAT eq <3> (new person)
I'm going to ask you about [fill TEMP] work
situation between [fill MONTH1] 1st and today, but
first. . .
else
[fill FIRSTFIL] I'd like to ask you about [fill TEMP] work
situation between [fill MONTH1] 1st and today.
PRESS "ENTER" TO CONTINUE
@
PDJBTHN
Mark One Only
[fill
[fill
[fill
[fill
[fill
TEMP]
TEMP2]
TEMP3]
TEMP4]
TEMP5]
Did [fill TEMPNAME] have at least one paid job, either full or
part time, at any time between [fill MONTH1] 1st and today?
H
[fill BIGTEMP]
(1)
(2)
Yes
No
@
NOPDJB
Mark One Only
Did [fill TEMPNAME] do any work at all that
earned some money?
(1)
(2)
Yes
No
@
JBORSE
Mark One Only
Was that for an employer or [fill WASWERE] [fill TEMPNAME]
self-employed or did [fill HESHE] have some other arrangement?
OTHER ARRANGEMENTS INCLUDE ODD JOBS, ON-CALL WORK, DAY LABOR,
ONE-TIME JOBS, AND INFORMAL ARRANGEMENTS LIKE BABYSITTING,
LAWN MOWING, OR LEAF RAKING FOR NEIGHBORS.
H
(1)
(2)
(3)
(4)
Employer
Self-Employed
Both employer and self-employed
Some other arrangement
@
Page 42 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
UNPAID
Mark One Only
Did [fill TEMPNAME] do any unpaid work
in a family business or farm?
(1)
(2)
Yes
No
@
NOWRK
Mark One Only
What is the main reason [fill TEMPNAME] did not work
at a job or business between [fill MONTH1] 1st
and today?
(1)
(2)
(3)
Temporarily unable to work because of an injury
Temporarily unable to work because of an illness
Unable to work because of chronic health condition
or disability
(4) Retired
(5) Pregnancy/childbirth
(6) Taking care of children/other persons
(7) Going to school
(8) Unable to find work
(9) On layoff (temporary or indefinite)
(10) Not interested in working at a job
(11) Other
@
ONOWRK
Mark One Only
ENTER THE SPECIFIC "OTHER" REASON DID NOT WORK
@
UECYN3
Mark One Only
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money
from unemployment compensation?
(1)
(2)
Yes
No
@
UECYNTP3
Multiple Entry
What type was it?
ENTER (N) FOR NO MORE
(1)
(2)
(3)
Regular
Supplemental
Other, including union benefits
@1
@2
@3
LAYOFF
Mark One Only
Did [fill TEMPNAME] spend any time on layoff from a
job since [fill MONTH1] 1st?
H
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 43 of 314
Survey:
Section: Labor Force 1
Items Booklet
LAYDT
Mark One Only
When [fill TEMPNAME] [fill WASWERE] laid off,
did [fill HISHER] employer give [fill HIMHER] a date
to return to work?
(1)
(2)
Yes
No
@
LAY6M
Mark One Only
[fill C_WASWERE] [fill HESHE] given any indication
that [fill HESHE] would be recalled to work within
6 months of being laid off?
(1) Yes
(2) No
@
LKWRK
Mark One Only
Did [fill TEMPNAME] spend any time looking for work
since [fill MONTH1] 1st?
H
(1)
(2)
Yes
No
@
Mark All That Apply
SHOW CALENDAR ON FLASHCARD E
Please look at the calendar. In which weeks [fill WASWERE]
[fill TEMPNAME] [fill LAYOFFFIL]?
WKSLKG
ENTER THE NUMBERS BESIDE THE WEEKS, EVEN IF ONLY ONE DAY
OF THAT WEEK WAS SPENT LOOKING OR ON LAYOFF.
ENTER (A) IF ALL WEEKS / ENTER (N) AFTER LAST REPORTED WEEK
[fill
[fill
[fill
[fill
[fill
[fill
WK(<1>)]
WK(<2>)]
WK(<3>)]
WK(<4>)]
WK(<5>)]
WK(<6>)]
[fill WK(<7>)]
[fill
[fill WK(<8>)]
[fill
[fill WK(<9>)]
[fill
[fill WK(<10>)] [fill
[fill WK(<11>)] [fill
[fill WK(<12>)] [fill
[if M5WRK eq <1>](19)
WK(<13>)]
WK(<14>)]
WK(<15>)]
WK(<16>)]
WK(<17>)]
WK(<18>)]
After [fill MONTH5] 1st
@KEY
Mark One Only
if LAYOFFLG eq <1> and (LAYDT eq <1> or LAY6M eq <1>) and LKWRK eq <1>
Could [fill TEMPNAME] have started a job during any
of those weeks if one had been offered or could
[fill HESHE] have returned to work if [fill HESHE]
had been recalled?
[else]
[if LKWRK eq <1>]
Could [fill TEMPNAME] have started a job during any of
those weeks if one had been offered?
[else]
Could [fill TEMPNAME] have returned to work during
any of those weeks if [fill HESHE] had been recalled?
(1)
(2)
TAKJOB
Yes
No
@
Page 44 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
NOTAKE
Mark One Only
Why was that?
H
(1)
(2)
(3)
(4)
Waiting for a new job to begin
Own temporary illness
School
Other
@
Mark One Only
[fill TEMP2]
[fill TEMP3]
How many employers [fill HAVHAS] [fill TEMPNAME] had
between [fill MONTH1] 1st and today?
EMPNUM
@
Mark One Only
Did [fill TEMPNAME] have a definite arrangement with
one or more employers to work on an ongoing basis?
(1)
(2)
(3)
CONCHK1
Yes
No
Not Sure or Don't Know
@
Mark One Only
How many employers did [fill TEMPNAME] have
between [fill MONTH1] 1st and today?
EMPNUM2
@
Mark One Only
How many employers did [fill TEMPNAME] have
between [fill MONTH1] 1st and today?
EMPNUM2A
ENTER (N) FOR NONE
@
Mark One Only
Did [fill TEMPNAME] have a definite arrangement with
any of [fill HISHER] [fill EMPNUM] employers
to work on an ongoing basis?
(1)
(2)
(3)
CONCHK2
Yes
No
Not Sure or Don't Know
@
Mark One Only
Did [fill TEMPNAME] generally do the same type of work for
[fill HISHER] [fill TEMP2] employers?
(READ IF NECESSARY: For example: construction work, private
household work, sales, consulting.)
(1)
(2)
WRKTYPE
Yes
No
@
Wednesday, August 22, 2007
Page 45 of 314
Survey:
Section: Labor Force 1
Items Booklet
EMPNAM
Enter Text
[fill TEMP]
What is the name of [fill TEMP2]
[fill TEMP3] [fill TEMP4]
H
@
Mark One Only
[if I_WAVE ge <2>]ASK OR VERIFY:[endif]
STRTJB
Did [fill TEMPNAME] start working for
[fill EMPNAM] at some time between [fill MONTH1] 1st and today?
(1)
(2)
Yes
No
@
Multiple Entry
Please look at the calendar and tell me the month and day
[fill TEMPNAME] began.
MONTH:
DAY:
@MON
@DAY
Mark One Only
Please tell me the year [fill TEMPNAME] began.
YEAR:
STRTREFP
STRTBEFR
@YR
Mark One Only
And in what month was that?
STRTMONJB
MONTH: @
Mark One Only
What is your BEST estimate of the year when
[fill TEMPNAME] began employment with
[fill EMPNAM]?
YEAR:
@
Mark One Only
What is your BEST estimate of the month
[fill TEMPNAME] began?
MONTH
STRTJDY
@
Mark One Only
Was it before [fill MONTH1] 1st?
(1)
(2)
STRTJMTH
@
Mark One Only
What is your BEST estimate of the day of the month
when [fill TEMPNAME] began?
DAY:
STRTJYR
BEFORE
Yes
No
@
Page 46 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
STLEMP
Mark One Only
[fill C_AREIS] [fill HESHE] employed by [fill EMPNAM] now?
H
(1)
(2)
Yes
No
@
ENDJB
Multiple Entry
When did [fill HISHER] employment with
[fill EMPNAM] end?
MONTH:
DAY:
@MON
@DAY
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT:
AL_ENDJB
Ending date of job is before beginning date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED
@
ENDJMTH
Mark One Only
What is your best estimate of the month
when [fill TEMPNAME] ended employment with
[fill EMPNAM]?
MONTH:
@
Mark One Only
What is your best estimate of the day of the month when
[fill TEMPNAME] ended employment with
[fill EMPNAM]?
DAY:
@
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT:
AL_ENDJDY
Ending date of job is before beginning date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED
@
Mark One Only
What is the main reason [fill HESHE] stopped working
for [fill EMPNAM]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
@
ENDJDY
RSEND
On Layoff
Retirement or old age
Childcare problems
Other family/personal obligations
Own Illness
Own Injury
School/Training
Discharged/Fired
Employer Bankrupt
Employer sold business
Job was temporary and ended
Quit to take another job
Slack work or business conditions
Unsatisfactory work arrangements (hours, pay, etc.)
Quit for some other reason
Wednesday, August 22, 2007
Page 47 of 314
Survey:
Section: Labor Force 1
Items Booklet
Mark One Only
Since [fill MONTH1] 1st, did [fill HESHE] receive any money from
workers' compensation as a result of any kind of job-related
injury or illness?
(1)
(2)
WCYN1
Yes
No
@
UECYN1
Mark One Only
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1)
(2)
Yes
No
@
UECYNTP1
Multiple Entry
What type was it?
ENTER (N) FOR NO MORE
(1)
(2)
(3)
Regular
Supplemental
Other, including union benefits
@1
@2
@3
ALLBUSNUM
Mark One Only
How many businesses did [fill TEMPNAME]
have, alone or jointly, between [fill MONTH1] 1st
and today?
CONSIDER A PROFESSIONAL PRACTICE OR A FARM TO BE A BUSINESS.
[fill TEMP]
H
@
Mark One Only
[TEMP]
What is the name of [fill TEMP2]
[fill TEMP3]
[fill TEMP4]
@
ALLBUS
|{display T_PREVBUS template}
|
|
|
|
|
REALBIZ
Mark One Only
Did [fill TEMPNAME] take an active part in
this business or did [fill HESHE] own it
as an investment only?
H
(1)
(2)
(3)
Active participant
Both participant and investment
Investment only
@
Page 48 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
Mark One Only
Did [fill TEMPNAME] start [fill ALLBUS]
at some time between [fill MONTH1] 1st
and today?
(1)
(2)
STRTBUS
Yes
No
@
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
STRTBSRP
Please look at the calendar and tell me the month and day
[fill TEMPNAME] started this business.
MONTH:
DAY:
@MON
@DAY
Mark One Only
Please tell me the year [fill TEMPNAME] started
working at this business.
YEAR:
STRTBSBF
@YR
Mark One Only
And in what month was that?
STRTMONBS
MONTH: @
Mark One Only
[fill ALLBUS]
Business:
STRTBYR
What is your BEST estimate of the year when
[fill TEMPNAME] started this business?
YEAR:
@
Mark One Only
[fill ALLBUS]
Business:
STRTBMTH
What is your BEST estimate of the month
when [fill TEMPNAME] started this business?
MONTH:
Business:
@
Mark One Only
[fill ALLBUS]
STRTBDY
What is your BEST estimate of the day of the month
when [fill TEMPNAME] started this business?
DAY:
@
Mark One Only
Was it before [fill MONTH1] 1st?
(1)
(2)
BEFORE2
Yes
No
@
Wednesday, August 22, 2007
Page 49 of 314
Survey:
Section: Labor Force 1
Items Booklet
Mark One Only
[fill C_DODOES] [fill TEMPNAME] still own this business?
(1)
(2)
BIZNOW
Yes
No
@
Multiple Entry
When was the last day that [fill TEMPNAME]
had this business?
MONTH:
DAY:
@MON
@DAY
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: Ending date of business is before beginning
date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @
Mark One Only
What is your best estimate of the last month
when [fill TEMPNAME] had this (business), [fill ALLBUS]?
MONTH:
ENDBMTH
ENDBDY
@
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: Ending date of business is before beginning
date.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @
Business:
AL_ENDBS
@
Mark One Only
What is your best estimate of the last day when
[fill TEMPNAME] had this (business), [fill ALLBUS]?
DAY:
ENDBS
Mark One Only
[fill ALLBUS]
AL_ENDBDY
RENDB
What is the main reason [fill HESHE] gave up or ended
the [fill ALLBUS]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Retirement or old age
Childcare Problems
Other Family/Personal Problems
Own Illness
Own Injury
School/Training
Went Bankrupt/Business Failed
Sold Business or Transferred Ownership
To start other business/take job
Season ended for a Seasonal Business
Quit for Some Other Reason
@
Mark One Only
ENTER THE SPECIFIC "OTHER" REASON ENDED BUSINESS
OENDB
@
Page 50 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
Mark One Only
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1)
(2)
WCYN2
Yes
No
@
Mark One Only
For which of these [fill JOBCNTR]
| Display ELST1 template
employers did [fill HESHE] work the most |
hours between [fill MONTH1] 1st and today?|
H|
@
|
LNGJOB
Mark One Only
For which of these [fill TEMP2] employers | Display ELST2 template
did [fill HESHE] work the next most hours |
between [fill MONTH1] 1st and today?
|
H|
@
|
LNGJOB2
INTRJ
Mark One Only
The next questions refer to [fill PTEMPNAME]
employment with [fill EMPNAM].
PRESS "ENTER" TO CONTINUE
@
CLWRK
Mark One Only
ASK OR VERIFY
[fill TEMP2] [fill EMPNAM]:
H
(1)
(2)
(3)
(4)
A Government organization (includes Armed Forces),
A Private, For Profit, Company,
A Non-Profit Organization, including tax exempt
and charitable organizations, OR
A family business or farm?
@
Mark One Only
[fill TEMP2] [fill TEMPNAME] paid for [fill HISHER]
work in the family business or farm?
(1)
(2)
FAMWRK
Yes
No
@
Wednesday, August 22, 2007
Page 51 of 314
Survey:
Section: Labor Force 1
EMPLOYER:
Items Booklet
KINDG
Mark One Only
[fill EMPNAM]
ASK OR VERIFY
[fill TEMP2] that Federal Government, State Government,
or Local Government or active-duty Armed Forces?
H
(1)
(2)
(3)
(4)
Federal (civilian only)
State
Local (County, City, Township)
Armed Forces (active duty only)
@
Employer:
FNCGV
Mark One Only
[fill EMPNAM]
What [fill TEMP2] the main function or activity of the
government organization that [fill TEMPNAME]
[fill TEMP3] for?
H
@
Employer:
KNDIN
Mark One Only
[fill EMPNAM]
What [fill TEMP3] [fill TEMP2]
[fill TEMP4] [fill TEMP7]
H
@
EMPLOYER:
TYPIN
Mark One Only
[fill EMPNAM]
ASK OR VERIFY
[fill TEMP2] it mainly -H
(1)
(2)
(3)
(4)
(5)
Manufacturing
Wholesale Trade
Retail Trade
Service
Or Something Else?
@
EMPLOYER:
KNDWK
Mark One Only
[fill EMPNAM]
What kind of work [fill TEMP2] [fill HESHE]
[fill TEMP4], that is, what [fill TEMP3] [fill HISHER] occupation?
READ IF NECESSARY:
For example: Bookkeeper, plumber, press operator
[r]H[n]
@
Page 52 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
Employer:
ACTVT
Mark One Only
[fill EMPNAM]
What [fill TEMP2] [fill HISHER] usual activities or
[fill TEMP4]
READ IF NECESSARY:
For example: Keeping account books,
repairing pipes, operating printing press
H
@
EMPLOYER:
YRSINOCC
Multiple Entry
[fill EMPNAM]
Considering [fill HISHER] entire working life, how many
years [fill TEMP2] [fill TEMPNAME] been in [fill TEMP3]
occupation or line of work?
H
@NMR
(1)
(2)
MONTHS
YEARS
@MY
AL_YRSINOCC
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: [fill TEMPNAME] began [fill HISHER]
occupation before the age of 15. (Person was 15 years old in
[fill INDEX].)
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @
EMPLOYER:
JOBHRS
Mark One Only
[fill EMPNAM]
[fill TEMP]
[fill TEMP2]
[fill TEMP3]
H
ENTER (V) IF HOURS VARY
@
Mark One Only
[fill DOESDIDFIL] [fill TEMPNAME] usually work 35 hours or more per
week for [fill EMPNAM]?
(1)
(2)
PTYN
Yes
No
@
EMPLOYER:
Mark One Only
[fill EMPNAM]
UNION
[if TEMP4 ne <>][fill TEMP4] [endif][fill TEMP2] [fill TEMPNAME]
a member of either a labor union or an employee
association like a union?
H
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 53 of 314
Survey:
Section: Labor Force 1
Items Booklet
CNTRC
Mark One Only
Employer: [fill EMPNAM]
[fill ISWASFIL] [fill HESHE] COVERED by either a union
contract or something like a union contract?
H
(1)
(2)
Yes
No
@
EMPLOC
Mark One Only
ASK OR VERIFY:
[fill TEMP2] [fill EMPNAM] operate in more than one location?
(1)
(2)
Yes
No
@
EMPSIZE
Mark One Only
About how many people [fill AREWEREFIL]
employed by [fill EMPNAM][if EMPLOC ne <2>] at the location where
[fill TEMPNAME] [fill WORKFIL][endif]?
H
...less than 10, 10 to 25, 25 to 100,
100 to 500, 500 to 1,000, or more than 1,000?
(1)
(2)
(3)
(4)
(5)
(6)
Under 10
10 to 24
25 to 99
100 to 499
500 to 999
1,000 or more
@
Mark One Only
ASK IF NECESSARY:
EMPALL
About how many people [fill AREWEREFIL] employed
by [fill EMPNAM] at ALL LOCATIONS together?
... less than 10, 10 to 25, 25 to 100,
100 to 500, 500 to 1,000, or more than 1,000?
(1)
(2)
(3)
(4)
(5)
(6)
Under 10
10 to 24
25 to 99
100 to 499
500 to 999
1,000 or more
@
Mark One Only
DO NOT READ TO RESPONDENT
ENTRY ILLOGICAL. MEANS THAT: More persons are employed at one location
than at all locations.
PRESS F1 TO BACKUP AND CORRECT/(P) TO PROCEED @
Page 54 of 314
AL_EMPALL
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
Mark One Only
Did a state or local welfare office help [TEMPNAME] in any way to
get this job?
(1)
(2)
EMPASSIST1
Yes
No
@
Mark One Only
Did [fill WELFAREPAYFIL]
money to cover all or part of [fill PTEMPNAME]
hiring, training, or wages?
(1)
(2)
(3)
EMPASSIST2
Yes
No
Don't know/not sure
@
Multiple Entry
I recorded that [fill TEMPNAME] had
**READ BUSINESS NAMES**
since [fill MONTH1] 1st. Which two of
these businesses produced the highest
earnings before expenses during this
time period?
@1
@2
BIGBUS
| Display BLST1 template
|
|
|
|
|
|
|
Mark One Only
The next questions refer to [fill PTEMPNAME] business
[fill ALLBUS].
INTRB
PRESS "ENTER" TO CONTINUE
@
Mark One Only
BUSINESSES OWNED BY OTHER HOUSEHOLD MEMBERS| Display BLST2 template
DO NOT READ TO RESPONDENT
|
|
Have questions about the kind
|
of business, type of business, and
|
number of employees, and whether or
|
not the business is incorporated
|
already been answered by somebody
|
for this business: [fill ALLBUS]?
|
|
(1) Yes
|
(2) No
|
|
@
|
Wednesday, August 22, 2007
LSTBS
Page 55 of 314
Survey:
Section: Labor Force 1
Items Booklet
KNDBS
Mark One Only
ASK OR VERIFY
Business:
[fill ALLBUS]
[if CNTNGTBS eq <1>]
You said that [fill TEMPNAME] had various businesses.
kind of businesses were these?
[else]
What kind of business [fill TEMP2] this?
[endif]
What
H
READ IF NECESSARY:
What [fill TEMP3] the business do or make?
@
TYPBS
Mark One Only
ASK OR VERIFY
Business:
[fill ALLBUS]
[fill TEMP2] [fill TEMP3] mainly -(1)
(2)
(3)
(4)
(5)
Manufacturing
Wholesale Trade
Retail Trade
Service
Or Something Else?
@
Business:
OCCBS
Mark One Only
[fill ALLBUS]
What kind of work [fill TEMP3] [fill TEMPNAME] do,
that is, what [fill TEMP2] [fill HISHER] occupation?
READ IF NECESSARY:
For example: sales manager, dentist, farmer
H
@
Business:
DUTYB
Mark One Only
[fill ALLBUS]
What [fill TEMP2] [fill HISHER] usual activities
or duties in [fill TEMP3]?
READ IF NECESSARY:
For example: managing sales staff,
repairing teeth, farming
H
@
HRSBS
Mark One Only
[fill DURINGWKSFIL]
how many hours per week did [fill HESHE]
usually work AT ALL ACTIVITIES for [fill ALLBUS]?
H
ENTER (V) IF HOURS VARY
@
Page 56 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
BPTYN
Mark One Only
[fill DIDFIL] [fill TEMPNAME] usually work 35
hours or more per week for [fill ALLBUS]?
(1)
(2)
Yes
No
@
Business:
GRSSB
Mark One Only
[fill ALLBUS]
Do you think the earnings before expenses from
[fill TEMP4] were $2500 or more over the [fill TEMP3]
that [fill HESHE] [fill TEMP2] [fill TEMP5]?
H
(1)
(2)
Yes
No
@
Business:
GROSB
Mark One Only
[fill ALLBUS]
Do you think that the earnings before expenses from
[fill TEMP4] will be $2500 or more during the next
12 months?
H
(1)
(2)
Yes
No
@
EMPB
Mark One Only
Between [fill MONTH1] 1st and today,
what was the maximum number of employees, including
[fill TEMPNAME], working for this business at any one time?
Was that less than 10, 10 to 25, 25 to 100, 100 to 500,
500 to 1,000, or more than 1,000?
(1)
(2)
(3)
(4)
(5)
(6)
Under 10
10 to 24
25 to 99
100 to 499
500 to 999
1,000 or more
@
Business:
INCPB
Mark One Only
[fill ALLBUS]
[fill TEMP2] this business incorporated?
H
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 57 of 314
Survey:
Section: Labor Force 1
Business:
Items Booklet
PROPB
Mark One Only
[fill ALLBUS]
[fill TEMP2] [fill TEMPNAME] own this business [fill SELF]
or [fill TEMP3] it a partnership?
H
(1)
(2)
Alone
Partnership
@
Business:
HPRTB
Mark One Only
[fill ALLBUS]
[fill TEMP2] any other member of this household
an owner or partner in this business?
(1)
(2)
Yes
No
@
Business:
Mark All That Apply
[fill ALLBUS]
Who [fill TEMP2] that?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
PARTB
|
|
|
|
|
|
|
|
|
Display T_HHROS template
Mark One Only
During the weeks that [fill TEMPNAME] worked between | Display T_HRSALL template
[fill MONTH1] 1st and today at
|
**READ LIST**, how many hours per week
|
did [fill TEMPNAME] usually work at all [fill JOBFIL]|
activities?
|
|
ENTER (V) IF HOURS VARY
|
|
@ hours
|
Mark One Only
Did [fill TEMPNAME] receive any
severance pay or lump sum payments from
a pension or retirement plan when
[fill HESHE][fill LEFTJOBFIL][fill ORFIL]
[fill LEFTBUSFIL][if LEFTBUSFIL ne <>]?
(1)
(2)
Yes
No
@
LMPNOW
| Display T_LMPNOW template
|
|
|
|
|
|
|
|
|
Mark One Only
[fill C_DODOES] [fill TEMPNAME] ever expect to receive
any such payments from [fill JOBFIL][fill ORFIL][fill BUSINESSFIL]?
(1)
(2)
HRSALL
LMPFUTR
Yes
No
@
Page 58 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
LUMPTYP
Multiple Entry
What type of payment?
ENTER ALL THAT APPLY
ENTER (N) NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Lump sum from pension/retirement plan
Severance pay
Deferred payment(s) payable at some later date
Something else [if @4 eq <4>]SPECIFY: @SP
@KEY
CONWKSWRK
Mark All That Apply
SHOW CALENDAR ON FLASHCARD E
FULL CALENDAR WEEK = SUNDAY THROUGH SATURDAY
Please look at the calendar. In which weeks did [fill TEMPNAME]
work at a job or business or do any work at all for pay or profit?
READ IF NECESSARY: Count PAID vacation and PAID sick time as weeks
worked
ENTER THE NUMBERS OF THE WEEKS
ENTER (A) IF ALL WEEKS
ENTER (N) FOR NONE OR NO MORE WEEKS
[fill
[fill
[fill
[fill
[fill
[fill
WK(<1>)]
WK(<2>)]
WK(<3>)]
WK(<4>)]
WK(<5>)]
WK(<6>)]
[fill
[fill
[fill
[fill
[fill
[fill
WK(<7>)]
WK(<8>)]
WK(<9>)]
WK(<10>)]
WK(<11>)]
WK(<12>)]
[fill
[fill
[fill
[fill
[fill
[fill
(19)
WK(<13>)]
WK(<14>)]
WK(<15>)]
WK(<16>)]
WK(<17>)]
WK(<18>)]
After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Mark One Only
HAND RESPONDENT CALENDAR/FULL CALENDAR WEEK = SUNDAY THROUGH SATURDAY
FPAWOP
Since [fill MONTH1] 1st,
were there any full calendar weeks
when [fill TEMPNAME] did not work at all?
H
(1)
(2)
Yes
No
@
FPAWAY
Mark One Only
Did [fill TEMPNAME] get paid for ALL those weeks [fill HESHE]
did not work?
H
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 59 of 314
Survey:
Section: Labor Force 1
Items Booklet
FPABWK
Mark All That Apply
SHOW CALENDAR ON FLASHCARD E
In which weeks [fill WASWERE]n't [fill TEMPNAME] paid?
ENTER THE NUMBERS OF THE WEEKS ABSENT WITHOUT PAY
ENTER (A) IF ALL WEEKS
ENTER (N) AFTER LAST WEEK IS ENTERED
[fill
[fill
[fill
[fill
[fill
[fill
WK(<1>)]
WK(<2>)]
WK(<3>)]
WK(<4>)]
WK(<5>)]
WK(<6>)]
[fill
[fill
[fill
[fill
[fill
[fill
WK(<7>)]
WK(<8>)]
WK(<9>)]
WK(<10>)]
WK(<11>)]
WK(<12>)]
[fill
[fill
[fill
[fill
[fill
[fill
(19)
WK(<13>)]
WK(<14>)]
WK(<15>)]
WK(<16>)]
WK(<17>)]
WK(<18>)]
After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
FPABRE
Mark One Only
What was the main reason [fill TEMPNAME] [fill WASWERE]n't
paid during [fill THATWKFIL]?
H
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
On layoff (temporary or indefinite)
Slack work or business conditions
Own injury
Own illness/medical problems
Pregnancy/childbirth
Taking care of children
On vacation/personal days
Bad weather
Labor dispute
New job to begin within 30 days
Participated in a job-sharing arrangement
Other
@
Mark One Only
ENTER THE SPECIFIC "OTHER" REASON ABSENT WITHOUT PAY
FPOTHR
@
Mark One Only
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1)
(2)
WCYN4
Yes
No
@
Mark One Only
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1)
(2)
UECYN4
Yes
No
@
Page 60 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
UECYNTP4
Multiple Entry
What type was it?
ENTER (N) FOR NO MORE
(1)
(2)
(3)
@1
Regular
Supplemental
Other, including union benefits
@2
@3
PPAWOP
Mark One Only
SHOW CALENDAR ON FLASHCARD E
FULL CALENDAR WEEK = SUNDAY THROUGH SATURDAY
During the weeks that [fill TEMPNAME] [fill WASWERE]
employed, were there any full calendar weeks when [fill HESHE]
did not work at all?
H
IF THE RESPONDENT NEEDS TO KNOW WHAT CALENDAR WEEKS TO CHOOSE
FROM, READ THE RESPONDENT THE FOLLOWING WEEKS:
[fill table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
[fill table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
[fill table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
[fill table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
[fill table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
[fill table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
(1) Yes
(2) No
@
[@] [equiv FPAWOP] <1> <2,D,R> [goto LF67] [etc ]
Mark One Only
Did [fill TEMPNAME] get paid for ALL those weeks
[fill HESHE] did not work?
(1)
(2)
PPAWAY
Yes
No
@
Mark All That Apply
Please look at the calendar. In which weeks [fill WASWERE]n't
[fill TEMPNAME] paid?
PPABWK
ENTER THE NUMBERS OF THE WEEKS ABSENT WITHOUT PAY
ENTER (A) IF ALL WEEKS
ENTER (N) AFTER LAST WEEK IS ENTERED
[fill
[fill
[fill
[fill
[fill
[fill
table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 61 of 314
Survey:
Section: Labor Force 1
Items Booklet
PPABRE
Mark One Only
What was the main reason [fill TEMPNAME] [fill WASWERE]n't
paid during [fill THATWKFIL]?
H
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
On layoff (temporary or indefinite)
Slack work or business conditions
Own injury
Own illness/medical problems
Pregnancy/childbirth
Taking care of children
On vacation/personal days
Bad weather
Labor dispute
New job to begin within 30 days
Participated in a job-sharing arrangement
Other
@
WCYN5
Mark One Only
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1)
(2)
Yes
No
@
UECYN5
Mark One Only
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1)
(2)
Yes
No
@
UECYNTP5
Multiple Entry
What type was it?
ENTER (N) FOR NO MORE
(1)
(2)
(3)
@1
Regular
Supplemental
Other, including union benefits
@2
@3
PPLOOK
Mark One Only
At any time since [fill MONTH1] 1st did [fill TEMPNAME]
spend any time on layoff from a job?
H
IF THE RESPONDENT NEEDS TO KNOW WHAT CALENDAR WEEKS TO CHOOSE
FROM, READ THE RESPONDENT THE FOLLOWING WEEKS:
[fill table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
[fill table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
[fill table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
[fill table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
[fill table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
[fill table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
(1) Yes
(2) No
@
Page 62 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
PPLAYDT
Mark One Only
When [fill TEMPNAME] [fill WASWERE] laid off, did
[fill HISHER] employer give [fill HIMHER] a date
to return to work?
(1)
(2)
Yes
No
@
PPLAY6M
Mark One Only
[fill C_WASWERE] [fill HESHE] given any indication
that [fill HESHE] would be recalled to work within 6
months of being laid off?
(1)
(2)
Yes
No
@
PPLKWRK
Mark One Only
[if PPLOOK ne <1>]
During the weeks when [fill HESHE] did not have a job
or business, did [fill TEMPNAME] spend any time looking
for work?
[else]
During those weeks did [fill TEMPNAME] spend any time
looking for work?
[endif]
H
(1)
(2)
Yes
No
@
PPLKWK
Mark All That Apply
In which of those weeks [fill WASWERE] [fill TEMPNAME]
[fill LOOKINGFIL]?
H
ENTER THE NUMBERS BESIDE THE WEEKS, EVEN IF ONLY
ONE DAY OF THAT WEEK WAS SPENT LOOKING OR ON LAYOFF.
ENTER (A) IF ALL WEEKS
ENTER (N) AFTER LAST REPORTED WEEK
[fill
[fill
[fill
[fill
[fill
[fill
table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 63 of 314
Survey:
Section: Labor Force 1
Items Booklet
PPTAKJOB
Mark One Only
[if PPLOOK eq <1> and (PPLAYDT eq <1> or PPLAY6M eq <1>) and
PPLKWRK eq <1>]
Could [fill TEMPNAME] have started a job during
those weeks?
[else]
[if PPLKWRK eq <1>]
Could [fill TEMPNAME] have started a job during any of
those weeks if one had been offered?
[else]
Could [fill TEMPNAME] have returned to work during any
of those weeks if [fill HESHE] had been recalled?
(1)
(2)
Yes
No
@
PPNOTAKE
Mark One Only
Why was that?
H
(1)
(2)
(3)
(4)
Waiting for a new job to begin
Own temporary illness
School
Other
@
NOTHER
Mark One Only
ENTER THE SPECIFIC "OTHER" REASON COULD NOT TAKE JOB
@
SOMWRK
Mark One Only
During the weeks that [fill TEMPNAME] did not
have a job or a business, did [fill HESHE] do
any work at all that earned some money?
H
(1)
(2)
Yes
No
@
Multiple Entry
In which of the months [fill MONTH1] through
[fill MONTH4] did [fill HESHE] do that work?
MTHWRK
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1)
[fill
[fill
[fill
[fill
Page 64 of 314
Yes
(2)
MONTH1]:
MONTH2]:
MONTH3]:
MONTH4]:
No
@1
@2
@3
@4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
Mark One Only
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1)
(2)
WCYN6
Yes
No
@
Mark One Only
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1)
(2)
UECYN6
Yes
No
@
Multiple Entry
What type was it?
ENTER (N) FOR NO MORE
(1)
(2)
(3)
@1
UECYNTP6
Regular
Supplemental
Other, including union benefits
@2
@3
Mark One Only
[fill JUSTCNTFIL]
[fill JUSTCNTFIL2]
were there any weeks when [fill HESHE]
worked less than 35 hours?
PTWRK
|Display T_HRSALL template
|
|
|
H|
INCLUDE HOURS WORKED AT ALL JOBS/BUSINESSES|
COMBINED
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark One Only
I have recorded that there were weeks in which [fill TEMPNAME]
worked less than 35 hours. What was the main reason [fill HESHE]
worked less than 35 hours in those weeks?
H
(1) Could not find full-time job
(2) Wanted to work part-time
(3) Temporarily unable to work full-time because of injury
(4) Temporarily unable to work full-time because of illness
(5) Unable to work full-time because of chronic
health condition/disability
(6) Taking care of children/other persons
(7) Full-time workweek is less than 35 hours
(8) Slack work or material shortage
(9) Participated in a job-sharing arrangement
(10) On vacation
(11) In school
(12) Other
@
Wednesday, August 22, 2007
PTRESN
Page 65 of 314
Survey:
Section: Labor Force 1
Mark One Only
What was the main reason [fill TEMPNAME] worked
less than 35 hours in those weeks?
Items Booklet
PTRESNB
H
Could not find full-time job
Wanted to work part-time
Temporarily unable to work full-time because of injury
Temporarily unable to work full-time because of illness
Unable to work full-time because of chronic
health condition/disability
(6) Taking care of children/other persons
(7) Full time workweek is less than 35 hours
(8) Slack work or material shortage
(9) Participated in a job-sharing arrangement
(10) On vacation
(11) In school
(12) Other
(1)
(2)
(3)
(4)
(5)
@
Mark One Only
ENTER THE SPECIFIC "OTHER" REASON FOR PART TIME WORK
PTSPEC
@
Mark One Only
ASK OR VERIFY
[fill C_DODOES] [fill HESHE] work at a job,
a business, or something else to earn money NOW?
(1)
(2)
(3)
SITNOWCT
Yes
No
Not sure or Don't know
@
Mark One Only
What best describes [fill HISHER] situation now?
READ ALL ANSWERS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
SITNOW
Looking for work
On layoff from a job
Waiting for a new job to begin
Retired
Taking care of home and family (including pregnancy)
In school
Not able to work because of illness or disability
Or something else?
@
Mark One Only
ENTER THE SPECIFIC "OTHER" SITUATION
OTHSIT
@
Page 66 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 1
Mark One Only
[fill LASTTIMEFIL] a physical, mental or
other health condition that limits the kind
or amount of work [fill HESHE] can do at a
job or business[fill PUNCTUATIONFIL]
DISABL
[fill CONDITIONFIL]
(1)
(2)
Yes
No
@
Mark One Only
DISPREV
Does [fill PTEMPNAME] health or condition prevent
[fill HIMHER] from working at a job or business?
(1)
(2)
Yes
No
@
Mark One Only
[fill C_HAVHAS] [fill HESHE] ever retired, for any reason,
from a job or business[fill TEMP]?
(1)
(2)
EVERET
Yes
No
@
Mark One Only
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1)
(2)
WCYN7
Yes
No
@
Mark One Only
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1)
(2)
UECYN7
Yes
No
@
Multiple Entry
What type was it?
ENTER (N) FOR NO MORE
(1)
(2)
(3)
@1
UECYNTP7
Regular
Supplemental
Other, including union benefits
@2
@3
Wednesday, August 22, 2007
Page 67 of 314
Survey:
Section: General Income 1
Page 68 of 314
Items Booklet
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
OTHINT
Mark One Only
Next are questions about [fill PTEMPNAME] other sources of
income since [fill MONTH1] 1st.
PRESS "ENTER" TO CONTINUE
@
VAYN
Mark One Only
Did [fill TEMPNAME] receive any payments from the VA - that is,
the Department of Veterans Affairs?
(1) Yes
(2) No
@
VAYNTYPE
Multiple Entry
What type of payment?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Service-connected disability compensation
Survivor Benefits
Veteran's Pension
Other VA Payments {pop up SPECIFY: @sp}
DO NOT READ:
(5) Military retirement pay
(6) GI Bill benefits
(7) Insurance proceeds
@KEY
VAMILRET
Mark One Only
Just to be sure -- was that regular military retirement,
disability compensation, or a survivor benefits?
(1)
(2)
(3)
Military retirement
Disability compensation
Survivor benefits
@
VAQUES
Mark One Only
[fill C_AREIS] [fill TEMPNAME] required to fill out an
annual income questionnaire in order to receive
VA benefits?
(1)
(2)
Yes
No
@
SSYN
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any Social
Security payments[fill FORSELFFIL]
H
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 69 of 314
Survey:
Section: General Income 1
Items Booklet
Multiple Entry
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any
Social Security on behalf of
[TEMP]?
(1) Yes
(2) No
@CHILD
Did [fill TEMPNAME] receive any Social
Security for [fill SELF]?
(1) Yes
(2) No
@SELF
SSCLDYN
| {display >GDLST< Template}
|
|
|
|
H |
|
|
|
|
H |
|
Mark One Only
Earlier I recorded that [fill TEMPNAME]
[fill HAVHAS] a health condition which limits
the kind or amount of work [fill HESHE] can do.
DISYN
(Since [fill MONTH1] 1st,)
Did [fill HESHE] receive any income
[fill OTHERTHANFIL]
because of [fill HISHER] health condition?
(1) Yes
(2) No
@
Multiple Entry
What kind of income was that? Anything else?
DISTYP
H
THAT APPLY / ENTER (N) FOR NO MORE/RE-ENTER PRECODE TO DELETE
Workers' Compensation
Payments from a sickness, accident, or disability insurance policy
Employer disability payments
Pension from company or union including income from profit-sharing
plans
(5) Federal Civil Service or other Federal civilian employee pension
(6) State government pension
(7) Local government pension
[fill <(8) U.S. Military retirement pay>/<>]
(9) U.S. Government Railroad Retirement
(10) Black Lung payments
(11) Supplemental Security Income (SSI)
(12) Other (SPECIFY: @SP)
ENTER ALL
(1)
(2)
(3)
(4)
@KEY
{pop-up}
[if @2 eq <2>] Did [fill TEMPNAME] purchase that policy on [fill HISHER] own?
(1) Yes
(2) No
@13
@KEY
Page 70 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
RETYN
Mark One Only
Earlier I recorded that [fill TEMPNAME] retired from a
previous job.
[fill
[fill
[fill
[fill
OTHERTHANFIL]
SSHLTHFIL] [fill DIDFIL]
HESHE] receive any [fill OTHERFIL] retirement income (since
MONTH1] 1st)?
(1) Yes
(2) No
@
RETTYP
Multiple Entry
What kind of income was that? Anything else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
REENTER PRECODE TO DELETE
(1)
Pension from company or union
including income from profit-sharing plans
(2) Federal Civil Service or other Federal civilian employee pension
(3) State government pension
(4) Local government pension
[fill <(5) U.S. Military retirement pay>/<>]
(6) U.S. Government Railroad Retirement
(7) National Guard or Reserve Forces retirement
(8) Supplemental Security Income
(9) Other {pop up SPECIFY: @SP}
@KEY [fill ERRORFIL]
LIFEYN
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any retirement income from
a paid-up life insurance policy or any other annuities?
H
(1)
(2)
Yes
No
@
LIFEREG
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any retirement income from
a paid-up life insurance policy or any other annuities?
H
(1) Yes
(2) No
1
Does that come as a regular series of payments, or a
single lump sum?
(1) Regular series
(2) Lump sum
@
Wednesday, August 22, 2007
Page 71 of 314
Survey:
Section: General Income 1
Items Booklet
Mark One Only
[fill OTHERTHANFIL]
[fill SSHLTHRETFIL]
(Since [fill MONTH1] 1st,)
[if OTHERTHANFIL eq <>]Did[else]did[endif] [fill TEMPNAME] recieve any [fill
OTHERFIL] income as a result of being a [fill WIDOWFIL]?
SURYN
(1) Yes
(2) No
@
Multiple Entry
What kind of income was that?
SURTYP
Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
REENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
[fill <(8)
(9)
(10)
(11)
(12)
(13)
Pension from company or union including
income from profit-sharing plans
Veterans' compensation or pension
Federal Civil Service or other Federal civilian employee pension
U.S. Government Railroad Retirement
State government pension
Local government pension
Income from paid-up life insurance policies or annuities
U.S. Military retirement pay> / <>]
Black Lung benefits
Workers' Compensation
Payments from estate or trust
National Guard or Reserve Forces retirement
Other {pop up SPECIFY: @SP}
@KEY [fill ERRORFIL]
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any foster child care payments?
FCCYN
(1) Yes
(2) No
@
Mark One Only
[If I_WAVE ge <2>] Since [fill MONTH1] 1st,
have support payments been court ordered
or informally agreed to for [CHILDFIL]?
[else] Have support payments ever been
court ordered or informally agreed to
for [CHILDFIL]?
(1) Yes
(2) No
Page 72 of 314
CSAGREE
| NAMES OF CHILDREN
| (display children)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive
any child support payments or other
financial help from the
[fill MOMDADFILL] of [fill CHILDFIL]?
DO NOT INCLUDE ALIMONY
(1) Yes
(2) No
(3) No, absent parent is deceased
(volunteered)
@
CSYN
| NAMES OF CHILDREN
| {display children}
|
|
|
|
|
|
|
|
|
|
|
|
ALIYN
Mark One Only
(Since [fill MONTH1] 1st,)
[fill ALIMONY]
[fill TEMPNAME] receive any
payments from [fill FORMERFIL] spouse,
such as alimony?
(1) Yes
(2) No
@
Mark One Only
(Just to be sure we don't miss anything…)
At any time since [fill MONTH1] 1st,
did [fill TEMPNAME] [fill CHILDFIL] receive
any kind of welfare or public assistance from
a state or local welfare office -any food or housing benefits,
welfare-to-work assistance, emergency help,
or anything like that?
(1) Yes
(2) No
@
INCASE
| CHILD(REN)
|{display TEMPNAME's children}
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
(Just to be sure we don't miss anything…)
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
[fill CHILDFIL] receive any kind of government
welfare or public assistance -- any food or housing benefits,
welfare-to-work assistance, emergency help, or anything like
that?
(1) Yes
(2) No
1
INCASESP
What kind of assistance was that?
@
ALSO RECORD THIS INCOME SOURCE AT THE
APPROPRIATE SPECIFIC QUESTION, TO FOLLOW
Wednesday, August 22, 2007
Page 73 of 314
Survey:
Section: General Income 1
Items Booklet
PUBHSE1
Mark One Only
Is this public housing - that is, is it owned by a local housing
authority or other public agency?
DO NOT INCLUDE MILITARY HOUSING
H
(1)
(2)
Yes
No
@
VERYRNT
Mark One Only
I have recorded that the rent here is lower because the Federal,
State, or Local government is paying part of the cost is that still true?
(1) Yes
(2) No
H
@
GVTRNT1
Mark One Only
Is the rent here lower because the Federal, State, or Local
government is paying part of the cost?
DO NOT INCLUDE MILITARY HOUSING
H
(1) Yes
(2) No
@
WRSECT8
Mark One Only
Is this through Section 8 or through some other government program?
H
(1) Section 8
(2) Some other government program
(D) Don't know; not sure
@
HOWLONG
Multiple Entry
When was the last time [fill TEMPNAME] did NOT live
in public or subsidized housing?
ENTER (A) FOR ALWAYS LIVED IN PUBLIC OR SUBSIDIZED HOUSING
H
MONTH: @MONTH
YEAR: @YEAR
Multiple Entry
When did [fill TEMPNAME] move into public or subsidized housing
on [fill HISHER] own, or in [fill HISHER] own name?
WHENAPP
MONTH: @MONTH
YEAR: @YEAR
Mark One Only
Excluding any rent subsidies, how much
[fill DOYOUFIL] currently pay in monthly rent?
MTHRNT
(N) NONE
@
Page 74 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
UTILYN
Mark One Only
[fill DIDFIL] pay [fill TEMP]
for water, electricity, gas, or oil?
(1) Yes
(2) No
@
WAITLIST
Mark One Only
[fill AREYOUFIL] on a waiting list for public or
subsidized housing?
(1) Yes
(2) No
@
Mark One Only
EGYASSYN
[If the respondent is 18 years old or older, then we make HAVEYOUFIL from C_HAVHAS < > TEMPNAME.
Else, we store in HAVEYOUFIL.]
[fill HAVEYOUFIL] received any energy assistance from the Federal,
State, or Local government since [fill MONTH1] 1st?
H
(1) Yes
(2) No
@
EGYPAYMT
Multiple Entry
Was this assistance received in the form of...
H
(1) Yes
(2) No
...checks sent to the household?
@1
...coupons or vouchers sent to the household?
@2
...payments sent directly to the utility company,
fuel dealer, or landlord?
@3
Mark One Only
[fill /<>]
Since [fill MONTH1] 1st, did
[fill DIDCLDFIL] usually get the
lunch that [fill YOURTHEIRFIL]
school provides?
H
ENTER (1) IF [if NUMCLD eq <1>]THE
[else] AT LEAST ONE [endif] CHILD
USUALLY BOUGHT THE SCHOOL LUNCH
OR RECEIVED FREE LUNCH
(1) Yes
(2) No
@
Wednesday, August 22, 2007
HOTLUNYN
|{Display Names of Children in HH
|and put a * in front of the ones
|marked in I_WHOHOTLN or I_WHOHOTLN2}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Page 75 of 314
Survey:
Section: General Income 1
Items Booklet
WHOHOTLN
Mark All That Apply
Which children usually got the school
lunch?
| CHILDREN BETWEEN AGES 5 AND 18
|
H| LN NAME
|
|
|
| {display >KIDS< template}
|
|
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
FREELNYN
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
H
(1) Yes
(2) No
@
FREREDLN
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
H
(1) Yes
(2) No
1
ASK OR VERIFY:
Were they free or reduced-price?
H
(1) Free lunch
(2) Reduced-price lunch
@
BRKFSTYN
Mark One Only
[fill /<>]
Since [fill MONTH1] 1st, did
[fill DIDCLDFIL] usually get the
breakfast that [fill YOURTHEIRFIL]
school provides?
H
ENTER (1) IF [if NUMCLD eq <1>]THE
[else] AT LEAST ONE [endif] CHILD
USUALLY BOUGHT THE SCHOOL BREAKFAST
OR RECEIVED FREE BREAKFAST
(1) Yes
(2) No
@
Page 76 of 314
|{Display Names of Children in HH
|and put a * in front of the ones
|marked in I_WHOBRK or I_WHOBRK2}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
WHOBRK
Mark All That Apply
Which children usually got the school
breakfast?
| CHILDREN BETWEEN AGES 5 AND 18
| LN NAME
H| {display >KIDS< template}
|
|
|
|
|
|
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
FREEBRK
Mark One Only
Were any of the breakfasts free or reduced-price because
[fill CHILDFIL] qualified for the
School Breakfast Program?
H
(1) Yes
(2) No
@
FREREDBK
Mark One Only
Were any of the breakfasts free or reduced-price because
[fill CHILDFIL] qualified for the
School Breakfast Program?
H
(1) Yes
(2) No
1
ASK OR VERIFY:
Were they free or reduced-price?
H
(1) Free breakfast
(2) Reduced-price breakfast
@
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any income from
a program called Supplemental Security Income that is, SSI[fill FORSELFFIL]
SSIYN
H
(1) Yes
(2) No
@
Multiple Entry
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any
Supplemental Security Income--that is,
SSI-- on behalf of [TEMP]?
(1) Yes
(2) No
@CHILD
Did [fill TEMPNAME] receive any SSI
income for [fill SELF]?
(1) Yes
(2) No
Wednesday, August 22, 2007
@SELF
SSICLDYN
| {display >GDLST< Template}
|
|
|
|
H |
|
|
|
|
H |
|
Page 77 of 314
Survey:
Section: General Income 1
Items Booklet
Multiple Entry
[if DIS3 eq <1>]Earlier I recorded that [fill TEMPNAME] received Supplemental
Security Income - that is, SSI - because of [fill HISHER] health
condition.[else][if RET3 eq <1>]Earlier I recorded that [fill TEMPNAME] received
Supplemental Security Income - that is, SSI.
STSSIYN
Did [fill TEMPNAME] receive SSI payments from the Federal government,
from the State or local welfare office, or from both?
H
(1) Federal government
(2) State or local welfare office
(3) Both, Federal and State
@1
popup:
ASK OR VERIFY
Did [fill TEMPNAME] receive separate Federal and State payments,
or were they combined in one payment?
(1) Separate payments
(2) Combined in one payment
@2
FSYN
Mark One Only
(Since [fill MONTH1] 1st,)
[fill C_WASWERE] [fill TEMPNAME] [fill WIFE_HUSBAND]
authorized to receive food stamps?
H
(1) Yes
(2) No
@
WICYN
Mark One Only
(At any time since [MONTH1] 1st,)
Did [fill TEMPNAME] receive benefits
from WIC - the Women, Infants,and
Children nutrition program
[fill TEMP)
H
(1) Yes
(2) No
@
|NAMES
|(display children's names
| who are either less or equal
| to the age of 5
| for whom R is a mom, dad
| or guardian)
|
|
|
|
|
|
|
WICEVER
Mark One Only
[fill C_HAVHAS] [fill TEMPNAME] ever received benefits from
WIC - the Women, Infants, and Children
nutrition program?
H
(1) Yes
(2) No
@
Page 78 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
WICEVERYN
Mark One Only
[fill C_HAVHAS] [fill TEMPNAME] ever received benefits from
WIC - the Women, Infants, and Children
nutrition program?
H
(1) Yes
(2) No
[fill WICEVER]
How about since [fill MONTH1]1st
(Did[fill HESHE]receive any WIC benefits at
any time since [fill MONTH1] 1st)
(1) Yes
(2) No
@
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] [fill CHILDFIL]
receive any CASH assistance from
a state or county welfare program,such as
[fill TANFIL1][fill TANFIL2]
[fill TANFIL 3] or AFDC?
(1) Yes
(2) No
@
H
PACASH1
|(display children's names
| under the age of 18
| for whom R is a mom, dad
| or guardian
|
|
|
|
|
|
|
PATANF
Multiple Entry
Which program was that? (What do you call it?)
Anything else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
[fill <(2)
[fill <(3)
[fill <(4)
(5)
(6)
@SP
[TANFFIL1]
[TANFFIL2]>/<>]
[TANFFIL3]>/<>]
TANF, Temporary Assistance for Needy Families>/<>]
AFDC or ADC
Other {pop-up} SPECIFY
@KEY [fill ERRORFIL]
PACASH2
Mark One Only
How about General Assistance or General Relief
[fill STATEFIL] (since [fill MONTH1] 1st)?
H
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 79 of 314
Survey:
Section: General Income 1
Mark One Only
(Did [fill TEMPNAME] receive) any short-term cash assistance
(since [fill MONTH1] 1st) to tide [fill HIMHER] over when
[fill HESHE] needed it to help [fill HIMHER] stay off welfare,
or for an emergency?
Items Booklet
PACASH3
(1) Yes
(2) No
@
Mark One Only
(Did [fill TEMPNAME] receive) any short-term cash assistance
(since [fill MONTH1] 1st) to tide [fill HIMHER] over when
[fill HESHE] needed it to help [fill HIMHER] stay off welfare,
or for an emergency?
PACSH3SP
(1) Yes
(2) No
1
Can you give me a label for this assistance, so I'll know how to refer
to it later?
IF RESPONDENT DOES NOT PROVIDE A NAME/DESCRIPTION,
ENTER "SHORT-TERM CASH ASSSISTANCE"
@
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any child support as a bonus or pass-through
from a state or county welfare program, or any disregard payments?
H
(1) Yes
(2) No
PSSTHRU
@
Mark One Only
People in need don't always receive unrestricted cash payments
from the government - they may receive money for specific
activities or other kinds of help.
PAINTRO
PRESS "ENTER" TO CONTINUE @
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any transportation assistance to help
[fill HIMHER] get to work, school, training, or doctor's appointments -such as gas vouchers, bus passes or help repairing a car?
PAOTHR1
(1) Yes
(2) No
@
Page 80 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
Mark One Only
How about child care services or assistance (since [fill MONTH1] 1st,)
so [fill HESHE] could go to work or school or training?
PAOTHR2
(1) Yes
(2) No
@
Mark One Only
Did [fill TEMPNAME] receive any food assistance
[fill FOODFIL] (since [fill MONTH1] 1st)?
PAOTHR3
(1) Yes
(2) No
@
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any clothing assistance or clothes
[fill CLOTHESFIL]?
PAOTHR4
(1) Yes
(2) No
@
Mark One Only
(At any time since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any
assistance to help pay for housing[fill ENERGYFIL]?
PAOTHR5
(1) Yes
(2) No
@
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any other type of state or county welfare
program assistance [fill [CHILDFIL]?
PAOTHR6
DO NOT RECORD MEDICAL ASSISTANCE HERE.
(1) Yes
(2) No
@1
Wednesday, August 22, 2007
Page 81 of 314
Survey:
Section: General Income 1
Items Booklet
PAOTH6SP
Mark One Only
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any other type of welfare program
assistance [fill [CHILDFIL]?
(1) Yes
(2) No
1
What kind of welfare assistance was that?
(What's it called?)
IF RESPONDENT DOES NOT PROVIDE A DESCRIPTION,
ENTER "OTHER WELFARE ASSISTANCE"
@
WELACTV1
Mark One Only
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
attend [fill ATTENDCLASSFIL] to improve basic reading
or math skills?
(1)
(2)
Yes
No
@
WELACTV2
Multiple Entry
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]...
(1)
Yes
(2)
No
...attend job readiness training to learn about resume writing,
job interviewing, or building self-esteem?
@1
...attend a job search program or job club, or use a job resource
center to find out about jobs, to schedule interviews,
or to fill out applications?
@2
...attend training to learn a specific job skill, such as computers,
car repair, nursing, day care work, or some other job skill?
@3
Mark One Only
Did [fill TEMPNAME] [TRAINJOBFIL] because the state or county
welfare office required it, or because [fill HESHE] chose to do it,
or for BOTH reasons?
(1)
(2)
(3)
WELACTV3
Required to [fill TRAINJOBFIL]
Chose to [fill TEMP]
Both required and chose
@
Mark One Only
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
participate in a work experience program, such as a
community service job?
(1)
(2)
WELACTV4
Yes
No
@
Page 82 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 1
Mark One Only
Did you already tell me about this
work when you reported [fill PTEMPNAME]
[fill JOBFIL] for
***READ LIST OF EMPLOYERS***?
(1)
(2)
Yes
No
@
Mark All That Apply
Which job?
(Which job did [fill HESHE] do because
of an arrangement with a state or
county welfare office?)
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
WORKEXP1
| {display employers from EMP roster
| and ODDNAME}
|
|
|
|
|
|
|
WHICHEXP1
|LN JOB NAME
|Display E_NO and EMPNAME
|If ODDNAME ne <> and ODDNAME onpath,
|display (JOBCNT+<1>) and ODDNAME
|
|
|
|
@KEY
Mark One Only
Earlier you told me [fill TEMPNAME] worked
for ***READ LIST OF EMPLOYERS***.
Did [fill HESHE] work at [fill JOBFIL]
in order to receive cash assistance?
(1)
(2)
Yes
No
@
Mark All That Apply
Which job?
(Which job did [fill HESHE] work
in order to receive cash assistance?)
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@
WORKEXP2
| {display employers from EMP roster
| and ODDNAME}
|
|
|
|
|
|
|
WHICHEXP2
|LN JOB NAME
|Display E_NO and EMPNAME
|If ODDNAME ne <> and ODDNAME onpath,
|display (JOBCNT+<1>) and ODDNAME
|
|
|
|
|
Mark One Only
Did [fill TEMPNAME] participate in a work experience program because
the state or county welfare office required it, or because [fill HESHE]
chose to do it, or for BOTH reasons?
(1)
(2)
(3)
WORKEXP3
Required to do work experience program
Chose to do work experience program
Both required and chose
@
Wednesday, August 22, 2007
Page 83 of 314
Survey:
Section: Assets 1
Page 84 of 314
Items Booklet
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 1
ASSETIRA
Mark One Only
Next are a couple of questions about retirement accounts.
At any time since [fill MONTH1] 1st, [fill HAVHAS]
[fill TEMPNAME] owned an Individual Retirement Account (IRA)
or a Keogh account?
H
(1)
(2)
Yes
No
@
ASSET401
Mark One Only
Did [fill TEMPNAME] [fill ALSOFIL] have a 401k, 403b,
or thrift plan?
H
(1)
(2)
Yes
No
@
ASETDRAW
Mark One Only
Since [fill MONTH1] 1st, [fill HAVHAS] [fill TEMPNAME] received
any lump sum or regular distribution payments from [fill ANYOFFIL]
[fill HISHER] [fill IRA401FIL]?
(1)
(2)
(3)
(4)
Yes, lump sum
Yes, regular distribution
Yes, both
No, no payments received
@
ASSET1
Multiple Entry
SHOW FLASHCARD F
The next few questions are about assets and other investments,
either individually or jointly owned [fill INCLCHILDFIL].
Since [fill MONTH1] 1st, did [fill TEMPNAME]
own, either individually or jointly...
H
(1)
Yes
(2)
No
...any U.S. Government savings bonds?
...an interest-earning checking account?
...a savings account?
[fill <
Aside from any assets held as part of [fill HISHER]
retirement accounts, did [fill HESHE] own, either
individually or jointly...
...a money market (MM) deposit account or MM fund?
...any CD's (that is, certificates of deposit)?
...mutual funds?
...stocks?
{pop-up}
...or any other assets that produced income,
such as rental property, mortgages from
which [fill HESHE] received payments, or
any other financial investments?
Wednesday, August 22, 2007
@1
@2
@3
@4
@5
@6
@7
@8
Page 85 of 314
Survey:
Section: Assets 1
Items Booklet
Multiple Entry
[fill /
]
H
READ (OR VERIFY) ALL RESPONSE OPTIONS
(1)
Yes
(2)
No
...any municipal or corporate bonds?
...U.S. Government securities?
...mortgages from which [fill HESHE]
received payments?
...rental property?
...royalties?
...or any other financial investments?
pop-up
SPECIFY: @6sp
@1 pop-up box:@A (see post temp)
@2
@3
@4
@5
@6
Mark One Only
Are these municipal/corporate bonds separate from the mutual
funds you just told me about?
(1)
(2)
@
MUNCOR
Yes
No
Mark One Only
Let me make sure that the information I have is correct.
So far, I have not recorded any sources of income
[fill OTHBONDFIL] for [fill TEMPNAME] since
[fill MONTH1] 1st. Did [fill HESHE] receive any income at all -- any
financial help from someone outside the household, any
cash or other assistance from a welfare-type program, any part-time or
odd jobs, or anything else?
(1)
(2)
ASSET2
NOINC
Yes
No
@
Page 86 of 314
Wednesday, August 22, 2007
Items Booklet
Mark One Only
Let me make sure that the information I have about [fill PTEMPNAME]
income sources since [fill MONTH1] 1st is correct.
[fill OTHERTHANFIL] I have recorded:
[fill table9(<1>)]
[fill table9(<2>)]
[fill table9(<3>)]
[fill table9(<4>)]
[fill table9(<5>)]
[fill table9(<6>)]
[fill table9(<7>)]
[fill table9(<8>)]
[fill table9(<9>)]
[fill table9(<10>)]
[fill table9(<11>)]
[fill table9(<12>)]
[fill table9(<13>)]
[fill table9(<14>)]
[fill table9(<15>)]
[fill table9(<16>)]
[fill table9(<17>)]
[fill table9(<18>)]
[fill table9(<19>)]
[fill table9(<20>)]
[fill table9(<21>)]
[fill table9(<22>)]
[fill table9(<23>)]
[fill table9(<24>)]
[fill table9(<25>)]
[fill table9(<26>)]
[fill table9(<27>)]
[fill table9(<28>)]
[fill table9(<29>)]
[fill table9(<30>)]
[fill table9(<31>)]
[fill table9(<32>)]
[fill table9(<33>)]
[fill table9(<34>)]
[fill table9(<35>)]
[fill table9(<36>)]
[fill table9(<37>)]
[fill table9(<38>)]
[fill table9(<39>)]
[fill table9(<40>)]
[fill table9(<41>)]
[fill table9(<42>)]
[fill table9(<43>)]
[fill table9(<44>)]
[fill table9(<45>)]
[fill table9(<46>)]
[fill table9(<47>)]
[fill table9(<48>)]
[fill table9(<49>)]
[fill table9(<50>)]
[fill table9(<51>)]
[fill table9(<52>)]
[fill table9(<53>)]
[fill table9(<54>)]
[fill table9(<55>)]
[fill table9(<56>)]
[fill table9(<57>)]
[fill table9(<58>)]
[fill table9(<59>)]
[fill table9(<60>)]
[fill table9(<61>)]
[fill table9(<62>)]
[fill table9(<63>)]
[fill table9(<64>)]
[fill table9(<65>)]
Wednesday, August 22, 2007
Survey:
Section: Assets 1
INCLIST
Page 87 of 314
Survey:
Section: Assets 1
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
Items Booklet
table9(<66>)]
table9(<67>)]
table9(<68>)]
table9(<69>)]
table9(<70>)]
table9(<71>)]
table9(<72>)]
table9(<73>)]
table9(<74>)]
table9(<75>)]
table9(<76>)]
table9(<77>)]
table9(<78>)]
table9(<79>)]
table9(<80>)]
table9(<81>)]
BUS]
EMP]
SENAME]
ODDNAME]
[ISTHISFIL]correct?
(1)
(2)
@
Page 88 of 314
Yes
No
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 1
Mark All That Apply
Which ones should NOT be on the list?
ERRSRC
Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
table9(<1>)]
table9(<2>)]
table9(<3>)]
table9(<4>)]
table9(<5>)]
table9(<6>)]
table9(<7>)]
table9(<8>)]
table9(<9>)]
table9(<10>)]
table9(<11>)]
table9(<12>)]
table9(<13>)]
table9(<14>)]
table9(<15>)]
table9(<16>)]
table9(<17>)]
table9(<18>)]
table9(<19>)]
table9(<20>)]
table9(<21>)]
table9(<22>)]
table9(<23>)]
table9(<24>)]
table9(<25>)]
table9(<26>)]
table9(<27>)]
table9(<28>)]
table9(<29>)]
table9(<30>)]
table9(<31>)]
table9(<32>)]
table9(<33>)]
table9(<34>)]
table9(<35>)]
table9(<36>)]
table9(<37>)]
table9(<38>)]
table9(<39>)]
table9(<40>)]
table9(<41>)]
table9(<42>)]
table9(<43>)]
table9(<44>)]
table9(<45>)]
table9(<46>)]
table9(<47>)]
table9(<48>)]
table9(<49>)]
table9(<50>)]
table9(<51>)]
table9(<52>)]
table9(<53>)]
table9(<54>)]
table9(<55>)]
table9(<56>)]
table9(<57>)]
table9(<58>)]
table9(<59>)]
table9(<60>)]
table9(<61>)]
table9(<62>)]
Wednesday, August 22, 2007
Page 89 of 314
Survey:
Section: Assets 1
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Items Booklet
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@KEY
ANYOTH
Mark One Only
Is anything missing? Did [fill TEMPNAME] [fill PERSONALLYFIL]
have any other income sources, such as help from someone outside
this household, from the government or military, from any [fill OTHERFIL]
kind of work, or from any other source outside this household?
IT IS EXTREMELY IMPORTANT TO GET A COPMPLETE LISTING OF
ALL INCOME SOURCES.
(1)
(2)
Yes
No
@
OTHSRCE2
Mark All That Apply
SHOW FLASHCARD F2 IF NECESSARY
What kind of income?
Anything else?
H
ENTER ALL THAT APPLY
ENTER (N) NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Income from Job/Business/Other Work
Unemployment or Workers Compensation, and Disability
Payments
Social Security, Pensions, Retirement, and Survivor Income
Military or Veterans Benefits/Pay
Public Assistance and Other Welfare Programs
Lump Sum Payments
Support from Others Outside the Household
Miscellaneous Cash Income
Assets
@KEY
Page 90 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 1
Multiple Entry
PROBE IF NECESSARY
Provide a brief label or description of work, job or business:
ADJOBUS
@1
{pop-up}
When we talk about this later, I'm going to refer to this as
[fill HISHER] [fill ADJOBUS@1] work.
Is this OK?
(1)
(2)
Yes, description OK
No, change description
@2
Mark All That Apply
PROBE IF NECESSARY:
What form of Unemployment or Workers Compensation, and
Disability Payments?
OTHUNEMP
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(5)
(6)
(7)
(9)
(10)
(11)
(12)
(13)
State Unemployment Compensation
Supplemental Unemployment Benefits
Other Unemployment Compensation
Black Lung Payments
Workers Compensation
State Temporary Sickness or Disability Benefits
Employer or Union Temporary Sickness Benefits
Payments from a Sickness, Accident, or Disability
Insurance Policy Purchased on your own
(14) Employer Disability Payments
@KEY
Mark All That Apply
PROBE IF NECESSARY:
What form of Social Security, Pensions, Retirement, and Survivor Income?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(8)
(30)
(31)
(32)
(33)
Social Security
Railroad Retirement
Federal SSI
State SSI
Veterans Compensation
or Pension
Pension from a Company
or Union
Federal Civil Service or
other Fed. Civilian
Employee Pension
U.S. Military Retirement Pay
National Guard or Reserve
Forces Retirement
OTHSS
(34) State Government Pension
(35) Local Government Pension
(36) Income from a Paid-up Life
Insurance Policy or Annuity
(37) Income from Estates or Trusts
(38) Payments for Retirement,
Disability or as a
Survivor Benefit
(39) Pension/Retirement Lump Sums
(42) Draw from IRA/Keogh/401k, 403B
or Thrift Plan
(52) Lump Sum Payments
@KEY
Wednesday, August 22, 2007
Page 91 of 314
Survey:
Section: Assets 1
Items Booklet
Mark All That Apply
PROBE IF NECESSARY:
What form of Military or Veterans Benefits or Pay?
OTHMIL
ENTER ALL THAT APPLY
RE-ENTER PRECODE TO DELETE
ENTER (N) FOR NO MORE
(8)
(32)
(33)
(40)
(41)
(54)
Veterans Compensation or Pension
U.S. Military Retirement Pay
National Guard or Reserve Forces Retirement
The G.I. Bill
Department of Veterans Affairs Educational Assistance
National Guard or Reserve Pay
@KEY
Multiple Entry
PROBE IF NECESSARY:
What form of Public Assistance and Other Welfare Programs?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE /RE-ENTER PRECODE TO DELETE
OTHPUB
(3) Federal Supplemental Security Income
(4) State Supplemental Security Income
(19) Energy Assistance
(20) Cash Assistance (TANF or AFDC)
(21) General Assistance or General Relief
(24) Other Welfare
(25) WIC, or Women, Infants and Children Nutrition Program
(26) Pass Through Child Support payments
(27) Food Stamps
(60) Transportation Assistance
(61) Food Assistance (grocery money, vouchers, certificates)
(62) Clothing Assistance
(63) Housing Assistance
(64) Short-Term Cash Assistance
@KEY
{pop-up} SPECIFY: @SP1
Mark All That Apply
PROBE IF NECESSARY:
What form of Lump Sum Payments?
OTHLUMP
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(15)
(36)
(39)
(52)
(56)
Severance Pay
Income from a Paid-up Life Insurance Policy or Annuity
Pension/Retirement Lump Sums
Lump Sum Payments
Miscellaneous Cash Income
@KEY
Page 92 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 1
Mark All That Apply
PROBE IF NECESSARY:
What form of Miscellaneous Cash Income?
OTHMISC
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(23)
(50)
(53)
(56)
Foster Child Care Payments
Income Assistance from a Charitable Group
Income from Roomers or Boarders
Miscellaneous Cash Income
@KEY
Multiple Entry
PROBE IF NECESSARY: What form of Assets?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
OTHASST
(1) IRA (Individual Retirement account) or a Keogh account
(2) 401K, 403b, or thrift plan
(3) Interest-earning checking account
(4) Savings account
(5) Money market deposit account
(6) Certificates of deposit
(7) Mutual funds
(8) Stocks
(9) Municipal or corporate bonds
(10) U.S. Government securities
(11) Mortgages from which he/she received payments
(12) Rental property
(13) Royalties
(14) U.S. Government savings bonds
(15) Other financial investments
@KEY
{pop-up)SPECIFY @SP
Mark One Only
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] owned [fill ASNAME].
JT
Subsequent times asked:
Earlier you told me that, since [fill MONTH1] 1st,
[fill TEMPNAME] owned [fill ASNAME].
Did [fill HESHE] own any [fill ASNAME] jointly
with someone else [fill OTHSPOUSE]
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 93 of 314
Survey:
Section: Assets 1
[fill /]
[fill TEMPNAME] own
[fill ASNAME] jointly
Items Booklet
Mark All That Apply
[fill ASNAME]
with [HISHER]
[fill DODOES]
with?
ENTER ALL THAT APPLY
ENTER (N) FOR NONE OR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
[fill ERRORFIL]
JTWHO
|LN NAME
|Display HH Roster plus
|(0) Non-Household Member(s)
|
|
|
|
|
|
|
|
|
|
OAST
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill INADDITIONFIL]
[fill INADDITIONFIL2] [fill HESHE] [fill ALSOFIL] own any in
[fill HISHER] name only?
(1) Yes
(2) No
@
Mark One Only
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] [fill FNDSTCK1FIL].
ANYJNT
Subsequent times asked:
(Earlier you told me that,) since [fill MONTH1] 1st,
[fill TEMPNAME] [fill FNDSTCK1FIL].
Did [fill TEMPNAME] [fill FNDSTCK2FIL]
jointly with someone else [fill OTHSPOUSE]
(1) Yes
(2) No
@
Mark All That Apply
[fill /] [fill DODOES]
[fill TEMPNAME] own
[fill ASNAME2] jointly with?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
[fill ERRORFIL]
Page 94 of 314
JTWHO2
|LN NAME
|Display HH Roster plus
|(0) Non-Household Member(s)
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 1
OAST2
Mark One Only
ASSET TYPE: [fill C_ASNAME3]
[fill INADDITIONFIL]
[fill INADDITIONFIL2] [fill TEMPNAME] fill FNDSTCK1FIL] in
just [fill HISHER] own name?
(1) Yes
(2) No
@
ANYJTRNT
Mark One Only
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] owned some rental property.
Subsequent times asked:
(Earlier you told me that,) since [fill MONTH1] 1st,
[fill TEMPNAME] owned some rental property.
Did [fill TEMPNAME] own any rental property jointly
with someone else [fill OTHSPOUSE]
H
(1) Yes
(2) No
@
Mark All That Apply
JTWHO3
[fill /] [fill
DODOES]
|18 and older plus}
[fill TEMPNAME] own
|(0) Non-Household Member(s)
rental property jointly with?
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
[fill ERRORFIL]
Mark One Only
ASSET TYPE: RENTAL PROPERTY
OWNRNT
[fill INADDITIONFIL]
[fill TEMPNAME] [fill ALSOFIL] own any
rental property in [fill HISHER] own name?
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 95 of 314
Survey:
Section: Assets 1
Items Booklet
MRTJNT
Mark One Only
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] held a mortgage from which [fill HESHE]
received payments.
Subsequent times asked:
(Earlier you told me that,) since [fill MONTH1] 1st,
[fill TEMPNAME] held a mortgage from which [fill HESHE]
received payments.
Did [fill HESHE] own this jointly with someone
else[fill OTHSPOUSE]
H
(1) Yes
(2) No
@
Mark All That Apply
[fill /] [fill DODOES]
[fill TEMPNAME] own
mortgages (from which [fill HESHE]
received interest) jointly with?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
[fill ERRORFIL]
JTWHO4
|LN NAME
|Display HH Roster plus
|members 18 and older
|(0) Non-Household Member(s)
|
|
|
|
|
|
|
|
|
Mark One Only
ASSET TYPE: MORTGAGES (FROM WHICH HE/SHE RECEIVED INTEREST)
MRTOWN
[fill INADDITIONFIL]
[fill TEMPNAME] [fill ALSOFIL] hold any in [fill HISHER]
own name?
(1) Yes
(2) No
@
Mark One Only
The next part of the interview is
about [fill PTEMPNAME] income since [fill MONTH1] 1st.
ADINCSRCE2
We want to be both as accurate and as efficient as we can,
so it would be very helpful if you could refer to any
records you might have.
(Also -- we know that people aren't used to talking about
their income, but we ask these questions to get an overall
picture of your community and the nation -- NOT to find
out about [fill YOUANYONEFIL] personally.)
AT APPROPRIATE MOMENTS, ENCOURAGE RESPONDENT TO GET RECORDS.
PRESS "ENTER" TO CONTINUE
@
Page 96 of 314
Wednesday, August 22, 2007
Items Booklet
Wednesday, August 22, 2007
Survey:
Section: Labor Force 2
Page 97 of 314
Survey:
Section: Labor Force 2
Items Booklet
PAYHR
Mark One Only
If JOB2 eq E_NO display:
The next questions are about income [fill TEMPNAME] received from
[fill HISHER] job with [fill EMPNAM].[else]
We'll start with [PTEMPNAME] job with [fill EMPNAM].
If I_PAYHR eq <1> display:
Last time I recorded [fill TEMPNAME] had a set annual salary.
[fill TEMP] that still the case, or [fill ISWASFIL] [fill HESHE]
paid by the hour, or [fill ISWASFIL] [fill HESHE] paid some other way?
Else if I_PAYHR eq <2> display:
Last time I recorded [fill TEMPNAME] [fill WASWERE] paid by the hour.
[fill TEMP] that still the case, or [fill TEMP2] [fill HESHE]
have a set annual salary, or [fill ISWASFIL] [fill HESHE] paid some
other way?
Else display:
[fill DIDFIL] [fill HESHE] have a set annual salary, [fill ISWASFIL]
[fill HESHE] paid by the hour, or [fill ISWASFIL] [fill HESHE]
paid some other way?
(1) Set annual salary
(2) Paid by the hour
(3) Paid some other way
@
PYRAT
Enter Number
[fill THENEXTQFIL]
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill ATJOBFIL]?
READ IF NECESSARY: Do not include your overtime rate here.
at overtime rates will be collected later.
Income earned
H
[fill ENTERNFIL]
[fill ENTERLFIL]
$@ per hour
Mark One Only
[fill SORRYFIL)
Can you give me an approximate amount?
HRAPRX
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGHOUR
THE HOURLY RATE ENTERED, $[fill PYRAT:,] IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 98 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
PYPER
Mark One Only
[fill THENEXTQFIL]
How often [fill ISWASFIL] [fill HESHE] paid by [fill EMPNAM]?
READ IF NECESSARY
(1)
(2)
(3)
(4)
(5)
(6)
Once a week
Once every 2 weeks
Once a month
Twice a month
On commission
Some other way
@
Mark One Only
[If PAYHR offpath and PYRAT offpath][If JOB2 eq E_NO] display;
The next questions are about the income [fill TEMPNAME] received
from [fill HISHER] job with [fill EMPNAM].
[Else] display;
We'll start with [PTEMPNAME] job with [fill EMPNAM].
OTHPY
How often [fill ISWASFIL] [fill HESHE] paid by [fill EMPNAM]?
READ IF NECESSARY
(1)
(2)
(3)
(4)
(5)
(6)
Once a week
Once every 2 weeks
Once a month
Twice a month
On commission
Some other way
6
SPECIFY THE OTHER PAY PERIOD:
@
Multiple Entry
[if PAYHR offpath and PYRAT offpath and PYPER offpath][if JOB2 eq E_NO]display:
The next questions are about the income [fill TEMPNAME] received
from [fill HISHER] job with [fill EMPNAM].
[Else]display:
We'll start with [fill PTEMPNAME] job with [fillEMPNAM].
LSTPY
SHOW CALENDAR ON FLASHCARD E
Please look at the calendar. On what date [fill WASWERE]
[fill TEMPNAME] last paid (by [fill EMPNAM])?
ENTER (N) IF NOT PAID DURING REFERENCE PERIOD
MONTH:
DAY:
NUDAY:
INCR:
PM1:
PM2:
PM3:
PM4:
PM5:
@
[fill
[fill
[fill
[fill
[fill
[fill
[fill
@MON
@DAY
Mark One Only
NUDAY]
INCR]
PM1]
PM2]
PM3]
PM4]
PM5]
Wednesday, August 22, 2007
LF14
dates1:
dates2:
dates3:
dates4:
dates5:
[fill
[fill
[fill
[fill
[fill
DATES(<1>)]
DATES(<2>)]
DATES(<3>)]
DATES(<4>)]
DATES(<5>)]
Page 99 of 314
Survey:
Section: Labor Force 2
Mark One Only
[fill THENEXTQFIL]
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL][fill HOURFIL]annual income amounts, if that would be
easier. What would be easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
Items Booklet
EASYWAY
Monthly totals
Weekly/Biweekly/Bimonthly>]
Hourly pay rates>/<>]
Annual amount
Some other way
@
Multiple Entry
[fill THENEXTQFIL]
MONTHLY
How much [fill RECEIVFIL] BEFORE deductions from
[fill JOBBIZFIL]...
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[If APPENDEMP ne <1> and HHSTATRIP ne <3>]ENTER (L) FOR SAME AS LAST
INTERVIEW
[fill MONTH5FIL]
@5 [fill ERRORFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
{pop-up: MONTHLY5_ERR or MONTHLY4_ERR or MONTHLY3_ERR or MONTHLY2_ERR or
MONTHLY1_ERR}
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MONTHLY5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MONTHLY4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MONTHLY3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MONTHLY2_ERR
Page 100 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MONTHLY1_ERR
BIGMONTH5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MONTHLY@5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGMONTH4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MONTHLY@4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGMONTH3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MONTHLY@3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGMONTH2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MONTHLY@2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGMONTH1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MONTHLY@1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 101 of 314
Survey:
Section: Labor Force 2
Items Booklet
VARY
Mark One Only
Since [fill MONTHXFIL], [fill PAYCKVARYFIL]?
(1) The same
(2) Varied
@
SAME
Enter Number
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
[fill ENTERVFIL]
[fill ENTERLFIL]
$@
PAYAPRX
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
BIGSAME
Mark One Only
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill SAME], IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
That comes out to about $[fill PAYMONTHFIL] per month.
sound about right?
(1)
(2)
CALCPYVR
Does that
Yes
No
@
Enter Number
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount
before all taxes and deductions?
SAMECHK
$@
Page 102 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Multiple Entry
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL] from [fill EMPNAM]...
.
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[If APPENDEMP ne <1> and HHSTATRIP ne <3>] ENTER (L) FOR SAME AS LAST
INTERVIEW
RECORD EACH PAYCHECK SEPARATELY, IF POSSIBLE.
[fill MONTH5FIL][fill PAYDAYFIL5]
@51
@52
@53
@54
@55
H
[fill MONTH4FIL] [fill PAYDAYFIL4]
@41
@42
@43
@44
@45
P1M
[fill MONTH3FIL] [fill PAYDAYFIL3]
@31
@32
@33
@34
@35
[fill MONTH2FIL] [fill PAYDAYFIL2]
@21
@22
@23
@24
@25
[fill MONTH1FIL] [fill PAYDAYFIL1]
@11
@12
@13
@14
@15
[fill ERRORFIL]
{pop-up P1M5_ERR or P1M4_ERR or P1M3_ERR or P1M2_ERR or P1M1_ERR}
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
P1M1_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
P1M2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
P1M3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
P1M4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
P1M5_ERR
Mark One Only
DO NOT READ TO RESPONDENT
MTOT5VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MTOTAL5], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 103 of 314
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
Items Booklet
MTOT4VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MTOTAL4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MTOT3VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MTOT2VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MTOTAL2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MTOT1VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when [fill TEMPNAME] received additional checks?
EXTRA1
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Page 104 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill HISHER] job with [fill EMPNAM] [fill ISWASFIL]
$[fill PYRAT].
RATECHG
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
Same pay rate throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill PYRAT] an hour pay rate first show up in
[fill PTEMPNAME] paycheck?
STRTPAY
MONTH: @MTH
DAY:
@DAY
Enter Number
What was [fill PTEMPNAME] hourly pay rate before that?
PYRAT2
[ENTERLFIL}
$@ per hour
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
HRAPRX2
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BIGHOUR2
THE HOURLY RATE ENTERED, $[fill PYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Earlier you stated that [fill TEMPNAME] usually worked [fill JOBHRS]
hours per week. At $[fill PYRAT], per hour, that works out to
about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right for [fill PTEMPNAME] gross income?
(1)
(2)
CALCHRVR
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income BEFORE deductions
from [fill EMPNAM] [fill WEEKFIL] at that $[fill PYRAT] pay rate?
ESTHR1
$@
Wednesday, August 22, 2007
Page 105 of 314
Survey:
Section: Labor Force 2
Mark One Only
$[fill PYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1)
(2)
Items Booklet
CALCHRV2
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income BEFORE deductions
from [fill EMPNAM] [fill WEEKFIL] at that $[fill PYRAT2]
pay rate?
ESTHR2
$@
Enter Number
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
with [fill EMPNAM] [fill JOBENDFIL]
AMOUNT1
[ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a couple of
thousand dollars or so?
APXAMT1
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BIGAMOUNT1
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
[fill HASWASFIL] [fill HISHER] annual salary for the whole time
[fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
SAMEAMT1
Same annual salary throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill PAYANN1FIL] annual salary first show up in
[PTEMPNAME] paycheck?
STRTANN1
MONTH: @MTH
YEAR: @DAY
Page 106 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Enter Number
What was [fill PTEMPNAME] annual salary before that?
AMOUNT2
[ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
APXAMT2
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BIGAMOUNT2
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
That $[fill PAYANN2FIL] annual salary, divided by 12 months, works out
to be about $[fill PAYANN1FIL]. Does that sound about right for a gross
monthly amount?
CALCANN1
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross monthly
income from [fill EMPNAM] at that annual salary rate?
ESTANN1
$@
Mark One Only
And for [fill HISHER] salary before that...
$[fill PAYANN1FIL] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
CALCANN2
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross monthly
income from [fill EMPNAM] at that annual salary rate?
ESTANN2
$@
Wednesday, August 22, 2007
Page 107 of 314
Survey:
Section: Labor Force 2
Multiple Entry
Let's try [fill ANOTHERFIL].
How much [fill RECEIVFIL] BEFORE deductions from
[fill EMPNAM]...?
Items Booklet
TRYMNTH
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[ENTERLFIL]
[fill MONTH5FIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
{pop-up TRYMTH5_ERR to TRYMTH1_ERR}
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
TRYMTH5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
TRYMTH4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
TRYMTH3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
TRYMTH2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
TRYMTH1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
BIGTRYMTH5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill TRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 108 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
BIGTRYMTH4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill TRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGTRYMTH3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill TRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGTRYMTH2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill TRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGTRYMTH1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill TRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Since [fill MONTH1STFIL], did [fill TEMPNAME] receive
any tips, bonuses, cash or monetary awards, overtime pay,
or commissions from [fill JOBBIZFIL]?
ANYTIPS
(1) Yes
(2) No
@
Mark One Only
Did the income amounts we just talked about include all of
[fill PTEMPNAME] (tips, bonuses, cash awards, overtime pay,
or commissions) from [fill JOBBIZFIL]?
TIPS
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 109 of 314
Survey:
Section: Labor Force 2
Items Booklet
Multiple Entry
How much [fill RECEIVFIL] in (tips, bonuses, cash awards, overtime
pay, or commissions) [fill JOBIZFIL]...
READ IF NECESSARY: Your best estimate here is fine.
ENTER
ENTER
[fill
@51
TIPSAMT
(N) FOR NONE OR NO MORE
(S) FOR SAME AS PREVIOUS AMOUNT
MONTHXFIL]
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
@14
@15
[fill MONTH1FIL]
@11
@12
@13
[fill ERRORFIL]
Mark One Only
DO NOT READ TO RESPONDENT
BIGTIP5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill TIPTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGTIP4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill TIPTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGTIP3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill TIPTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGTIP2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill TIPTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 110 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
BIGTIP1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill TIPTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Multiple Entry
The next questions are about the income [fill TEMPNAME] received from all
of [fill HISHER] [fill JOBFIL].
What [fill ISWASFIL] the total amount of income, BEFORE taxes and other
deductions, that [fill TEMPNAME] [fill HAVHAS] received from
[fill JOBEMPFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
@15
Mark One Only
DO NOT READ TO RESPONDENT
CONTING
BIGCON5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill CONTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGCON4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill CONTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGCON3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill CONTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 111 of 314
Survey:
Section: Labor Force 2
Items Booklet
BIGCON2
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill CONTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
BIGCON1
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill CONTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
TAKEHOME
Mark One Only
[fill REGPAYFIL] the amounts you gave me
[fill HISHER] take-home pay, or were they [fill HISHER] gross pay
BEFORE any taxes and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Mark One Only
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available, such
as pay stubs, that would show the gross amount?
GETGROSS
(1) Yes
(2) No
@
Multiple Entry
What were the gross pay amounts in [fill MONTH5]?
GROSSPAYM5
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M5_2]
$[fill P1M5_3]
$[fill P1M5_4]
$[fill P1M5_5]
Page 112 of 314
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
GROSSM5VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH5], $[fill GTOTAL5],
IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
ALLGROSSM5
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH4]?
GROSSPAYM4
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill fill GROSSFIL]
$[fill P1M4_2]
$[fill P1M4_3]
$[fill P1M4_4]
$[fill P1M4_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
GROSSM4VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH4], $[fill GTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
ALLGROSSM4
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Wednesday, August 22, 2007
Page 113 of 314
Survey:
Section: Labor Force 2
Items Booklet
Multiple Entry
What were the gross pay amounts in [fill MONTH3]?
GROSSPAYM3
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M3_2]
$[fill P1M3_3]
$[fill P1M3_4]
$[fill P1M3_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
GROSSM3VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH3], $[fill GTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
ALLGROSSM3
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH2]?
GROSSPAYM2
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M2_2]
$[fill P1M2_3]
$[fill P1M2_4]
$[fill P1M2_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
GROSSM2VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH2], $[fill GTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 114 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
ALLGROSSM2
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH1]?
GROSSPAYM1
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M1_2]
$[fill P1M1_3]
$[fill P1M1_4]
$[fill P1M1_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
GROSSM1VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH1], $[fill GTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
ALLGROSSM1
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
What was the gross annual amount?
GROSSPAYANN
$@
Mark One Only
DO NOT READ TO RESPONDENT
ALLGROSSANN
ARE ALL AMOUNTS NOW GROSS AMOUNTS?
(1)
(2)
Yes, all amounts are gross
No, some net amounts remain
@
Wednesday, August 22, 2007
Page 115 of 314
Survey:
Section: Labor Force 2
Items Booklet
MLMOREJ
Multiple Entry
{Display employers that are not the top two jobs}
Earlier you told me that since [fill MONTH1] 1st, you also
worked for the following employer(s):
**READ LIST OF EMPLOYERS ABOVE**
What was the total amount of income you received from
[fill EMPLOYERFIL] in [fill MONTH5]?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51
@52
@53
@54
@55
How about in [fill MONTH4]?
@41
@42
@43
@44
@45
And [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
[fill ERRORFIL]
Mark One Only
The next few questions are about the income [fill TEMPNAME]
received from [fill ALLBUS] since [fill BUSSTRTFIL].
H
SLRYB
[fill DOESDIDFIL] [fill HESHE] draw a regular salary from this
business? (That is, take a regular paycheck, as opposed to
just treating the profits as [fill HISHER] income.)
(1) Yes, [fill DRAWFIL] a regular salary
(2) No, [fill DIDFIL] NOT draw a regular salary
@
BPAYHR
Mark One Only
[fill THENEXTQFIL1]
[fill THENEXTQFIL2]
How [fill ISWASFIL] [fill TEMPNAME] paid? [fill C_DOESDIDFIL]
[fill HESHE] have a set annual salary, [fill DIDFIL] the business pay
[fill HIMHER] by the hour, or [fill ISWASFIL] [fill HESHE] paid some
other way?
[fill NOTEFIL]
(1) Set annual salary
(2) Pay by the hour
(3) Paid some other way
@
BPYRAT
Enter Number
[fill THENEXTQFIL]
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill FROMBIZFIL]?
READ IF NECESSARY: Do not include overtime rate here.
earned at overtime rates will be collected later.
Income
[fill ENTERNFIL]
[fill ENTERLFIL]
$@ per hour
Page 116 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
[fill SORRYFIL]
Can you give me an approximate amount?
BHRAPRX
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGHOUR
THE HOURLY RATE ENTERED, $[fill BPYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
[fill THENEXTQFIL]
BPYPER
How often [fill ISWASFIL] [fill HESHE] paid by [fill ALLBUS]?
READ IF NECESSARY
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Once a week
Once every 2 weeks
Once a month
Twice a month
Quarterly
On commission
Some other way
@
Mark One Only
[fill THENEXTQFIL]
BOTHPY
How often [fill ISWASFIL] [fill HESHE] paid by [fill ALLBUS]?
READ IF NECESSARY
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Once a week
Once every 2 weeks
Once a month
Twice a month
Quarterly
On commission
Some other way
7
SPECIFY THE OTHER PAY PERIOD:
@
Wednesday, August 22, 2007
Page 117 of 314
Survey:
Section: Labor Force 2
Items Booklet
BLSTPY
Multiple Entry
[fill THENEXTQFIL]
SHOW CALENDAR ON FLASHCARD E
Please look at the calendar. On what date [fill WASWERE]
[fill TEMPNAME] last paid (by [fill ALLBUS])?
ENTER (N) IF NOT PAID DURING REFERENCE PERIOD
Month:
Day:
BNUDAY:
BINCR:
BPM1:
BPM2:
BPM3:
BPM4:
BPM5:
@
@MTH
@DAY
[fill
[fill
[fill
[fill
[fill
[fill
[fill
Mark One Only
BNUDAY]
BINCR]
BPM1]
BPM2]
BPM3]
BPM4]
BPM5]
BLF14
dates1:
dates2:
dates3:
dates4:
dates5:
[fill
[fill
[fill
[fill
[fill
BDATES(<1>)]
BDATES(<2>)]
BDATES(<3>)]
BDATES(<4>)]
BDATES(<5>)]
BEASYWAY
Mark One Only
[fill THENEXTQFIL]
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL] [fill HOURFIL]quarterly, or annual income amounts,
if that would be easier. What's easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
(6)
Monthly totals
Weekly/Biweekly/Bimonthly>]
Hourly pay rates>/<>]
Quarterly amount
Annual amount
Some other way
@
Multiple Entry
[fill THENEXTQFIL]
How much income [fill RECEIVFIL] from this business BEFORE taxes and
other deductions?
[fill NOTEFIL]
FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[ENTERLFIL]
[fill MONTHFIL]
@5
BMONTHLY
ENTER (N)
H
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill SORRYFIL]
Page 118 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BMONTHLY5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BMONTHLY4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BMONTHLY3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BMONTHLY2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BMONTHLY1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
BBIGMONTH5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BMONTHLY@5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGMONTH4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BMONTHLY@4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGMONTH3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BMONTHLY@3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 22, 2007
Page 119 of 314
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
Items Booklet
BBIGMONTH2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BMONTHLY@2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGMONTH1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BMONTHLY@1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
Since [fill MONTHFIL], [fill PAYCKVARYFIL]?
BVARY
(1) The same
(2) Varied
@
Enter Number
[fill RECORDSAMEFIL]
BSAME
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
[fill ENTERVFIL]
[fill ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
BPAYAPRX
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGSAME
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill BSAME], IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 120 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
That comes out to about $[fill BPAYMONFIL] per month.
Does that sound about right?
(1)
(2)
BCALCPYVR
Yes
No
@
Enter Number
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount before all
taxes and deductions?
BSAMECHK
$@
Multiple Entry
Please tell me the GROSS AMOUNT, before deductions, of each
paycheck [fill TEMPNAME] [fill RECEIVFIL]
from [fill ALLBUS]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill SORRYFIL]
[fill MONTH5FIL][fill PAYDAYFIL5]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
[fill PAYDAYFIL4]
@44
@45
[fill MONTH3FIL]
@31
@32
@33
[fill PAYDAYFIL3]
@34
@35
[fill MONTH2FIL]
@21
@22
@23
[fill PAYDAYFIL2]
@24
@25
[fill MONTH1FIL]
@11
@12
@13
[fill ERRORFIL]
[fill PAYDAYFIL1]
@14
@15
BP1M
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BP1M5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BP1M4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BP1M3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BP1M2_ERR
Wednesday, August 22, 2007
Page 121 of 314
Survey:
Section: Labor Force 2
Items Booklet
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BP1M1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
BMTOT5VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BMTOTAL5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BMTOT4VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BMTOTAL4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BMTOT3VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BMTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BMTOT2VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BMTOTAL2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BMTOT1VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BMTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 122 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when [fill TEMPNAME] received additional checks?
BEXTRA1
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Mark One Only
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill ALLBUS] [fill ISWASFIL]
$[fill BPYRAT].
BRATECHG
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill BUSSTRTFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
Same pay rate throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill BPYRAT] an hour pay rate first show up
in [fill PTEMPNAME] paycheck?
BSTRTPAY
MONTH: @MTH
DAY: @DAY
Enter Number
What was [fill PTEMPNAME] hourly pay rate before that?
[ENTERLFIL]
BPYRAT2
$@ per hour
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
BHRAPRX2
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGHOUR2
THE HOURLY RATE ENTERED, $[fill BPYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 123 of 314
Survey:
Section: Labor Force 2
Mark One Only
Earlier you stated that [fill TEMPNAME] usually worked
[fill HRSBS] hours per week. At $[fill BPYRAT], that works out to
about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right?
(1)
(2)
Items Booklet
BCALCHRVR
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income BEFORE deductions
from [fill ALLBUS] [fill WEEKFIL] at that $[fill BPYRAT] pay rate?
BESTHR1
$@
Mark One Only
$[fill BPYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1)
(2)
BCALCHRV2
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income
BEFORE deductions from [fill ALLBUS] [fill WEEKFIL]
at $[fill BPYRAT2] pay rate?
BESTHR2
$@
Enter Number
What was [fill PTEMPNAME] income before taxes
and personal deductions from [fill ALLBUS]
for the most recent quarter (or the most recent quarter
that you can tell me about)?
BQTRAMT
[ENTERFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate quarterly salary amount -within a couple thousand dollars or so?
BAPXQTR
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGQTR
THE QUARTERLY RATE ENTERED, $[fill BQTRAMT], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 124 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Multiple Entry
And when did that quarter close?
BQTRMNTH
(What was the last month and year of
the quarter that the [fill QTRAMTFIL] dollars applies to?)
MONTH:
YEAR:
@MTH
@YEAR
Enter Number
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
with [fill ALLBUS] [fill BIZENDFIL]
BAMOUNT1
[ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a couple
of thousand dollars or so?
BAPXAMT1
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGAMT1
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
[fill HASWASFIL] [fill HISHER] [fill CURRENTFIL] for the whole time
[fill BUSSTRTFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
BSAMEAMT1
Same [fill CURRENTFIL] throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill PAYANN1FIL] annual salary first show up in
[PTEMPNAME] paycheck?
BSTRTANN1
MONTH: @MTH
YEAR: @DAY
Enter Number
What was [fill PTEMPNAME] annual salary before that?
BAMOUNT2
[ENTERLFIL]
$@
Wednesday, August 22, 2007
Page 125 of 314
Survey:
Section: Labor Force 2
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
Items Booklet
BAPXAMT2
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGAMT2
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
That $[fill PAYANN2FIL] annual income, divided by 12 months, works out
to be about $[fill PAYANN1FIL]a month. Does that sound about right for
a gross monthly amount?
BCALCANN1
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross monthly
income from [fill ALLBUS] at that annual salary rate?
BESTANN1
$@
Mark One Only
And for [fill HISHER] salary before that...
$[fill PAYANN1FIL] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
BCALCANN2
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross monthly
income from [fill ALLBUS] at that annual salary rate?
BESTANN2
$@
Page 126 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Multiple Entry
Let's try [fill ANOTHERFIL].
How much [fill RECEIVFIL] BEFORE deductions from
[fill ALLBUS]...?
BTRYMNTH
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[ENTERLFIL]
[fill MONTH5FIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
{popup: BTRYMNTH5_ERR or BTRYMNTH4_ERR or BTRYMNTH3_ERR or BTRYMNTH2_ERR or
BTRYMNTH1_ERR}
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BTRYMTH5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BTRYMTH4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BTRYMTH3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BTRYMTH2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
BTRYMTH1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTRY5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BTRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 127 of 314
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
Items Booklet
BBIGTRY4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BTRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTRY3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BTRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTRY2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BTRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTRY1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BTRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Other than [fill HISHER] regular income, since [fill MONTH1] 1st,
did [fill TEMPNAME] receive any tips, bonuses, overtime pay,
or commissions from [fill HISHER] work with [fill ALLBUS]?
BANYTIPS
(1) Yes
(2) No
@
Mark One Only
Did the income amounts we just talked about include all of
[fill PTEMPNAME] tips, bonuses, overtime pay, or commissions
from [fill ALLBUS]?
BTIPS
(1) Yes
(2) No
@
Page 128 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Multiple Entry
How much [fill RECEIVFIL] in tips, bonuses, overtime pay, or commissions
[fill FROMBIZFIL]...
READ IF NECESSARY: Your best estimate here is fine.
ENTER
ENTER
[fill
@51
BTIPSAMT
(N) FOR NONE OR NO MORE
(S) FOR SAME AS PREVIOUS AMOUNT
MONTHXFIL]
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
@14
@15
[fill MONTH1FIL]
@11
@12
@13
[fill ERRORFIL]
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTIP5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BTIPTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTIP4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BTIPTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTIP3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BTIPTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BBIGTIP2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BTIPTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 129 of 314
Survey:
Section: Labor Force 2
Items Booklet
BBIGTIP1
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BTIPTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
BTAKEHOME
Mark One Only
Just to be sure -- were the amounts you gave me [fill HISHER]
take-home pay, or were they [fill HISHER] gross pay BEFORE any taxes
and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Mark One Only
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available,
such as pay stubs, that would show the gross amount?
BGETGROSS
(1) Yes
(2) No
@
Multiple Entry
What were the gross pay amounts in [fill MONTH5]?
BGROSSPAYM5
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M5_2]
$[fill BP1M5_3]
$[fill BP1M5_4]
$[fill BP1M5_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
BGROSSM5VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH5], $[fill BGTOTAL], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 130 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
BALLGROSSM5
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH4]?
BGROSSPAYM4
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M4_2]
$[fill BP1M4_3]
$[fill BP1M4_4]
$[fill BP1M4_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
BGROSSM4VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH4], $[fill BGTOTAL4], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BALLGROSSM4
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH3]?
BGROSSPAYM3
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M3_2]
$[fill BP1M3_3]
$[fill BP1M3_4]
$[fill BP1M3_5]
Wednesday, August 22, 2007
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Page 131 of 314
Survey:
Section: Labor Force 2
Items Booklet
Mark One Only
DO NOT READ TO RESPONDENT
BGROSSM3VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH3], $[fill BGTOTAL3], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BALLGROSSM3
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH2]?
BGROSSPAYM2
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M2_2]
$[fill BP1M2_3]
$[fill BP1M2_4]
$[fill BP1M2_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
BGROSSM2VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH2], $[fill BGTOTAL2], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BALLGROSSM2
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Page 132 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
BGROSSPAYM1
Multiple Entry
What were the gross pay amounts in [fill MONTH1]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M1_2]
$[fill BP1M1_3]
$[fill BP1M1_4]
$[fill BP1M1_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
BGROSSM1VER
Mark One Only
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH1], $[fill BGTOTAL1], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
BALLGROSSM1
Mark One Only
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
BGROSSPAYANN
Enter Number
What was the gross annual amount?
$@
BALLGROSSANN
Mark One Only
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS NOW GROSS AMOUNTS?
(1)
(2)
Yes, all amounts are gross
No, some net amounts remain
@
Mark One Only
[fill ASIDEFRMFIL] [fill MONTH1] 1st) did [fill TEMPNAME] receive any
[fill OTHERFIL] income for [fill SELF] out of the money
that [fill ALLBUS] brought in, or from the profits of the business?
(1) Yes
(2) No
OINCB
H
@
Wednesday, August 22, 2007
Page 133 of 314
Survey:
Section: Labor Force 2
Items Booklet
OINCAMT
Multiple Entry
What was the total amount of other income [fill HESHE] received from
[fill ALLBUS]...
ENTER
ENTER
[fill
@51
(N) FOR NONE OR NO MORE
(S) FOR SAME AS PREVIOUS AMOUNT
MONTH5FIL]
@52
@53
@54
@55
[fill MONTH4]?
@41
@42
@43
@44
@45
[fill MONTH3]
@31
@32
@33
@34
@35
[fill MONTH2]
@21
@22
@23
@24
@25
@14
@15
[fill MONTH1]
@11
@12
@13
[fill ERRORFIL]
LSTB
Mark One Only
HAVE YOU ASKED ANOTHER PERSON IN THIS HOUSEHOLD ABOUT
THE NET PROFIT OR LOSS FROM [FILL ALLBUS]?
(1) YES
(2) NO
@
PRFTB
Multiple Entry
For [fill ALLBUS], what was [fill YOURSHAREFIL]
the net profit or loss [fill BIZDATESFIL] Net profit or loss is the
difference between gross receipts and expenses.
H
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount:
$@1
OR
Net loss amount:
$@2
Multiple Entry
Can you give me an annual figure?
ANNPRFT
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount:
$@1
OR
Net loss amount:
Does that
from this
add [fill
profit or
$@2
Mark One Only
[fill PRFTLOSSFIL] include [fill PTEMPNAME] own income
business (that we talked about earlier), or do we need to
HISHER] income to the [fill PRFTLOSSFIL] to get a total net
loss?
PRFTBCHK
(1) Salary/draw is included in the net profit/loss amount
(2) Add salary/draw to net profit/loss amount
to get total net profit/loss
Page 134 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
MLMOREB
Multiple Entry
Display businesses that are not the top two businesses
Earlier you told me that since [fill MONTH1] 1st, you also
had the following businesses:
**READ LIST OF BUSINESSES ABOVE**
What was the total amount of income you received from
[fill BUSINESSFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51
@52
@53
@54
@55
How about [fill MONTH4]?
@41
@42
@43
@44
@45
And [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
H
MOONLITE
Mark One Only
People sometimes earn extra money doing work outside of their regular
jobs, such as freelancing, consulting, or moonlighting.
Other than what we've already talked about, did [fill TEMPNAME] do
any of that kind of work since [fill MONTH1] 1st?
H
(1) Yes
(2) No
@
MLM4
Multiple Entry
What was the total amount of income [fill TEMPNAME] received
from this work so far this month?
ENTER
ENTER
[fill
@51
(N) FOR NONE OR NO MORE.
(S) FOR SAME AS PREVIOUS AMOUNT.
ERRORFIL]
@52
@53
@54
@55
H
How about in [fill MONTH4]?
@41
@42
@43
@44
@45
And [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
Mark One Only
Earlier you said that [fill TEMPNAME] received a lump sum payment
from [fill LUMPFIL].
Did [fill HESHE] re-invest or "roll over" any of the money into an IRA or
some other kind of retirement plan?
ROLLOVR1
(1) Yes
(2) No
@
Wednesday, August 22, 2007
Page 135 of 314
Survey:
Section: Labor Force 2
Items Booklet
Mark One Only
[fill C_DODOES] [fill HESHE] plan to re-invest or "roll over"
any of the money?
ROLLOVR2
(1) Yes
(2) No
@
ROLLAMT
Enter Number
How much [fill PLANFIL] "roll over" into
another RETIREMENT account?
$@
Mark One Only
What was the total amount of income [fill TEMPNAME] received
since [fill MONTH1] 1st?
DEFERAMT
$@
Enter Text
[fill C_HAVHAS] [fill TEMPNAME] received any Pension or
Retirement Lump Sums yet this month?
(1) Yes
(2) No
@5
LUMP1YN
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] -- did [fill HESHE] [if @5 eq <1>] also
receive Pension or Retirement Lump Sums?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1)
Yes
(2)
[fill MONTH1]
[fill MONTH2]
Page 136 of 314
@1
@2
No
[fill MONTH3]
[fill MONTH4]
@3
@4
Mark One Only
@5
Mark One Only
@1
Mark One Only
@2
Mark One Only
@3
Mark One Only
@4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Multiple Entry
How much [fill RECEIVFIL]
in Pension or Retirement Lump Sum
income ...
LUMP1AMT
ENTER (N) FOR NONE/NO MORE / ENTER (S) for SAME AS PREVIOUS AMOUNT
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
@15
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP15
THE AMOUNT ENTERED - $[fill INDEX]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP14
THE AMOUNT ENTERED - $[fill INDEX2]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP13
THE AMOUNT ENTERED - $[fill INDEX3]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP12
THE AMOUNT ENTERED - $[fill INDEX4]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 137 of 314
Survey:
Section: Labor Force 2
Items Booklet
BIGLUMP11
Mark One Only
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX5]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Multiple Entry
[fill C_HAVHAS] [fill TEMPNAME] received any Severence Pay
yet this month?
(1) Yes
(2) No
@5
LUMP2YN
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] -- did [fill HESHE][if @5 eq <1>] also
receive Severence Pay?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1) Yes
(2) No
[fill MONTH1]
[fill MONTH2]
@1
@2
[fill MONTH3]
[fill MONTH4]
@3
@4
Multiple Entry
How much [fill RECEIVFIL]
in Severance Pay income ...
LUMP2AMT
ENTER (N) FOR NONE/NO MORE / ENTER (S) for SAME AS PREVIOUS AMOUNT
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
@15
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP25
THE AMOUNT ENTERED - $[fill INDEX]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Page 138 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Labor Force 2
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP24
THE AMOUNT ENTERED - $[fill INDEX2]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP23
THE AMOUNT ENTERED - $[fill INDEX3]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP22
THE AMOUNT ENTERED - $[fill INDEX4]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
BIGLUMP21
THE AMOUNT ENTERED - $[fill INDEX5]
IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
LFREC
Did the respondent use any records to answer any
labor force earnings questions?
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 139 of 314
Survey:
Section: General Income 2
Page 140 of 314
Items Booklet
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
CSHMTHB
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2] in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
(2) No
@2
@3
@4
@5
Multiple Entry
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2].
[fill C_HAVHAS] [fill HESHE] received any of those
payments yet this month?
CSHMTH
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] -- did
[fill HESHE] [fill ALSOFIL] receive those payments?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
[fill MONTH3]? @3
[fill MONTH4]? @4
Multiple Entry
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need [fill INCTYP1]
[fill INCTYP2] in [fill MONTH5]? Anything else?
YBEG20
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 141 of 314
Survey:
Section: General Income 2
Multiple Entry
Why did [fill TEMPNAME] stop receiving
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH4]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Items Booklet
YSTOP21
Got a job or earning increased
Family situation changed
Others in the household earned enough money
Penalized or sanctioned for non-cooperation
Time limit expired
Didn't want to use up time limit
Chose not to participate
The money is not worth it
Other [if @1 eq <9>]SPECIFY:
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need [fill INCTYP1]
[fill INCTYP2]
in [fill MONTH4]? Anything else?
YBEG21
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY
Multiple Entry
Why did [fill TEMPNAME] stop receiving
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH3]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
YSTOP22
Got a job or earning increased
Family situation changed
Others in the household earned enough money
Penalized or sanctioned for non-cooperation
Time limit expired
Didn't want to use up time limit
Chose not to participate
The money is not worth it
Other [if @1 eq <9>]SPECIFY:
@SP1
@SP2
@1
Page 142 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH3]? Anything else?
YBEG22
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH2]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
YSTOP23
Got a job or earning increased
Family situation changed
Others in the household earned enough money
Penalized or sanctioned for non-cooperation
Time limit expired
Didn't want to use up time limit
Chose not to participate
The money is not worth it
Other [if @1 eq <9>]SPECIFY:
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need
[fill INCTYP1][fill INCTYP2]
in [fill MONTH2]? Anything else?
YBEG23
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 143 of 314
Survey:
Section: General Income 2
Multiple Entry
When did [fill TEMPNAME] start receiving [fill INCTYP1]
[fill INCTYP2]?
Items Booklet
BEG120
MONTH: @MON
YEAR: @YEAR
Multiple Entry
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]?
BEG120A
MONTH: [fill BEG120@MON]
YEAR: [fill BEG120@YEAR]
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]
on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
[fill RECEIVFIL]?
BEG120B
(1) Yes
(2) No
@
Multiple Entry
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]
CONTINUOUSLY, every month [fill THROUGHFIL]?
BEG120C
MONTH: @MTH
YEAR: @YR
Multiple Entry
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need
[fill INCTYP1][fill INCTYP2]?
[fill MONTH1FIL] Anything else?
YBEG220
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 144 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
[fill NOTINCFSFIL] much [fill RECEIVFIL]
from [fill INCTYP1] [fill INCTYP2] ...
CSHAMT15
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill ERRORFIL]
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
@15
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
CSHSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX:,]
IS [fill LGSMFIL].
(1)
(P)
CHCK5
BACKUP AND CORRECT
Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2:,]
IS [fill LGSMFIL].
(1)
(P)
CHCK4
BACKUP AND CORRECT
Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3:,]
IS [fill LGSMFIL].
(1)
(P)
CHCK3
BACKUP AND CORRECT
Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4:,]
IS [fill LGSMFIL].
(1)
(P)
CHCK2
BACKUP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 145 of 314
Survey:
Section: General Income 2
Items Booklet
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5:,]
IS [fill LGSMFIL].
(1)
(P)
CHCK1
BACKUP AND CORRECT
Proceed
@
Mark One Only
Earlier I recorded that [TEMPNAME] received pass through
child support payments from a state or county welfare
program.
INCPASS
Were these payments INCLUDED in the amount(s) you just gave me?
PASS THROUGH CHILD SUPPORT MAY ALSO BE KNOWN AS "BONUS"
CHILD SUPPORT OR "DISREGARD PAYMENTS".
(1) Yes, bonus/pass through amounts are included
(2) No, amounts do NOT include bonus/pass through
(3) (did not receive any bonus/pass through income)
@
Multiple Entry
How much pass through child support did
[fill TEMPNAME] receive [fill MONTHXFIL]
PASSAMT5
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill ERRORFIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
PASSSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
BIGPASS5
THE AMOUNT ENTERED - [fill INDEX]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 146 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Mark One Only
BIGPASS4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGPASS3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGPASS2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGPASS1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
How much child support was collected by the agency
on [PTEMPNAME] behalf in [MONTHXFIL]
CSAGCY5
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill ERRORFIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
Wednesday, August 22, 2007
Page 147 of 314
Survey:
Section: General Income 2
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
Items Booklet
CSASORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX:,]
IS [fill LGSMFIL].
(1)
(P)
BACKUP AND CORRECT
Proceed
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2:,]
IS [fill LGSMFIL].
(1)
(P)
BIGCSAGCY5
BIGCSAGCY4
BACKUP AND CORRECT
Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3:,]
IS [fill LGSMFIL].
(1)
(P)
BIGCSAGCY3
BACKUP AND CORRECT
Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4:,]
IS [fill LGSMFIL].
(1)
(P)
BIGCSAGCY2
BACKUP AND CORRECT
Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5:,]
IS [fill LGSMFIL].
(1)
(P)
BIGCSAGCY1
BACKUP AND CORRECT
Proceed
@
Mark One Only
Were [fill PTEMPNAME]
[fill INCTYP1] [fill INCTYP2]
payments for both adults AND children in the household,
or JUST the children?
KIDONLY
(1) Both adults and children
(2) Children only
@
Page 148 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Mark All That Apply
Who [fill ISWASFIL] [fill PTEMPNAME]
[fill MONTHFIL]
[fill INCTYP1] [fill INCTYP2]
payment for?
ENTER LINE NUMBER OF PERSON COVERED
ENTER (A) FOR ALL PERSONS COVERED
ENTER (N) FOR NONE/NO MORE
RE-ENTER LINE NUMBER TO DELETE
@KEY [fill ERRORFIL]
CASHCOV
| LN
NAME
| {display HH roster}
|
|
|
|
|
|
|
|
|
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
WICMNTHB
Earlier I recorded that [fill TEMPNAME] received
WIC, or the Women, Infants and Children Nutrition Program
in [fill MONTH1].
Did [fill HESHE] also receive those benefits
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
(2) No
@1
@2
@3
@4
Multiple Entry
Earlier I recorded that [fill TEMPNAME] received WIC, or the Women,
Infants and Children Nutrtion Program. [fill C_HAVHAS][fill TEMPNAME]
received any benefits from the WIC program yet this month?
WICMNTH
(1) Yes
(2) No
@WIC5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] - did [fill HESHE] [/ <>] receive
WIC benefits?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1] @WIC1
[fill MONTH2] @WIC2
Wednesday, August 22, 2007
[fill MONTH3] @WIC3
[fill MONTH4] @WIC4
Page 149 of 314
Survey:
Section: General Income 2
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need WIC in [fill MONTH5]? Anything else?
Items Booklet
WYBEG20
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving WIC in [fill MONTH4]?
WYSTOP21
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Couldn't get to the WIC clinic
(5) Benefits are not worth it
(6) Other [if @1 eq <6>]SPECIFY
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC in [fill MONTH4]? Anything else?
WYBEG21
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 150 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
Why did [fill TEMPNAME] stop receiving WIC in [fill MONTH3]?
WYSTOP22
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Couldn't get to the WIC clinic
(5) Benefits are not worth it
(6) Other [if @1 eq <6>]SPECIFY
@SP1
@SP2
@
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC in [fill MONTH3]? Anything else?
WYBEG22
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERROFFIL]
Multiple Entry
Why did [fill TEMPNAME] stop recveiving WIC in [fill MONTH2]?
WYSTOP23
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Couldn't get to the WIC clinic
(5) Benefits are not worth it
(6) Other [if @1 eq <6>]SPECIFY
@SP1
@SP2
@
Wednesday, August 22, 2007
Page 151 of 314
Survey:
Section: General Income 2
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC in [fill MONTH2]? Anything else?
Items Booklet
WYBEG23
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
When did [fill TEMPNAME] start receiving WIC?
WBEG120
MONTH: @MON
YEAR: @YEAR
Multiple Entry
When did [fill TEMPNAME] start receiving WIC?
WBEG120A
MONTH: [fill WBEG120@MON]
YEAR: [fill WBEG120@YEAR]
When did [fill TEMPNAME] start receiving
WIC on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
[fill RECEIVFIL]?
WBEG120B
(1) Yes
(2) No
@
Multiple Entry
When did [fill TEMPNAME] start receiving WIC CONTINUOUSLY, every month
[fill THROUGHFIL]?
WBEG120C
MONTH: @MTH
YEAR: @YR
Page 152 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC [fill MONTH1FIL]? Anything else?
WYBEG220
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERRORFIL]
Mark All That Apply
Who [fill DIDFIL] [fill PTEMPNAME]
[fill MTHFIL] WIC benefits cover?
ENTER LINE NUMBER OF PERSON COVERED
ENTER (A) FOR ALL PERSONS COVERED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
WICPER
|
|
|
|
|
|
|
LN NAME
{display all women ages 16-65,
children le 5, single fathers with
children le 5}
@KEY [fill ERRORFIL]
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
FSMTHYNB
Earlier I recorded that [fill TEMPNAME] received
Food Stamps in [fill MONTH1].
Did [fill HESHE] also receive Food Stamps
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
(2) No
@2
@3
@4
@5
Wednesday, August 22, 2007
Page 153 of 314
Survey:
Section: General Income 2
Items Booklet
Multiple Entry
Earlier I recorded that [fill TEMPNAME] [fill WASWEREFIL] authorized
to receive Food Stamps. [fill C_HAVHAS] [fill TEMPNAME] received any
Food Stamp benefits yet this month?
FSMTHYN
(1) Yes
(2) No
@2
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] - did
[fill HESHE] [fill ALSOFIL] receive Food Stamps?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) YES
[MONTH1] @
[MONTH2] @
(2) No
[MONTH3] @
[MONTH4] @
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need Food Stamps in [fill MONTH5]? Anything else?
FYBEG20
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving Food Stamps
in [fill MONTH4]?
FYSTOP21
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other [if @1 eq <7>]SPECIFY
@SP1
@SP2
@1
Page 154 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need Food Stamps in [fill MONTH4]? Anything else?
FYBEG21
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other {pop up: SPECIFY}
@SP1
@SP2
@KEY[fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving Food Stamps
after [fill MONTH3]?
FYSTOP22
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other [if @1 eq <7>]SPECIFY
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need Food Stamps in [fill MONTH3]? Anything else?
FYBEG22
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 155 of 314
Survey:
Section: General Income 2
Multiple Entry
Why did [fill TEMPNAME] stop receiving Food Stamps
in [fill MONTH2]?
Items Booklet
FYSTOP23
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other [if @1 eq <7>]SPECIFY
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER]
to need Food Stamps in [fill MONTH2]? Anything else?
FYBEG23
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
When did [fill TEMPNAME] start receiving Food Stamps?
FBEG120
MONTH: @MON
YEAR: @YEAR
Multiple Entry
When did [fill TEMPNAME] start receiving Food Stamps?
FBEG120A
MONTH: [fill FBEG120@MON]
YEAR: [fill FBEG120@YEAR]
When did [fill TEMPNAME] start receiving
Food Stamps on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
[fill RECEIVFIL]?
FBEG120B
(1) Yes
(2) No
@
Page 156 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
When did [fill TEMPNAME] start receiving Food Stamps CONTINUOUSLY,
every month [fill THROUGHFIL]?
FBEG120C
MONTH: @MTH
YEAR: @YR
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER]
to need Food Stamps[fill MONTH1FIL]? Anything else?
FYBEG220
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
How much [fill RECEIVFIL] in
Food Stamps [fill MONTHXFIL]
ENTER
[fill
[fill
@51
FSAMT15
(N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
ENTERLFIL]
ERRORFIL]
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31 @32
@33
@34
@35
[fill MONTH2FIL]
@21 @22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
@15
Mark One Only
THE AMOUNT ENTERED - [fill INDEX]
IS [fill LGSMFIL].
BIGFS5
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
BIGFS4
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 157 of 314
Survey:
Section: General Income 2
Items Booklet
BIGFS3
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGFS2
Mark One Only
THE AMOUNT ENTERED -[fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGFS1
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark All That Apply
Who [fill ISWASFIL] covered by
[fill PTEMPNAME] [fill MTHFIL]
Food Stamp benefits?
ENTER LINE NUMBER OF PERSON COVERED
ENTER (A) FOR ALL PERSONS COVERED
ENTER (N) FOR NO MORE
@KEY
FSPER
| LN NAME
| {display HH roster}
|
|
|
|
|
|
|
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
CSMTHB
Earlier I recorded that [fill TEMPNAME] received
child support payments in [fill MONTH1].
[fill DIDFIL]
[fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
Page 158 of 314
(2) No
@2
@3
@4
@5
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
Earlier I recorded that [fill TEMPNAME] received child support
payments. [fill PASSTHRUFIL] [fill TEMPNAME]
received any [if OTHERFIL] child support payments yet this month?
CSMTH
(1) Yes
(2) No
@
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] - did [fill HESHE] [/ <>]
receive child support payments?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
[MONTH1] @
[MONTH2] @
(2) No
[MONTH3] @
[MONTH4] @
Multiple Entry
[fill HOWFIL]
much [fill RECEIVFIL] in child support
payments [fill MONTHXFIL]
CSAMT15
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
[fill ERRORFIL]
@15
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
CSSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX]
IS [fill LGSMFIL].
BIGCS5
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 159 of 314
Survey:
Section: General Income 2
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
Items Booklet
BIGCS4
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
BIGCS3
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
BIGCS2
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
BIGCS1
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
Earlier I recorded that [fill TEMPNAME]
received [fill INCTYP1][fillINCTYP2]
on behalf of
**READ NAME(S)OF CHILD(REN)**
KCOVBEG
|NAMES
|(display children's names
|under the age of 18
|for whom R is a mom, dad
|or guardian)
When did [fill TEMPNAME] begin to receive |
[fill INCTYP3]for
|
**READ NAME(S)OF CHILD(REN)**?
|
|
MONTH: @STRTMTH
|
YEAR: @STRTYR
@
Page 160 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
KDMTHYNB
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2]
for **READ NAME(S) OF CHILD(REN)** in [fill MONTH1].
Did [fill HESHE] also receive [fill INCTYP3]
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
(2) No
@2
@3
@4
@5
Multiple Entry
[C_HAVHAS] [fill TEMPNAME] received any
[fill INCTYP1] [fill INCTYP2] for
**READ NAME(S) OF CHILD(REN)**
yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months [fill MONTH1], [fill MONTH2],
[fill MONTH3],or [fill MONTH4] did [fill HESHE] [fill ALSOFIL]receive
[fill INCTYP3] for
**READ NAME(S) OF CHILD(REN)**?
KDMTHYN
|NAMES
|{display children's names
|under the age of 18
|for whom R is a mom, dad,
|or guardian}
|
|
|
|
|
|
|
|
|
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[MONTH1] @1
[MONTH3] @3
[MONTH2] @2
[MONTH4] @4
Multiple Entry
How much [fill RECIEVFIL] in [fill INCTYP1] [fill INCTYP2]
on behalf of the [fill GICHILD]...
KIDAMT15
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill ERRORFIL]
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
@15
Wednesday, August 22, 2007
Page 161 of 314
Survey:
Section: General Income 2
Items Booklet
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
KIDSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
BIGKAMT5
Mark One Only
THE AMOUNT ENTERED - [fill INDEX:]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGKAMT4
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGKAMT3
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGKAMT2
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGKAMT1
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark All That Apply
Who did these [fill INCTYP3]
cover?
ENTER LINE NUMBER OF PERSON COVERED
ENTER (A) FOR ALL PERSONS COVERED
ENTER (N) FOR NONE/NO MORE
RE-ENTER LINE NUMBER TO DELETE
@KEY [fill ERRORFIL]
Page 162 of 314
SSKIDCOV
| LN
NAME
| {display >GDLST< template}
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2] [fill FORSELFFIL].
RESNSS
What is the reason [fill HESHE] [fill AREIS] getting
[fill INCTYP1] [fill INCTYP2]?
Any other reason?
ENTER (N) IF NO SECOND REASON
(1)
(2)
(3)
(4)
(5)
Retired
Disabled
Widowed or surviving child
Spouse or dependent child
Other reason [if @1 eq <5> or @2 eq <5>]SPECIFY: @SP}
@1
@2
Mark One Only
[fill EARLIERFIL]
AGESS
At what age did [fill TEMPNAME] begin receiving
[fill INCTYP1] [fill INCTYP2] because of
[fill HISHER] disability?
(REPORT AGE IN YEARS)
AGE: @
Mark One Only
[fill EARLIERFIL]
JNTSSYN
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive [fill INCTYP1] [fill INCTYP2]
jointly with [fill HISHER] spouse?
(1)
(2)
Yes
No
@
Mark One Only
[fill EARLIERFIL]
WHENSS
On what day of the month are [fill HISHER] payments
usually deposited?
(1)
(2)
(3)
(4)
First day of the month
Third day of the month
2nd, 3rd, or 4th Wednesday
Other
@
Wednesday, August 22, 2007
Page 163 of 314
Survey:
Section: General Income 2
Items Booklet
Multiple Entry
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received transportation assistance. Did [fill HESHE] receive...
(1) Yes
TRANTYP
(2) No
...gas vouchers?
@1
...bus or subway tokens or passes?
@2
...help registering, repairing, or insuring a car?
@3
...rides to a doctor's office or medical appointment?
@4
...some other kind of transportation assistance?
{pop up: What was that?}
@5
@SP
Multiple Entry
Did [fill HESHE] receive the gas vouchers through a government social
service agency or through someplace else?
GASVSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Multiple Entry
[fill C_HAVHAS] [fill TEMPNAME] received any gas vouchers
yet this month?
GASMTH
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] -- did
[fill HESHE] [fill ALSOFIL] receive gas vouchers?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
Page 164 of 314
[fill MONTH3]? @3
[fill MONTH4]? @4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
GASMTHB
Earlier I recorded that [fill TEMPNAME] received
gas vouchers in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1)
[fill
[fill
[fill
[fill
Yes
(2)
MONTH2]
MONTH3]
MONTH4]
MONTH5]
No
@2
@3
@4
@5
Multiple Entry
How much [fill RECEIVFIL]
in gas vouchers ...
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
[fill ERRORFIL]
GASAMT
@15
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
GASSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX]
IS [fill LGSMFIL].
BIGGAS5
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
BIGGAS4
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 165 of 314
Survey:
Section: General Income 2
Items Booklet
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
BIGGAS3
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
BIGGAS2
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
BIGGAS1
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
Did [fill HESHE] receive the bus or subway tokens or passes
through a government social service agency or through
someplace else?
TOKENSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Multiple Entry
[fill C_HAVHAS] [fill TEMPNAME] received any bus or subway tokens
or passes yet this month?
TOKMTH
(1) Yes
(2) No
@5
SHOW CALENDAR
In which of the last four months -- [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] -- did
[fill HESHE] [fill ALSOFIL] receive bus or subway tokens or passes?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
[fill MONTH1]? @1
[fill MONTH2]? @2
Page 166 of 314
(2) No
[fill MONTH3]? @3
[fill MONTH4]? @4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
TOKMTHB
Earlier I recorded that [fill TEMPNAME] received
bus or subway tokens or passes in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
(2) No
@2
@3
@4
@5
Multiple Entry
How much [fill RECEIVFIL]
in bus or subway tokens or passes ...
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill MONTHXFIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
[fill MONTH1FIL]
@11
@12
@13
@14
[fill ERRORFIL]
TOKAMT
@15
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
TOKSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX]
IS [fill LGSMFIL].
BIGTOK5
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 167 of 314
Survey:
Section: General Income 2
Items Booklet
BIGTOK4
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGTOK3
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGTOK2
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
BIGTOK1
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received some food assistance. [fill FOODFIL] [fill HESHE] receive...
(1) Yes
FOODTYP
(2) No
... Money, vouchers, or certificates to buy groceries or
food?
@1
... Bags of groceris or packaged foods?
@2
... Any meals from a shelter, soup kitchen, Meals-on-Wheels,
or other charity?
@3
... Any other food assistance? {pop up: What was that?}
@4
@SP
Page 168 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
Did [fill HESHE] get the grocery money, vouchers,
or certificates through a government social service agency, through
a community or religious charitable organization, through family or
friends, or through someplace else? Any place else?
FOODSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Government agency
Community or religious charity
Family or friends
Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Mark One Only
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received clothing assistance or clothes. Did [fill HESHE]
receive clothes or money or vouchers to buy clothes?
CLOTHTYP
(1) Clothes
(2) Money or vouchers
(3) Both clothes and money or vouchers
@
Multiple Entry
Did [fill HESHE] get that through a government social service
agency, through a community or religious charitable organization,
through family or friends, through an employer, or through
someplace else? Any place else?
CLOTHSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
Government agency
Community or religious charity
Family or friends
Employer
Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Mark One Only
Earlier you said that [fill TEMPNAME] received assistance
to help pay for housing since [fill MONTH1] 1st. Was that
through Section 8, some other rental assistance program,
some other kind of housing program, or are you not sure?
(1)
(2)
(3)
(4)
PUBHSTYP
Section 8
Other rental assistance
Other housing program
Not sure; don't know
@
Wednesday, August 22, 2007
Page 169 of 314
Survey:
Section: General Income 2
Multiple Entry
Did [fill HESHE] get that through a government social service agency,
through a local housing authority, through a community or religious
charitable organization, or through someplace else? Any place else?
Items Booklet
PUBHSSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Government agency
Housing authority
Community or religious charity
Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Multiple Entry
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received [fill INCTYP1]. Did [fill HESHE] get that through a
government social service agency, through a community or religious
charitable organization, through family or friends, or
through someplace else? Any place else?
CASHSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Government agency
Community or religious charity
Family or friends
Someplace else {pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Mark One Only
Was that through the federal, state, or local government?
CASHGVT
(1) Federal
(2) State
(3) Local
@
Multiple Entry
Earlier you said that since [fill MONTH1] 1st,
[fill TEMPNAME] received [fill INCTYP1]. Did [fill HESHE] get that
through a government social service agency, through a community or
religious charitable organization, through family or friends, or through
someplace else? Any place else?
OTHSCE
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Government agency
Community or religious charity
Family or friends
Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Page 170 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
MNTHYNB
Multiple Entry
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2] in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
[MONTH2]
[MONTH3]
[MONTH4]
[MONTH5]
(2) No
@2
@3
@4
@5
Multiple Entry
[fill TEMP]
[fill TEMP2] [fill TEMP3]
[fill C_HAVHAS] [fill TEMPNAME] received any [fill INCTYP3] yet
this month?
(1) Yes
(2) No
@5
MNTHYN
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] - did [fill HESHE] [if @5 eq <1>]also
[endif] receive [fill INCTYP1][if INCTYP2 ne <>] [fill INCTYP2][endif]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1]
[fill MONTH2]
@1
@2
[fill MONTH3]
[fill MONTH4]
@3
@4
Multiple Entry
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH5]? Anything else?
MYBEG20S
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other,[if @4 eq <4>]SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 171 of 314
Survey:
Section: General Income 2
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH5]? Anything else?
Items Booklet
MYBEG20L
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving [fill INCTYP1]
[fill INCTYP2] in [fill MONTH4]?
MYSTOP21
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other [if @1 eq <7>]SPECIFY:
@SP1
@SP2
@
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH4]? Anything else?
MYBEG21L
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 172 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH4]? Anything else?
MYBEG21S
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other {[if @4 eq <4>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving [fill INCTYP1]
[fill INCTYP2] in [fill MONTH3]?
MYSTOP22
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other [if @1 eq <7>]SPECIFY:
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH3]? Anything else?
MYBEG22L
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 173 of 314
Survey:
Section: General Income 2
Multiple Entry
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH3]? Anything else?
Items Booklet
MYBEG22S
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other {pop up: SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
Why did [fill TEMPNAME] stop receiving [fill INCTYP1]
[fill INCTYP2] in [fill MONTH2]?
MYSTOP23
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other [if @1 eq <7>]SPECIFY:
@SP1
@SP2
@1
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH2]? Anything else?
MYBEG23L
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation, divorce or widowed
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 174 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Multiple Entry
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2] in [fill MONTH2]? Anything else?
MYBEG23S
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other [if @4 eq <4>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]?
MBEG120
MONTH: @MON
YEAR: @YEAR
Multiple Entry
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]?
MBEG120A
MONTH: [fill MBEG120@MON]
YEAR: [fill MBEG120@YEAR]
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]
on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
[fill RECEIVFIL]
[fill RECEIVFIL2]?
MBEG120B
(1) Yes
(2) No
@
Multiple Entry
When did [fill TEMPNAME] start receiving [fill INCTYP1] [fill INCTYP2]
CONTINUOUSLY, every month [fill THROUGHFIL]?
MBEG120C
MONTH: @MTH
YEAR: @YR
Wednesday, August 22, 2007
Page 175 of 314
Survey:
Section: General Income 2
Items Booklet
Multiple Entry
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1][if INCTYP2 ne <>] [fill INCTYP2][endif][fill
MONTH1FIL] Anything else?
MYBEG220L
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY
[fill ERRORFIL]
Multiple Entry
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2][fill MONTH1FIL] Anything else?
MYBEG220S
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other, [if @4 eq <4>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
[fill EXCLUDEFIL] [fill CHILDPAYFIL]
how much [fill RECEIVFIL]
in [fill INCTYP1] [fill INCTYP2]...
MNTHAMT15
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill MONTH1FIL]?
@41
@42
@43
@44
@45
[fill MONTH2FIL]?
@31
@32
@33
@34
@35
[fill MONTH3FIL]?
@21
@22
@23
@24
@25
[fill MONTH4FIL]?
@11
@12
@13
@14
[ fill ERRORFIL]
Page 176 of 314
@15
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: General Income 2
Mark One Only
I'm sorry. That information doesn't seem to be in my computer.
Can you give me an approximate amount?
MNSORRY
IF YES, PRESS F1 TO BACK UP AND ENTER APPROXIMATE AMOUNT(S)
IF NO, ENTER (P) TO PROCEED
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX]
IS [fill LGSMFIL].
BIGAMT5
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX2:,]
IS [fill LGSMFIL].
BIGAMT4
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
BIGAMT3
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
BIGAMT2
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
BIGAMT1
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 177 of 314
Survey:
Section: General Income 2
Items Booklet
Mark One Only
Some people have what is called a "Medicare Part B" premium
taken out of their Social Security benefit before it reaches
them.
SSPARTB
[fill DODOES][fill TEMPNAME]?
H
(1) Yes
(2) No
@
SSPARTBAMT
Mark One Only
Do you know how much is deducted?
(1) Yes
(2) No
@
SSPARTBAMTSP
Mark One Only
Do you know how much is deducted?
(1) Yes
(2) No
@1
DEDUCTED AMOUNT $@
Mark All That Apply
Who [fill DIDFIL] [fill PTEMPNAME]
[fill MONTHFIL] [fill INCTYP1]
[fill INCTYP2] cover?
ENTER LINE NUMBER OF PERSON COVERED
ENTER (A) FOR ALL PERSONS COVERED
ENTER (N) FOR NONE/NO MORE
RE-ENTER LINE NUMBER TO DELETE
@KEY
TMCOV
| LN
NAME
| {display HH roster}
|
|
|
|
|
|
|
|
Mark One Only
DO NOT READ TO RESPONDENT
GINCRECUSE
Did the respondent use any records to answer any
general income earnings questions?
(1)
(2)
Yes
No
@
Page 178 of 314
Wednesday, August 22, 2007
Items Booklet
Wednesday, August 22, 2007
Survey:
Section: Assets 2
Page 179 of 314
Survey:
Section: Assets 2
Items Booklet
JINTSP_PD
Mark One Only
(Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME] jointly with
[fill SPOUSEFIL].)
|JOINT WITH:
|{display names marked in JTWHO}
|{star small children's names}
|
What is the easiest way
|
for you to tell me about [fill SHAREFIL]
|
the interest or dividend income
|
[fill ANDSPKIDFIL] received from those
|
jointly held [fill ASNAME]?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H |
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) DO NOT READ -- None of these
|
|
@
|
JTINTSP
Multiple Entry
[fill SHAREFIL]
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
by these joint [fill ASNAME]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL1]
Multiple Entry
[fill HOWMUCHFIL] interest or dividend
income [fill WASFIL] produced by these
joint [fill ASNAME]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JNTINTSP]
Page 180 of 314
|JOINT WITH:
|{display names marked in JTWHO}
|{star small children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
JTINTSP2
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
H |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST1
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 10 dollars,
between 10 and 25 dollars,
between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than
25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more
than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than
50 dollars, between 50 and 150 dollars,
between 150 and 500 dollars, or more
than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Wednesday, August 22, 2007
JCATSP1Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
JCATSP1Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
JCATSP2Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
Page 181 of 314
Survey:
Section: Assets 2
Items Booklet
Mark One Only
ASSET TYPE: [fill C_ASNAME]
JCATSP2Y
Mark One Only
ASSET TYPE: [fill C_ASNAME]
JCATSP3Q
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
150 dollars, between 150 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 500
dollars, between 500 and 1,500 dollars,
between 1,500 and 5,000 dollars, or more
than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $1,499.99
$1,500 to $4,999.99
$5,000 or more
@
Page 182 of 314
JCATSP3Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
JINTCH_PD
Mark One Only
(Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME] jointly with
**READ STARRED NAMES**.)
|JOINT WITH:
|{display names marked in JTWHO
|{star children's names}
|
What is the easiest way for you to tell
|
me about the interest or dividend income |
from those joint [fill ASNAME]?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H |
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) DO NOT READ -- None of these
|
|
@
|
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
by these joint [fill ASNAME]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL2]
Multiple Entry
How much interest or dividend income was
produced by these joint [fill ASNAME]?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JNTINTCH]
JTINTCH
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
JTINTCH2
|JOINT WITH:
|{display names marked in JTWHO}
H |{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST2
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 183 of 314
Survey:
Section: Assets 2
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than
10 dollars, between 10 and 25 dollars,
between 25 and 50 dollars, or more
than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than
25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more
than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than
50 dollars, between 50 and 150 dollars,
between 150 and 500 dollars, or more
than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
Items Booklet
JCATCH1Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
JCATCH1Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
JCATCH2Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
JCATCH2Y
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Page 184 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Mark One Only
ASSET TYPE: [fill C_ASNAME]
JCATCH3Q
Mark One Only
ASSET TYPE: [fill C_ASNAME]
JCATCH3Y
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
150 dollars, between 150 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
(Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME] jointly with
**READ NAME(S)**.)
What is the easiest way for you to tell
me about the share of the interest or
dividend income [fill TEMPNAME]
[fill ANDSPKIDFIL] received from these
jointly held [fill ASNAME]?
READ ANSWER CATEGORIES IF NECESSARY
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) DO NOT READ -- None of these
@
Wednesday, August 22, 2007
JTOTHINT_PD
|JOINT WITH:
|{display names marked in JTWHO}
|{star childrens' names}
|
|
|
|
|
|
|
H|
|
|
|
|
|
|
|
Page 185 of 314
Survey:
Section: Assets 2
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL] [fill HOWMUCHFIL2]
by these joint
[fill ASNAME]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL3]
Multiple Entry
What was [fill PTEMPNAME]
[fill ANDSPKIDFIL] share of the interest
or dividend income produced by these
joint [fill ASNAME]?
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JNTOTINT]
Items Booklet
JTOTHINT
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
JTOTHINT2
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST3
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 10 dollars,
between 10 and 25 dollars,
between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Page 186 of 314
JCATOT1Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than
25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more
than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
Survey:
Section: Assets 2
JCATOT1Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
JCATOT2Q
Mark One Only
ASSET TYPE: [fill C_ASNAME]
JCATOT2Y
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 50 dollars,
|
between 50 and 150 dollars, between 150
|
and 500 dollars, or more than 500 dollars?|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 150 dollars,
between 150 and 500 dollars, between 500
and 1,500 dollars, or more than 1,500
dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Wednesday, August 22, 2007
JCATOT3Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
Page 187 of 314
Survey:
Section: Assets 2
Items Booklet
JCATOT3Y
Mark One Only
ASSET TYPE: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
EXCL_CD
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill ASNAME] [fill OWNNAMEFIL].
Are these CDs included in [fill PTEMPNAME] [fill IRA401FIL] account,
or [fill DODOES] [fill HESHE] own them separately from any retirement
account -- or both?
H
(1)
(2)
(3)
All CDs are included in IRA/Keogh/401k/403b/thrift accounts
All CDs are owned separately from retirement accounts
Both -- some are included in retirement accounts
and some are owned separately
@
OINT_PD
Mark One Only
[fill INCOMENOWFIL]
[fill EARLIERFIL] What is the easiest way for you to tell me about
[fill PTEMPNAME] interest or dividend income from those [fill ASNAME]?
READ ANSWER CATEGORIES IF NECESSARY
H
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
OINT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL] by these [fill ASNAME]?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL4]
Page 188 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
OINT2
Multiple Entry
What was the total amount of interest or dividend income
[fill TEMPNAME] earned from these [fill ASNAME]...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill OWNINT]
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST4
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
OCAT1Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL]
less than 10 dollars, between 10 and 25 dollars,
between 25 and 50 dollars, or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
OCAT1Y
[fill SORRYFIL]
Is the annual amount less than 25 dollars,
between 25 and 75 dollars, between 75 and
150 dollars, or more than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Wednesday, August 22, 2007
Page 189 of 314
Survey:
Section: Assets 2
Items Booklet
Mark One Only
ASSET TYPE: [fill C_ASNAME]
OCAT2Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIl] amount [fill SINCEFIL] less
than 50 dollars, between 50 and 150 dollars, between 150
and 500 dollars, or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
OCAT2Y
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between
100 and 500 dollars, between 500 and 1,500 dollars,
or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $1,499.99
$1,500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
OCAT3Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less
than 150 dollars, between 150 and 500 dollars, between 500
and 1,500 dollars, or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
OCAT3Y
[fill SORRYFIL]
Is the annual amount less than 500 dollars, between
500 and 1,500 dollars, between 1,500 and 5,000 dollars,
or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $1,499.99
$1,500 to $4,999.99
$5,000 or more
@
Page 190 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Enter Number
[fill ASIDEFRMFIL]
is the total amount of interest or dividend income
[fill TEMPNAME] [fill HAVHAS] earned since [fill MONTH1] 1st on all
[fill OTHERFIL] [fill ASNAME] [fill HESHE] owned?
DKINT
[fill ENTERLFIL]
$@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
DKCAT1Q
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 10 dollars,
between 10 and 25 dollars, between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
DKCAT2Q
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 50 dollars,
between 50 and 150 dollars, between 150 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
DKCAT3Q
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 150 dollars,
between 150 and 500 dollars, between 500 and 1,500 dollars,
or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Wednesday, August 22, 2007
Page 191 of 314
Survey:
Section: Assets 2
Items Booklet
JTANYWSP
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME2] jointly with
**READ NAMES**.
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
What kind of dividends do [fill YOUTHEYFIL]|
[fill BOTHALLFIL] get from these joint
|
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends
|
credited against a margin account or
|
automatically reinvested?
|
H |
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
ASK IF NECESSARY: Just to be sure,
[fill TEMPNAME] and [fill SPOUSEFIL]
have received no dividends of any kind
from these joint [fill ASNAME2] since
[fill MONTH1] 1st -- is that correct?
(1)
(2)
Yes; correct;
no dividends received
No; incorrect;
DID RECEIVE dividends
@
Mark One Only
What is the easiest way for you to tell
me about [fill SHAREFIL] the dividend
income [fill ANDSPKIDFIL] received from
those jointly held [fill ASNAME2]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
Page 192 of 314
NODIVSP
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
|
|
|
|
|
|
|
JTDIVSP_PD
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
|
H |
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
JTDIVSP
Multiple Entry
[fill SHAREFIL]
[fill INCLUDEFIL] [fill HOWMUCHFIL]
[fill ISWASFIL][fill YOURTHEIRFIL]
[fill CREDITEDFIL]
dividend income [fill WASFIL]
[fill PRODUCEDFIL]
by all these joint [fill ASNAME2]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@3
$@5
$@2
$@4
$@6
Total: $[TOTALFIL5]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
|
|
|
H |
|
|
|
|
|
|
|
|
|
JTDIVSP2
Multiple Entry
[fill SHAREFIL]
|JOINT WITH:
|{display name marked in JTWHO2
[fill INCLUDEFIL] was [fill YOURTHEIRFIL] |{star small children's names}
[fill CREDITEDFIL] dividend
|
income produced by all these joint
|
[fill ASNAME2]...
|
ENTER (N) FOR NONE OR NO MORE
H |
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
|
[fill ENTERLFIL]
|
|
in [fill MONTH4]?
|
@41
@42
@43
|
How about in [fill MONTH3]?
|
@31
@32
@33
|
And [fill MONTH2]?
|
@21
@22
@23
|
And [fill MONTH1]?
|
@11
@12
@13
|
4-Month Total: $[fill JNTDIVSP]
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST5
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars,
between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Wednesday, August 22, 2007
JDIVSP1Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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Page 193 of 314
Survey:
Section: Assets 2
Items Booklet
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250
dollars, between 250 and 1,000 dollars,
between 1,000 and 2,500 dollars, or more
than 2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
JDIVSP1Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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JDIVSP2Q
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount
[fill SINCEFIL] less than 25 dollars,
between 25 and 100 dollars,
between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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JDIVSP2Y
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the annual amount less than 100
dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Page 194 of 314
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
JTANYWCH
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME2] jointly with
**READ STARRED NAME(S)**.
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
What kind of dividends do [fill YOUTHEYFIL]|
[fill BOTHALLFIL] get from these joint
|
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends
|
credited against a margin account or
|
automatically reinvested?
|
H |
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
[fill TEMPNAME] and **READ STARRED
|{display names marked in JTWHO2}
NAME(S)** have received no dividends of
|{star small children's names}
any kind from these joint [fill ASNAME2]
|
since [fill MONTH1] 1st -- is that correct?|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
|
Mark One Only
What is the easiest way for you to tell
me about the dividend income received
from those jointly held [fill ASNAME2]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
Wednesday, August 22, 2007
NODIVCH
JTDIVCH_PD
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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H |
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Page 195 of 314
Survey:
Section: Assets 2
Multiple Entry
[fill INCLUDEFIL] [fill CREDITEDFIL]
dividend income [fill ISWASFIL]
[fill PRODUCEDFIL]
by all these joint [fill ASNAME2]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL7]
Multiple Entry
[fill INCLUDEFIL] [fill CREDITEDFIL]
dividend income was produced by all
these joint [fill ASNAME2]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JNTDIVCH]
Items Booklet
JTDIVCH
|JOINT WITH:
|(display names marked in JTWHO2)
|{star small children's names}
|
H |
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JTDIVCH2
|JOINT WITH:
|(display names marked in JTWHO2)
|{star small children's names}
|
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Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST6
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars,
between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Page 196 of 314
JDIVCH1Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250
dollars, between 250 and 1,000 dollars,
between 1,000 and 2,500 dollars, or more
than 2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
JDIVCH1Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
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JDIVCH2Q
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount
[fill SINCEFIL] less than 25 dollars,
between 25 and 100 dollars,
between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
|
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|
|
|
|
|
|
|
|
JDIVCH2Y
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Is the annual amount less than 100
dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Wednesday, August 22, 2007
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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Page 197 of 314
Survey:
Section: Assets 2
Items Booklet
JTOTHANY
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME2] jointly with
**READ NAME(S)**.
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
What kind of dividends do these joint
|
[fill ASNAME2] produce? Do they produce |
dividend checks, or are the dividends
|
credited against a margin account or
|
automatically reinvested?
|
H |
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
ASK IF NECESSARY: Just to be sure,
these joint [fill ASNAME2] produced no
dividends of any kind since
[fill MONTH1] 1st -- is that correct?
(1)
(2)
Yes; correct;
no dividends received
No; incorrect;
DID RECEIVE dividends
@
Mark One Only
What is the easiest way for you to tell
me about the share of the dividend
income [fill TEMPNAME]
[fill ANDSPKIDFIL] received from
those jointly held [fill ASNAME2]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
Page 198 of 314
NODIVOTH
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
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JTOTHDIV_PD
|JOINT WITH:
|{display names marked in JTWHO2
|{star small children's names}
|
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|
H |
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|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Multiple Entry
INCOME SHARE FOR: [fill SHAREFIL]
[fill INCLUDEFIL] [fill ISWASFIL]
[fill YOURTHEIRFIL]
[fill CREDITEDFIL]
dividend income
[fill PRODUCEDFIL]
by all these joint [fill ASNAME2]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@3
$@5
$@2
$@4
$@6
Total: $[TOTALFIL9]
Multiple Entry
INCOME SHARE FOR: [fill SHAREFIL]
[fill INCLUDEFIL] was
[fill YOURTHEIRFIL]
[fill CREDITEDFIL]
dividend income produced
by all these joint [fill ASNAME2]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JAMTDVOT]
JTOTHDIV
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
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|
H |
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JTOTHDIV2
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
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|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST7
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 199 of 314
Survey:
Section: Assets 2
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars,
between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250
dollars, between 250 and 1,000 dollars,
between 1,000 and 2,500 dollars, or more
than 2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
Mark One Only
Income Share For: [fill TEMPNAME]
[fill ANDSPKIDFIL]
Asset Type: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount
[fill SINCEFIL] less than 25 dollars,
between 25 and 100 dollars,
between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Page 200 of 314
Items Booklet
JDIVOT1Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
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|
JDIVOT1Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
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|
|
|
|
|
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|
|
JDIVOT2Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
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Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: STOCKS
[fill SORRYFIL]
Is the annual amount less than 100
dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
JDIVOT2Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
|
|
|
|
|
|
|
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|
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|
EXCLUDE
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill SOMEFIL] [fill FNDSTKFIL2][fill INNAMEFIL]
Are these [fill FNDSTKFIL2] included in
[fill IRA401FIL]
or [fill DODOES] [fill HESHE] own them separately from any
retirement account -- or both?
H
(1)
(2)
(3)
All shares are included in IRA/Keogh/401k/403b/
thrift accounts
All shares are owned separately from retirement accounts
Both -- some are included in retirement accounts
and some are owned separately
@
Mark One Only
[fill EARLIERFIL]
OWNTYPE
What kind of dividends [fill DODOES] [fill TEMPNAME] get from these
[fill FNDSTK1FIL]? [fill C_DODOES] [fill HESHE] get dividend checks,
or are the dividends credited against a margin account or
automatically reinvested?
(1)
(2)
(3)
(4)
Dividend CHECKS
CREDITED or AUTOMATICALLY REINVESTED dividends
Both
Neither; no dividends received
@
Mark One Only
ASK IF NECESSARY:
Just to be sure, these [fill ASNAME2] produced no dividends
of any kind since [fill MONTH1] 1st -- is that correct?
NODIVOWN
(1) Yes; correct; no dividends received
(2) No; incorrect; DID RECEIVE dividends
@
Wednesday, August 22, 2007
Page 201 of 314
Survey:
Section: Assets 2
Items Booklet
OWNDIV_PD
Mark One Only
[fill EARLIERFIL]
[fill INCOMENOWFIL]
What is the easiest way for you to tell me about
[fill YOURNAMEFIL] dividend income from
[fill ASNAME2] [fill OWNNAMEFIL]
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
Multiple Entry
[fill ANOTHERFIL]
[fill INCLUDEFIL]
[if CREDITEDFIL ne <>][fill CREDITEDFIL] [endif]dividend income [fill ISWASFIL]
[fill PRODUCEDFIL]
by the [fill ASNAME2] [fill HESHE] owned
[fill INNAMEFIL]?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
OWNDIV
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL11]
OWNDIV2
Multiple Entry
[fill INCLUDEFIL] [fill CREDITEDFIL] dividend income did
[fill TEMPNAME] receive from the [fill NONRETFIL] [fill ASNAME2]
[fill HESHE] owned in [fill HISHER] own name...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill OWNADV]
Page 202 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST8
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
ODIV1Q
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount [fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars, between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
ODIV1Y
[fill SORRYFIL]
Is the annual amount less than 250 dollars, between 250 and
1,000 dollars, between 1,000 and 2,500 dollars, or more than
2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
Mark One Only
ASSET TYPE: STOCKS
ODIV2Q
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount [fill SINCEFIL] less than
25 dollars, between 25 and 100 dollars, between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Mark One Only
ASSET TYPE: STOCKS
ODIV2Y
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Wednesday, August 22, 2007
Page 203 of 314
Survey:
Section: Assets 2
Items Booklet
Enter Number
[fill ASIDEFRMFIL]
is the total amount of dividend income [fill TEMPNAME]
[fill HAVHAS] earned since [fill MONTH1] 1st on all [fill OTHERFIL]
[fill ASNAME2] [fill HESHE] owned?
DKDIV
[fill ENTERLFIL]
$@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
DKDIV1M
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 100 dollars,
between 100 and 400 dollars, between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
ASSET TYPE: STOCKS
DKDIV2M
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 25 dollars,
between 25 and 100 dollars, between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Mark One Only
(Earlier I recorded that [fill TEMPNAME]
owned rental property jointly with
[fill SPOUSEFIL].)
JTRENT_PD
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
What is the easiest way for you to tell
|
me about [fill SHAREFIL] the income
|
[fill ANDSPKIDFIL] received from those
|
jointly held properties?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H |
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these
|
|
@
|
Page 204 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
in GROSS RENT from all property
[fill THEYFIL] owned jointly?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL13]
JTRENT
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
H |
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST9
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
[fill HOWMUCHFIL] GROSS RENT from the
property [fill YOUTHEYFIL] owned jointly?
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
@44
@45
How about in [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
4-Month Total: $[fill JARNT_TOT]
JTRENT2
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST10
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 205 of 314
Survey:
Section: Assets 2
Items Booklet
Multiple Entry
[fill PERIODFIL]
[fill HOWMUCHFIL]
NET INCOME or net loss after expenses?
READ NAMES IF NECESSARY
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL14]
Multiple Entry
[fill WHATWASFIL] NET INCOME
or net loss after expenses...
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
@44
@45
How about in [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
4-Month Total: $[fill JACLR_TOT]
JTCLEAR
|JOINT WITH:
|{display names marked in JTWHO3}
|
H |
|
|
|
|
|
|
|
|
|
|
|
|
|
JTCLEAR2
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark All That Apply
DO NOT READ TO RESPONDENT
AL_CLEAR
NET AMOUNT CANNOT EXCEED GROSS.
PRESS F1 TO BACK UP AND CORRECT
(P) TO PROCEED @
Mark One Only
BIGAST11
[fill RESPFIL]
THE AMOUNT ENTERED IS [fill LARGEFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 206 of 314
Wednesday, August 22, 2007
Items Booklet
Mark One Only
ASSET TYPE: RENTAL PROPERTY
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 250 dollars,
between 250 and 1,000 dollars,
between 1,000 and 2,000 dollars,
or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Survey:
Section: Assets 2
JTCLR1Q
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
ASSET TYPE: RENTAL PROPERTY
JTCLR1Y
|JOINT WITH:
|{display names marked in JTWHO3}
[fill SORRYFIL]
|
Is the annual amount less than
|
500 dollars, between 500 and 2,500
|
dollars, between 2,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
(Earlier I recorded that [fill TEMPNAME]
owned rental property jointly with
**READ NAME(S)**.)
JTOTHRNT_PD
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
What is the easiest way for you to tell
|
me about the share of the
|
income [fill TEMPNAME]
|
received from this property?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H |
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these
|
|
@
|
Wednesday, August 22, 2007
Page 207 of 314
Survey:
Section: Assets 2
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL] [fill HOWMUCHFIL2]
GROSS RENT from all jointly-owned rental
property?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL15]
Items Booklet
JTOTHRNT
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
H |
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST12
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
What was [fill PTEMPNAME]
share of the GROSS RENT from all
jointly-owned rental property?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JARNTOTH]
JTOTHRNT2
|JOINT WITH:
|{display names marked in JTWHO3}
|
H |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST13
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 208 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Multiple Entry
[fill PERIODFIL]
[fill HOWMUCHFIL] [fill HOWMUCHFIL2]
NET INCOME or loss after expenses?
READ NAMES IF NECESSARY
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL16]
Multiple Entry
What was [fill PTEMPNAME]
share of the NET INCOME or net loss after
expenses...
ENTER A NET LOSS AS A NEGATIVE AMOUNT
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill JACLR2_TOT]
JTOTHCLR
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
JTOTHCLR2
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
BIGAST14
[fill RESPFIL]
THE AMOUNT ENTERED IS [fill LARGEFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 209 of 314
Survey:
Section: Assets 2
Items Booklet
Mark One Only
ASSET TYPE: RENTAL PROPERTY
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 250 dollars,
between 250 and 1,000 dollars,
between 1,000 and 2,000 dollars,
or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
JCLROT1Q
|JOINT WITH:
|{display names marked in JTWHO3}
|
|
|
|
|
|
|
|
|
|
|
|
|
JCLROT1Y
Mark One Only
ASSET TYPE: RENTAL PROPERTY
|JOINT WITH:
|{display names marked in JTWHO3}
[fill SORRYFIL]
|
Is the annual amount less than
|
500 dollars, between 500 and 2,500
|
dollars, between 2,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
OWNRENT_PD
Mark One Only
(Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned some
rental property[fill OWNNAMEFIL].)
What is the easiest way for you to tell me about the income
from this rental property?
READ ANSWER CATEGORIES IF NECESSARY
H
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
Page 210 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
OWNRENT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
from this rental property?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL17]
BIGAST15
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
OWNRENT2
Multiple Entry
How much GROSS RENT did [fill TEMPNAME] receive
from this rental property...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill OARNT_TOT]
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST16
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
Page 211 of 314
Survey:
Section: Assets 2
Items Booklet
OWNCLEAR
Multiple Entry
[fill PERIODFIL]
[fill HOWMUCHFIL]
NET INCOME or net loss after expenses?
H
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL18]
OWNCLEAR2
Multiple Entry
What was [fill PTEMPNAME] NET INCOME
or net loss after expenses...
H
ENTER
ENTER
ENTER
[fill
(N) FOR NONE OR NO MORE
A NET LOSS AS A NEGATIVE AMOUNT
(S) FOR SAME AS PREVIOUS AMOUNT
ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill OACLR_TOT]
Mark One Only
BIGAST17
[fill RESPFIL]
THE AMOUNT ENTERED IS [fill LARGEFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: RENTAL PROPERTY
OCLR1Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than
250 dollars, between 250 and 1,000 dollars, between 1,000
and 2,000 dollars, or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Page 212 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
OCLR1Y
Mark One Only
ASSET TYPE: RENTAL PROPERTY
[fill SORRYFIL]
Is the annual amount less than 500 dollars, between 500 and 2,500
dollars, between 2,500 and 5,000 dollars, or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $2,499.99
$2,500 to $4,999.99
$5,000 or more
@
DKRNT
Enter Number
[fill ASIDEFRMFIL]
is the total amount of income
[fill TEMPNAME] received in GROSS RENT since [fill MONTH1] 1st
from all [fill OTHERFIL] rental property [fill HESHE] owned?
H
[fill ENTERLFIL]
$@
BIGAST18
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
DKCLEAR
Enter Number
[fill INSTEADFIL]
Since [fill MONTH1] 1st, what has been [fill PTEMPNAME]
NET INCOME or net loss after expenses from this rental property?
H
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE
[fill ENTERLFIL]
$@
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST19
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: RENTAL PROPERTY
DKRNT1Q
[fill SORRYFIL]
Was it less than 250 dollars, 250 to 1,000 dollars,
1,000 to 2,000 dollars, or more than 2,000 dollars?
(1)
(2)
(3)
(4)
less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Wednesday, August 22, 2007
Page 213 of 314
Survey:
Section: Assets 2
Mark One Only
(Earlier I recorded that [fill TEMPNAME]
held a mortgage from which [fill HESHE]
received payments jointly with
[fill SPOUSEFIL].)
Items Booklet
JTMRTINT_PD
|JOINT WITH:
|{display names marked in JTWHO4}
|
|
|
What is the easiest way for you to tell
|
me about [fill SHAREFIL] the interest
|
income [fill ANDSPKIDFIL] received from
|
the joint mortgages?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H |
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these
|
|
@
|
Multiple Entry
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO4}
[fill HOWMUCHFIL]
|
from all mortgages (from which [fill HESHE]
received interest)the two of
|
[fill THEMYOUFIL] held jointly?
|
H |
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: [FILL TOTALFIL19]
|
JTMRTINT
Multiple Entry
How much interest did [fill TEMPNAME]
|JOINT WITH:
and [fill HISHER] [fill SPOUSE] receive
|{display names marked in JTWHO4}
from all mortgages (from which [fill HESHE]
received interest) the two of
|
[fill THEMYOUFIL] held jointly...
|
H |
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
|
[fill ENTERLFIL]
|
|
in [fill MONTH4]?
|
@41
@42
@43
|
How about in [fill MONTH3]?
|
@31
@32
@33
|
And [fill MONTH2]?
|
@21
@22
@23
|
And [fill MONTH1]?
|
@11
@12
@13
|
4-Month Total: $[fill MIJNT_TOT]
|
JTMRTINT2
Page 214 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST20
(1) BACKUP AND CORRECT
(P) Proceed
@
MRTRG1Q
Mark One Only
ASSET TYPE: MORTGAGES
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 250 dollars,
between 250 and 1,000 dollars,
between 1,000 and 2,000 dollars,
or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
|JOINT WITH:
|{display names marked in JTWHO4}}
|
|
|
|
|
|
|
|
|
|
|
|
|
MRTRG1Y
Mark One Only
ASSET TYPE: MORTGAGES
[fill SORRYFIL]
Was the annual amount less than 500
dollars, between 500 and 2,500 dollars,
between 2,500 and 5,000 dollars,
or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $2,499.99
$2,500 to $4,999.99
$5,000 or more
@
|JOINT WITH:
|{display names marked in JTWHO4}
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
held a mortgage (from which [fill HESHE] |{display names marked in JTWHO4}
received interest) with **READ NAME(S)**.)|
|
What is the easiest way for you to tell
|
me about the share of the interest
|
income [fill TEMPNAME] received from
|
those jointly-owned mortgages?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these
|
|
|
@
|
Wednesday, August 22, 2007
JTOTHMRT_PD
Page 215 of 314
Survey:
Section: Assets 2
Items Booklet
Multiple Entry
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO4}
[fill HOWMUCHFIL]
|
from all mortgages (from which [fill HESHE]
received interest) held jointly by
|
[fill HIMHER] and [fill HISHER]
|
investment partner?
|
H |
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
Total: $[FILL TOTALFIL20]
|
JTOTHMRT
Multiple Entry
What was [fill PTEMPNAME] share of the
|JOINT WITH:
interest received from all mortgages
|{display names marked in JTWHO4}
(from which [fill HESHE] received
|
interest) held jontly by [fill HIMHER] and|
[fill HISHER] investment partner...
|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
|
[fill ENTERLFIL]
|
in [fill MONTH4]?
H |
@41
@42
@43
|
|
How about in [fill MONTH3]?
|
@31
@32
@33
|
|
And [fill MONTH2]?
|
@21
@22
@23
|
|
And [fill MONTH1]?
|
@11
@12
@13
|
4-Month Total: $[fill MIJNTOTH]
|
JTOTHMRT2
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST21
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 216 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
OMRTRG1Q
Mark One Only
ASSET TYPE: MORTGAGES
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 250 dollars,
between 250 and 1,000 dollars,
between 1,000 and 2,000 dollars,
or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
|JOINT WITH:
|{display names marked in JTWHO4}
|
|
|
|
|
|
|
|
|
|
|
|
|
OMRTRG1Y
Mark One Only
ASSET TYPE: MORTGAGES
|JOINT WITH:
|{display names marked in JTWHO4}
[fill SORRYFIL]
|
Is the annual amount less than
|
500 dollars, between 500 and 2,500
|
dollars, between 2,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
OWNMTINT_PD
Mark One Only
(Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] held
mortgages [fill OWNAMEFIL](from which [fill HESHE] received interest).)
What is the easiest way for you to tell me about [fill HISHER]
interest income from those mortgages?
READ ANSWER CATEGORIES IF NECESSARY
H
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ -- None of these
@
Wednesday, August 22, 2007
Page 217 of 314
Survey:
Section: Assets 2
Items Booklet
OWNMTINT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
from all mortgages (from which [fill HESHE] received interest)
held in [fill HISHER] own name?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL21]
OWNMTINT2
Multiple Entry
How much interest did [fill TEMPNAME] receive from
all mortgages held in [fill HISHER] own name...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill MIOWN_TOT]
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST22
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: MORTGAGES
OWNMTR1Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than
250 dollars, between 250 and 1,000 dollars, between 1,000 and
2,000 dollars, or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Page 218 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
OWNMTR1Y
Mark One Only
ASSET TYPE: MORTGAGES
[fill SORRYFIL]
Was the annual amount less than 500 dollars, between 500 and
2,500 dollars, between 2,500 and 5,000 dollars, or more than
5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $2,499.99
$2,500 to $4,999.99
$5,000 or more
@
DKMRT
Enter Number
[fill ASIDEFRMFIL] is the total amount of interest
income [fill TEMPNAME] received since [fill MONTH1] 1st
from all [fill OTHERFIL] mortgages [fill HESHE] owned?
H
[fill ENTERLFIL]
$@
BIGAST23
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
DKMRT1MQ
Mark One Only
ASSET TYPE: MORTGAGES
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 250 dollars,
between 250 and 1,000 dollars, between 1,000 and 2,000 dollars,
or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
ROYALTY_PD
Mark One Only
[fill ASFIL1]
[fill ASFIL2]
(Earlier you said [fill TEMPNAME] had income from
royalties.)
What is the easiest way for you to tell me about
[fill HISHER] royalty income?
READ ANSWER CATEGORIES IF NECESSARY
H
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ -- None of these
@
Wednesday, August 22, 2007
Page 219 of 314
Survey:
Section: Assets 2
Items Booklet
ROYALTY
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
(If royalty income is shared, count only [fill HISHER] share.)
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL22]
ROYALTY2
Multiple Entry
How much royalty income did [fill HESHE] receive ...
(If royalty income is shared, count only [fill HISHER]
share.)
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill RNDUP1_TOT]
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
BIGAST24
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: ROYALTIES
ROYAL1Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than
25 dollars, between 25 and 100 dollars,
between 100 and 500 dollars, or more
than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Page 220 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Assets 2
ROYAL1Y
Mark One Only
ASSET TYPE: ROYALTIES
Was the annual amount less than
25 dollars, between 25 and 250 dollars,
between 250 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $249.99
$250 to $999.99
$1,000 or more
@
Mark One Only
Earlier you told me that [fill TEMPNAME]
had [fill OTHFIN]. Since [fill MONTH1]
1st, how much income did [fill HESHE]
receive from this investment?
(If this income is shared, count only
[fill HISHER] [fill CHILDFIL]
ENTER (N) FOR NONE
ENTER A NET LOSS AS A NEGATIVE AMOUNT
$@
RNDUP2_TOT
|{Display list of investments: I_OTHFIN}
|
|
|
|
|
H|
|
|
|
|
BIGAST25
Mark One Only
[fill RESPFIL]
THE AMOUNT ENTERED IS [fill LARGEFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
ASSET TYPE: [fill I_OTHFIN]
Was it less than 25 dollars, 25 to 100
dollars, 100 to 500 dollars, or more than
500 dollars?
(1)
(2)
(3)
(4)
$0 to $25
$25 to $99
$100 to $499
$500 or more
@
RNDP2RNG
|{Display list of investments}
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
DO NOT READ TO RESPONDENT
ASTRECUSE
Did the respondent use any records to answer any asset questions?
(1)
(2)
Yes
No
@
Wednesday, August 22, 2007
Page 221 of 314
Survey:
Section: Health Insurance
Page 222 of 314
Items Booklet
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
Multiple Entry
[fill HAVHAS] [fill TEMPNAME] been covered at any time in this month?
(1)
(2)
TCHIPMNTH
Yes
No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS/ENTER (N) FOR NO MORE
(1)
[fill
[fill
[fill
[fill
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
Yes
(2)
No
@1
@2
@3
@4
Mark One Only
At any time between [fill MONTH1] 1st and today
[fill WASWERE] [fill TEMPNAME][if ALSOFIL ne <>] [fill ALSOFIL][endif]
covered by Medicaid,[if CAIDPROG1 ne <>][fill CAIDPROG1], [endif]Medical
Assistance, or any other kind of government assistance program that
helps pay for health care?
H
READ IF NECESSARY: Do not include Medicare or government military health
insurance here; that will be covered later in another question.
CAIDANY
PRESS (M) TO VIEW MORE NAMES OF GOVERNMENT
HEALTH PROGRAMS OFFERED IN THIS STATE
(1)
(2)
Yes
No
@
Multiple Entry
What program [fill WASWERE] [fill TEMPNAME] covered by?
IF MORE THAN ONE NAME GIVEN ASK FOR THE ONE NAME USED MOST FREQUENTLY
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
CAIDNAME
Medicaid
Medical Assistance
[fill CAIDPROG1]
[fill CAIDPROG2]
[fill CAIDPROG3]
[fill CAIDPROG4]
[fill CAIDPROG5]
[fill NONMED1]
[fill NONMED2]
[fill NONMED3]
[fill NONMED4]
[fill CHIPFIL]
[fill CHIPFIL]
[fill CHIPFIL]
Other {SPECIFY: @SP}
@KEY [fill ERRORFIL]
Wednesday, August 22, 2007
Page 223 of 314
Survey:
Section: Health Insurance
Items Booklet
Multiple Entry
[fill HAVHAS] [fill TEMPNAME] been covered by
[fill MEDICAIDFIL] at any time in this month?
(1)
(2)
CDMNTH
Yes
No
@CDMTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill
[fill
[fill
[fill
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
@CDMTH1
@CDMTH2
@CDMTH3
@CDMTH4
Mark One Only
In what year did [fill PTEMPNAME] coverage start?
CAIDBEGYR
ENTER (A) FOR ALWAYS COVERED
YEAR:
@
Mark One Only
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT COVERAGE
STARTED IS BEFORE RESPONDENT WAS BORN, OR IN A FUTURE YEAR.
CAIDBEGPB
F1 to back up and correct
Press (P) to Proceed
Mark One Only
In what month did that coverage start?
MONTH:
CAIDBEGMTH
@
Mark One Only
And [fill HAVEHAS] [fill TEMPNAME] been covered every month since then,
up to [fill MONTHXFI]?
CAIDALL
(1) Yes
(2) No
@
Multiple Entry
When did [fill TEMPNAME] start receiving CONTINUOUS coverage,
every month up to today?
CAIDBEGST
MONTH:@MTH
YEAR: @YR
Page 224 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
CAIDBEGPB2
Mark One Only
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT
COVERAGE STARTED IS MORE THAN 3 YEARS AGO,
OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
MCARE
Mark One Only
At any time between [fill MONTH1] 1st and today
[fill WASWERE] [fill TEMPNAME] [fill ALSOFIL]
covered by Medicare?
H
READ IF NECESSARY: Medicare is the government health insurance program for
people 65 years old and older or people with certain disabilities.
(1)
(2)
Yes
No
@
Multiple Entry
[fill MEDIFIL] [fill C_WASWERE] [fill HESHE] covered by Medicare at any
time in this month?
(1)
(2)
CARETHEN
Yes
No
@CRMTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1)
[fill
[fill
[fill
[fill
Yes
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
(2)
No
@CRMTH1
@CRMTH2
@CRMTH3
@CRMTH4
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill WASWERE] covered under
[fill NAMEFIL] At any time between [fill MONTH1] 1st and today,
did [fill TEMPNAME] also have health insurance in [fill HISHER] own name?
(1)
(2)
HIOWN
Yes
No
@
Mark One Only
Earlier I recorded that [fill TEMPNAME] had health insurance
in [fill HISHER] own name. Is that correct?
POLVER
(1) Yes
(2) No
Wednesday, August 22, 2007
Page 225 of 314
Survey:
Section: Health Insurance
Items Booklet
HIDEP
Mark One Only
[fill OTHERFIL]
At any time between [fill MONTH1] 1st and today, (fill WASWERE] [fill
TEMPNAME] [fill ALSOFIL] covered as a family member on
someone else's plan?
(1) Yes
(2) No
PRICOV
Mark One Only
[fill OTHERFIL] [fill MEDICAREFIL][fill ANDFIL] [fill CAIDFIL]
[fill ATFIL] any time between [fill MONTH1] 1st
and today [fill WASWERE] [fill TEMPNAME] [fill ALSOFIL]
covered by [fill KINDFIL] health insurance?
INCLUDE MEDICARE SUPPLEMENT ("MEDIGAP") AND
GOVERNMENT MILITARY HEALTH INSURANCE HERE
(1) Yes
(2) No
@
HIOWNER
Mark One Only
[fill ISWASFIL] that health insurance coverage in [fill HISHER]
own name or [fill WASWERE] [fill HESHE] covered as a family member on
someone else's plan?
(1) Plan(s) in own name
(2) Covered by someone else's plan(s)
(3) Both
@
HIHOLDR
Mark All That Apply
Who is the policy holder?
| LN HOUSEHOLD MEMBER'S NAME
|{display ge <15>} plus
ENTER THE LINE NUMBER OF THE POLICY HOLDER(S)|(0 Non- Household Members
ENTER ALL THAT APPLY
|
ENTER (N) FOR NONE OR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@
|
Multiple Entry
[C_HAVHAS] [fill TEMPNAME] been covered
[fill EITHERFIL]
at any time in this month?
INCLUDE ALL PRIVATE PLANS THAT COVERED [fill CAPTEMPNAME] EITHER AS A
POLICY HOLDER OR AS A DEPENDENT ON SOMEONE ELSE'S PLAN.
(1) Yes
(2) No
PRIMNTH
H
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING
ENTER (N) FOR NO MORE
(1)
Yes
[fill MONTH1]?
[fill MONTH2]?
Page 226 of 314
(2)
@1
@2
No
[fill MONTH3]?
[fill MONTH4]?
@3
@4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
Mark All That Apply
And did [fill PTEMPNAME] health
insurance also cover [fill POLICYFIL]
at any time since [fill MONTH1] 1st?
(1) Yes
(2) No
@KEY
HIPERS
|LINE NO HOUSEHOLD MEMBER'S NAME
|Display HH members 15+
|
|
|
|
|
|
WHOHIPERS
Mark All That Apply
Who was covered?
@KEY
ENTER LINE NUMBERS OF PERSONS COVERED
ENTER (A) FOR ALL PERSONS COVERED
ENTER (N) FOR NO MORE
RE-ENTER LINE NUMBER TO DELETE
Mark One Only
[fill WASWEREFIL] **READ NAME(S)**
[fill ALSOFIL] covered during the same
months [fill TEMPNAME] [fil WASWEREFIL]
covered…?
[fill MONTH1FIL]
[fill MONTH2FIL]
[fill MONTH3FIL]
[fill MONTH4FIL]
[fill MONTHXFIL]
(1) Yes
(2) No
@
Mark All That Apply
Who was not covered in [fill MONTH1]?
MARK ALL THAT APPLY
ENTER (N) FOR NONE OR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
|LINE NO HOUSEHOLD MEMBER'S NAME
|[Display HH members 15+]
|
|
|
|
|
|
|
MNTHDEP
|List names as reported in HIPERS
|
|
|
|
|
|
|
|
|
|
|
|
|
MNTHERR1
|List names as reported in HIPERS
|
|
|
|
|
|
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH1]?
MNTHERR1B
(1) Yes
(2) No
@
Mark All That Apply
Who was not covered in [fill MONTH2]?
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
Wednesday, August 22, 2007
MNTHERR2
|List names as reported in HIPERS
|
|
|
|
|
|
Page 227 of 314
Survey:
Section: Health Insurance
Items Booklet
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH2]?
MNTHERR2B
(1) Yes
(2) No
Mark All That Apply
Who was not covered in [fill MONTH3]?
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
MNTHERR3
|List names as reported in HIPERS
|
|
|
|
|
|
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH3]?
MNTHERR3B
(1) Yes
(2) No
Mark All That Apply
Who was not covered in [fill MONTH4]?
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
MNTHERR4
|List names as reported in HIPERS
|
|
|
|
|
|
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH4]?
MNTHERR4B
(1) Yes
(2) No
Mark All That Apply
Who was not covered in [fill MONTH5]?
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
MNTHERR5
|List names as reported in HIPERS
|
|
|
|
|
|
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH5]?
MNTHERR5B
(1) Yes
(2) No
@
Mark One Only
During the period from [fill MONTH1] 1st through today,
did [fill HISHER] health insurance cover anyone who did NOT
live in this household?
HIOTHR
(1) Yes
(2) No
@
Page 228 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
HIWHO
Multiple Entry
Who was that?
(Who, OUTSIDE this household, did the health insurance cover?)
(1)
Yes
(2)
No
...Spouse/Partner
@HISPSE
...Children 18 years of age or older @HIOLDKID
...Children under 18 years old
@HIYNGKID
...Others
@HIOTHR
HEMPLY
Multiple Entry
Was the health insurance obtained through-H
READ ANSWER CATEGORIES
THIS QUESTION REFERS TO THE RESPONDENT'S CURRENT PRIMARY SOURCE OF
COVERAGE. IF THEY ARE NOT COVERED NOW, REFER TO THEIR MOST RECENT PRIMARY
PLAN.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
A Current employer, work or business
A Former employer or business
A Union
TRICARE/CHAMPUS
CHAMPVA
Military/VA health care
Private purchased
Or in some other way {pop up: SPECIFY: @SP}
@HE
Multiple Entry
Which employer [if R currently works for both
an employer and a business fill: or business]
provides that coverage?
MULTEMP
| JOBS
|
|
|
THIS QUESTION REFERS TO THE RESPONDENT'S
|
CURRENT PRIMARY SOURCE OF COVERAGE. IF THEY ARE | BUSINESSES
NOT COVERED NOW, REFER TO THEIR MOST RECENT
|
PRIMARY COVERAGE.
|
|
ENTER (1) TO SELECT A JOB
|
ENTER (2) TO SELECT A BUSINESS
|
|
@1
|
|
ENTER THE NUMBER OF THE [fill JOB/BUSINESS]
|
@2
|
Mark One Only
[fill DIDFIL] [fill HISHER] [fill EMPLOYERFIL] pay
all, part, or none of the premium of the coverage?
HICOST
THIS QUESTION REFERS TO THE RESPONDENT'S CURRENT PRIMAEY SOURCE OF
COVERAGE. IF THEY ARE NOT COVERED NOW, REFER TO THEIR MOST RECENT PRIMARY
COVERAGE.
(1)
(2)
(3)
All
Part
None
@
Wednesday, August 22, 2007
Page 229 of 314
Survey:
Section: Health Insurance
Items Booklet
CHIP
Mark One Only
[fill TEENFIL]
[fill COVERFIL]
At any time between [fill MONTH1] 1st
and today, [fill WASWEREFIL]
**READ LIST OF CHILD(REN)** covered
by [fill CHIPFIL] [fill CHIPORFIL]
SCHIP, the State Children's Health
Insurance Program that helps families
get health insurance for children?
(1)
(2)
Yes
No
@
|NAMES OF CHILDREN UNDER 20
|Display (L_NO)'s children under
|20
|
|
|
|
|
|
|
H |
|
|
|
|
CHIPKIDS
Mark All That Apply
PARENT IS
Which of [fill HISHER] children were
covered?
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
|
|
|LINE NO CHILD'S NAME
|Display (L_NO)'s children
|under <20>
|
|
|
|
|
|
|
Mark One Only
MORCHIP
ASK OR VERIFY
How about [NAME OF NEXT CHILD SELECTED IN CHIPKIDS]? Was [fill HESHEFIL]
also covered during **READ MONTHS**?
(1) Yes, covered same exact months
(2) No, covered different months
Multiple Entry
Has [fill KIDNAME1] been covered at any time this month?
(1)
(2)
CHIPMNTH
Yes
No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], [fill MONTH4] -- was [fill HESHEFIL] [fill ALSOFIL]
covered?
ENTER (A) FOR ALL REMAINING MONTHS / ENTER (N) FOR NO MORE
(1)
[fill
[fill
[fill
[fill
[fill
Yes
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
ERRORFIL]
Page 230 of 314
(2)
No
@1
@2
@3
@4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
Mark One Only
At any time between [fill MONTH1] 1st
|LINE NO CHILD'S NAME
and today, [fill WASWEREFIL]
|Display (L_NO)'s children
**READ NAME(S) OF CHILD(REN)**
|under <20>
[fill ALSOFIL] covered by Medicaid,
|
[if CAIDPROG1 ne <>][fill CAIDPROG1],
|
Medical Assistance, or any other kind of
|
government assistance program that helps pay |
for health care?
|
|
READ IF NECESSARY:
|
Do not include Medicare or government
|
military health insurance here; that will be |
covered later in another question.
|
|
PRESS (M) TO VIEW MORE NAMES OF
|
GOVERNMENT HEALTH PROGRAMS OFFERED IN
|
THIS STATE
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
PARENT IS: [fill TEMPNAME]
Which of [fill HISHER] children
were covered?
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER LINE NUMBER TO DELETE
@KEY
[fill ERRORFIL]
KIDANY
CAIDKIDS
|LINE NO CHILD'S NAME
|Display (L_NO)'s children under 20
|
|
|
|
|
|
|
|
|
|
Mark One Only
MORCAID
ASK OR VERIFY
How about [fill KIDNAME2]? Was [fill TEMP]
also covered during **READ MONTHS**?
(1) Yes, covered same exact months
(2) No, covered different months
@
Wednesday, August 22, 2007
Page 231 of 314
Survey:
Section: Health Insurance
Items Booklet
Multiple Entry
Has [fill KIDNAME2] been covered by
[fill KMEDICAID] at any time in this month?
(1)
(2)
KCDMNTH
Yes
No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], [fill MONTH4] -- was [fill HESHEFIL] [fill ALSOFIL]
covered?
ENTER (A) FOR ALL REMAINING MONTHS/ENTER (N) FOR NO MORE
(1)
[fill
[fill
[fill
[fill
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
Yes
(2)
No
@1
@2
@3
@4
Multiple Entry
First time asked:
What program was [fill KIDNAME2] covered by?
Subsequent times asked:
How about [fill KIDNAME2]?
(What program was [fill KIDNAME2] covered by?)
IF MORE THAN ONE NAME GIVEN ASK FOR THE ONE NAME USED MOST FREQUENTLY
(1) Medicaid
(2) Medical Assistance
(3) [fill CAIDPROG1]
(4) [fill CAIDPROG2]
(5) [fill CAIDPROG3]
(6) [fill CAIDPROG4]
(7) [fill CAIDPROG5]
(8) [fill NONMED1]
(9) [fill NONMED2]
(10) [fill NONMED3]
(11) [fill NONMED4]
(12) [fill CHIPFIL]
(13) [fill CHIPFIL]
(14) [fill CHIPFIL]
(15) Other {SPECIFY: @SP}
@KEY [fill ERRORFIL]
Mark One Only
In what year did [fill KIDNAME1]'s [fill CHIPFIL] coverage start?
KCAIDNAME
KDCAIDBEGYR
ENTER (A) FOR ALWAYS COVERED
YEAR: @
Mark One Only
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THAT COVERAGE STARTED IS BEFORE
[fill KIDNAME1] WAS BORN, OR IN A FUTURE YEAR.
KDCAIDBEGPB
F1 to back up and correct
Press (P) to Proceed
Mark One Only
In what month did that coverage start?
KDCAIDBEGMTH
MONTH: @
Page 232 of 314
Wednesday, August 22, 2007
Items Booklet
Mark One Only
And has [fill KIDNAME1] been covered
every month since then up to today?
Survey:
Section: Health Insurance
KDCAIDALL
(1) Yes
(2) No
@
Multiple Entry
When did [fill KIDNAME1] start receiving CONTINUOUS coverage,
every month, up through today?
KDCAIDBEGST
MONTH: @MTH
YEAR: @YR
Mark One Only
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THE COVERAGE STARTED IS BEFORE
[fill KIDNAME1] WAS BORN, OR IN A FUTURE YEAR.
KDCAIDBEGPB2
F1 to back up and correct
Press (P) to proceed
Mark One Only
In what year did [fill KIDNAME2]'s coverage start?
KDCAIDBEGYR2
ENTER (A) FOR ALWAYS COVERED
YEAR: @
Mark One Only
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THAT COVERAGE STARTED IS BEFORE
[fill KIDNAME2] WAS BORN, OR IN A FUTURE YEAR.
KDBEGPB2
F1 to back up and correct
Press (P) to proceed
Mark One Only
In what month did that coverage start?
KDCAIDBEGMTH2
MONTH: @
Mark One Only
And has [fill KIDNAME2] been covered
every month since then up to today?
KDCAIDALL2
(1) Yes
(2) No
@
Multiple Entry
When did [fill KIDNAME2] start receiving CONTINUOUS coverage,
every month, up through today?
KDCAIDBEGST2
MONTH: @MTH
YEAR: @YR
Wednesday, August 22, 2007
Page 233 of 314
Survey:
Section: Health Insurance
Items Booklet
Mark One Only
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THAT COVERAGE STARTED IS BEFORE
[fill KIDNAME2] WAS BORN, OR IN A FUTURE YEAR.
KDCAIDBEGPB2_2
F1 to back up and correct
Press (P) to Proceed
Mark One Only
[fill OTHERTHANFIL]
|LN NAME(S)
[fill ATFILL] any time since [fill MONTH1] 1st,|[any kid that was not covered all
[fill WASWEREFIL] **READ NAME(S)**
|months by private insurance
covered by any [fill OTHERFIL] type
|in current wave.]
of health insurance?
|
|
(1) Yes
|
(2) No
|
|
@
Mark All That Apply
PARENT IS: [fill NAME(L_NO)]
Which of [fill HISHER] children
were covered?
**READ NAME(S)**
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
@KEY
KDCOV
PRIKIDS
|LINE NO CHILD'S NAME
|Display (L_NO)'s children under 20
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
MORPRI
ASK OR VERIFY
How about [fill KIDNAME3]? Was [fill HESHE] also
covered during **READ MONTHS**?
(1) Yes, covered exact same months
(2) No, covered different months
Multiple Entry
Has [fill KIDNAME3] been covered [fill TEMP]
at any time in this month?
KDMNTH
(1) Yes
(2) No
@MONTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2], [fill
MONTH3], and [fill MONTH4] was [fill HESHEFIL] [fill /<>] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1) Yes
(2) No
[fill
[fill
[fill
[fill
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
Page 234 of 314
@1
@2
@3
@4
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
KDPOL
Mark All That Apply
ASK OR VERIFY
[if FIRST_TIME eq <0>]Who is the policy
holder for [fill KIDNAME3]'s plan?
[else]How about [fill KIDNAME3]?
(Who is the policy holder for
[fill KIDNAME3]'s plan?)[endif]
ENTER THE LINE NUMBER(S)
OF THE POLICY HOLDER(S)
ENTER (N) FOR NO MORE
@KEY
| Display HH members 15+
|(0) Non-Household Member
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
[fill JUSTFIL] I have recorded that [fill TEMPNAME] [fill WASWERE] not
covered by a health insurance plan at any time since [fill MONTH1] 1st.
VERIFY
Is that correct?
(1) Yes (not covered/none covered)
(2) No
@
Mark One Only
What type of insurance [fill WASWERE] [fill TEMPNAME] covered by?
VERPLAN
PRESS (M) TO VIEW MORE NAMES OF GOV'T HEALTH PROGRAMS OFFERED IN THIS STATE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
@
Medicare
Medicaid[/fill CAIDPROG1]
State Children's Health Insurance Program (CHIP)
TRICARE or CHAMPUS
CHAMPVA ("CHAMPVA" is the civilian health and medical program
of the Department of Veteran's Affairs)
VA healthcare
Military healthcare
Indian Health Service
Other government health care[if NONMED1 ne <>]/
[fill NONMED1][endif]
Employer/union provided (policyholder)
Employer/union provided (as dependent)
Privately purchased (policyholder)
Privately purchased (as dependent)
Plan of someone outside the household
Other
Wednesday, August 22, 2007
Page 235 of 314
Survey:
Section: Health Insurance
Items Booklet
Multiple Entry
[fill HAVHAS] [fill TEMPNAME] been covered at any time in this month?
VERMNTH
(1) Yes
(2) No
@MONTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill
[fill
[fill
[fill
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
@MONTH1
@MONTH2
@MONTH3
@MONTH4
Author Note: Repeat VERIFY thru VERMNTH for each person identified as not covered (in HINS12) then
goto HINS13A.
Multiple Entry
SHOW FLASHCARD H
Which ONE OR MORE of these reasons describe why [fill HESHE] [fill WASWERE]
not covered?
HINONE
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) Too expensive, can't afford health insurance
(2) No health insurance offered by (employer of self, spouse, or parent)
(3) Not working at a job long enough to qualify
(4) Job layoff, job loss, or any reason related to unemployment
(5) Not eligible because working part time or temporary job
(6) Can't obtain insurance because of poor health, illness, age, or a
pre-existing condition
(7) Dissatisfied with previous insurance OR don't believe in insurance
(8) Have been healthy, not much sickness in the family, haven't needed
health insurance
(9) Able to go to VA or military hospital for medical care
(10) Covered by some other health plan, such as Medicaid or CAID
(11) No longer covered by parents policy
(12) Other @SPEC @KEY
Mark One Only
(Earlier I recorded that [fill TEMPNAME] [fill HAVHAS] been
covered by private health insurance for the past several months.)
As far as you know, was there ever a time in [fill HISHER]
life when [fill TEMPNAME] [fill WASWERE] not covered by
private insurance?
(1)
(2)
HIHOWLNG
Yes
No
@
Page 236 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Health Insurance
Mark One Only
[if HIHOWLNG offpath](Earlier I recorded that you were covered by private
health insurance in [fill COVERAGEFIL].) Before [fill MONTHFIL],
when was the last time [fill TEMPNAME] [fill WASWERE] WITHOUT
private health insurance coverage?
HIHOWLNGYR
[else]When was the last time [fill TEMPNAME] [fill WASWERE]
WITHOUT private health insurance coverage?[endif]
ENTER (A) FOR ALWAYS COVERED
YEAR: @
Mark One Only
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT THE
UNINSURANCE SPELL STARTED IS BEFORE [fill NAME(L_NO)] WAS BORN,
OR IN A FUTURE YEAR.
PRICOVPB
F1 to back up and correct
Press (P) to Proceed
Mark One Only
In what month was that?
MONTH:
HIHOWLNGMTH
@
Mark One Only
[fill VERIFYFILL]
[fill TEMPNAME] EVER covered by private health insurance?
HINOLNG
(1) Yes
(2) No
@
Mark One Only
In what year did [fill TEMPNAME] last have
private health insurance?
HINOLNGYR
YEAR: @
Mark One Only
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT THE
UNINSURANCE SPELL STARTED IS BEFORE RESPONDENT WAS
BORN, OR IN A FUTURE YEAR.
UNINSPB
F1 to back up and correct
Press (P) to Proceed
Mark One Only
And what month (did [fill TEMPNAME] last have insurance)?
MONTH:
HINOLNGMTH
@
Wednesday, August 22, 2007
Page 237 of 314
Survey:
Section: Education
Page 238 of 314
Items Booklet
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Education
ENROLL
Mark One Only
Now I am going to ask about school enrollment.
[fill C_WASWERE] [fill TEMPNAME] enrolled in school, either full-time or
part-time, at any time between [fill MONTH1] 1st and today?
READ IF NECESSARY:
Include any regular school, such as elementary,
high school, or college, or any vocational, technical,
or business school beyond high school.
(1)
(2)
Yes
No
@
FULLPART
Mark One Only
[fill ISAREFIL] [fill HESHE] enrolled full-time or part-time?
H
(1)
(2)
Full-time
Part-time
@
Multiple Entry
[fill C_HAVHAS] [fill HESHE] been enrolled in school this month?
(1)
(2)
MNTHENRL
Yes
No
@ENRLM5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] enrolled in school?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1)
[fill
[fill
[fill
[fill
Yes
(2)
MONTH1]?
MONTH2]?
MONTH3]?
MONTH4]?
No
@ENRLM1
@ENRLM2
@ENRLM3
@ENRLM4
Wednesday, August 22, 2007
Page 239 of 314
Survey:
Section: Education
Items Booklet
Mark One Only
At what level or grade [fill WASWERE] [fill HESHE] enrolled?
(PROBE IF NECESSARY: Or are you enrolled in a vocational, technical,
or business school that doesn't really have a grade
or doesn't lead to an academic degree?)
"COLLEGE YEAR" INDICATES THE LEVEL ACCORDING TO ACADEMIC STANDING, NOT
THE NUMBER OF YEARS ENROLLED IN COLLEGE.
ENLEVEL
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Elementary grades 1-8
High School grades 9-12
College year 1 (Freshman)
College year 2 (Sophomore)
College year 3 (Junior)
College year 4 (Senior)
First year graduate or professional school
Second year or higher in graduate or professional school
Vocational, technical, or business school beyond high school
level
(10) Enrolled in college, but not working towards degree
@
Mark One Only
You said that [fill TEMPNAME] [fill WASWERE] ENROLLED in
[fill EDFIL1]
[fill EDFIL2]
Earlier I recorded that the highest grade or level [fill HESHE]
COMPLETED was
[fill EDFIL3]
Are both of these statements correct?
(1)
(2)
(3)
(4)
EDCHCK1
Yes, both statements are correct
Only COMPLETED statement is correct, ENROLLED statement should be
changed
Only ENROLLED statement is correct, COMPLETED statement should be
changed
Both the COMPLETED statement and the ENROLLED statement should be
changed
@
Mark One Only
At what level or grade [fill WASWERE] [fill HESHE] enrolled?
FXENRL
"COLLEGE YEAR" INDICATES THE LEVEL ACCORDING TO ACADEMIC STANDING,
NOT THE NUMBER OF YEARS ENROLLED IN COLLEGE.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Elementary grades 1-8
High School grades 9-12
College year 1 (Freshman)
College year 2 (Sophomore)
College year 3 (Junior)
College year 4 (Senior)
First year graduate or professional school
Second year or higher in graduate or professional school
Vocational, technical, or business school beyond
high school level
(10) Enrolled in college, but not working towards degree
@
Page 240 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Education
Mark One Only
What is the highest level of school [fill TEMPNAME] [fill HAVHAS]
completed or the highest degree [fill HESHE] [fill HAVHAS] received?
FXEDUC
REPORT ONLY "REGULAR" EDUCATIONAL ATTAINMENT HERE. DO NOT INCLUDE ANY
VOCATIONAL, TECHNICAL, TRADE, OR BUSINESS TRAINING.
(31)
(32)
(33)
(34)
(39)
(40)
(41)
(43)
(44)
(45)
(46)
(47)
Less than 1st grade
(35) 9th grade
1st, 2nd, 3rd or 4th grade
(36) 10th grade
5th or 6th grade
(37) 11th grade
7th or 8th grade
(38) 12th grade, no diploma
HIGH SCHOOL GRADUATE (diploma or GED or equivalent)
Some college credit, but less than 1 year
1 or more years of college, no degree (regular Jr. coll./coll./univ.)
Associate (2-yr) college degree
Bachelor's degree (for example: BA, AB, BS)
Master's degree (for example: MA, MS, MENG, Med, MSW, MBA)
Professional School degree (for example: MD, DDS, JD)
Doctorate degree (for example: Ph.D., Ed.D.)
@
Mark One Only
[fill C_WASWERE] [fill HESHE] enrolled in a program working
towards a degree?
EDCHCK2
(1) Yes
(2) No
@
Mark One Only
Since [fill MONTH1] 1st, were any of [fill TEMPNAME] educational expenses
paid for by any type of educational assistance or financial aid?
EDFUND
READ IF NECESSARY: Include financial assistance such as loans, grants,
scholarships, employer assistance, veterans benefits, or any other type of
financial aid.
(1) Yes
(2) No
@
Mark All That Apply
SHOW FLASHCARD J
H
What kind of educational assistance did [fill TEMPNAME] receive? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NONE/NO MORE / RE-ENTER PRECODE TO DELETE
(1) Federal PELL Grant
(2) Assistance from the Department of Veteran's Affairs (VA) such as GI or
Montgomery Bill, Survivors and Dependents, other Veterans'
Administration Educational Assistance Programs
(3) College (or Federal) Work Study Program
(4) Any Other Federal grant or program; for example, SEOG, Health or
Nursing Grant, ROTC, NSF Grant
(5) A loan that has to be repaid, for example, Stafford, Perkins, or SLS
(6) A grant, scholarship, or tuition remission from the school attended
(7) A teaching or research assistantship from the school attended
(8) A grant/scholarship from the state, such as SSIGP, Douglas Scholarships
(9) A grant or scholarship from some other source, such as a foundation,
corporation, or community group, National Merit Scholarship, etc.
(10) Assistance provided by [fill HISHER] employer
(11) Aid from some other source (EXCLUDE all direct aid from parents
including trusts or college savings funds)
(12) Assistance from a state or local welfare office
@KEY
Wednesday, August 22, 2007
EDASST
Page 241 of 314
Survey:
Section: Programs
Page 242 of 314
Items Booklet
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Programs
HOTLUNYN2
Mark One Only
[fill /<>]
|{Display Names of Children in HH
|and put a * in front of the ones
|marked in I_WHOHOTLN or I_WHOHOTLN2}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Since [fill MONTH1] 1st, did
[fill DIDCLDFIL] usually get the
lunch that [fill YOURTHEIRFIL]
school provides?
ENTER (1)[if NUMCLD eq <1>]THE [else]
AT LEAST ONE CHILD USUALLY BOUGHT
THE SCHOOL LUNCH OR RECEIVED FREE LUNCH
(1) Yes
(2) No
@
Mark All That Apply
Which children usually got the school
lunch?
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
WHOHOTLN2
H
| CHILDREN BETWEEN AGES 5 AND 18
| LN NAME
|{Display >KIDS< template}
|
|
|
|
|
@KEY
FREELNYN2
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
H
(1) Yes
(2) No
@
FREREDLN2
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
(1) Yes
(2) No
1
ASK OR VERIFY:
Were they free or reduced-price?
H
(1) Free lunch
(2) Reduced-price lunch
@
Wednesday, August 22, 2007
Page 243 of 314
Survey:
Section: Programs
Items Booklet
BRKFSTYN2
Mark One Only
[fill /<>]
Since [fill MONTH1] 1st, did
[fill DIDCLDFIL] usually get the
breakfast that [fill YOURTHEIRFIL]
school provides?
H
ENTER (1) [if NUMCLD eq <1>]THE [else]
AT LEAST ONE CHILD USUALLY BOUGHT
THE SCHOOL BREAKFAST OR RECEIVED
FREE BREAKFAST
(1) Yes
(2) No
@
Mark All That Apply
Which children usually got
the school breakfast?
ENTER ALL THAT APPLY
ENTER (A) FOR ALL CHILDREN LISTED
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
|{Display Names of Children in HH
|and put a * in front of the ones
|marked in I_WHOBRK or I_WHOBRK2}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
WHOBRK2
| CHILDREN BETWEEN AGES 5 AND 18
| LN NAME
H | display >KIDS< template
|
|
|
|
|
@KEY
Mark One Only
IF NO BLANK/MISSING ITEMS ARE SHOWN, DO NOT READ THIS QUESTION.
ENTER "NO" AND CONTINUE..
CALLBCK
We are missing some information that is very important to this survey.
If I were to call back later would you be able to tell me…?
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill
A_CALLBACK(1)]
A_CALLBACK(2)]
A_CALLBACK(3)]
A_CALLBACK(4)]
A_CALLBACK(5)]
A_CALLBACK(6)]
A_CALLBACK(7)]
A_CALLBACK(8)]
A_CALLBACK(9)]
A_CALLBACK(10)]
A_CALLBACK(11)]
A_CALLBACK(12)]
A_CALLBACK(13)]
(1)
(2)
@
Page 244 of 314
Yes
No
Wednesday, August 22, 2007
Items Booklet
Mark One Only
DO NOT READ TO RESPONDENT
NAME has been skipped.
Survey:
Section: Skip
PRSNSKIP
HIT ENTER TO CONTINUE
@
Wednesday, August 22, 2007
Page 245 of 314
Survey:
Section: Wrapup
Items Booklet
Mark One Only
Now I have a number of questions for [fill NAMEFIL].
It would be best if I could talk to
[fill HERHIMFIL] directly.
Is [fill SHEHEFIL] available now?
(1)
(2)
LFSELF
Yes [fill RIPFIL]
No
@
LFSELF2
Mark One Only
[fill AWAYFIl]
[fill COULDFIL] you or someone else in the household answer
these questions for [fill PERSONFIL]?
(1)
(2)
(3)
(4)
Yes, (take proxy interview)
No
No, skip for now, try again before leaving household
TYPE-Z -- not available during entire interviewing period
@
WHYTYPZ1
Mark One Only
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
WHYSP1
Mark One Only
Enter other TYPE-Z reason.
@
Mark One Only
ASK IF NECESSARY
Who will be answering for [fill NAMEFIL]?
@
LFPROXY
| HOUSEHOLD ROSTER
| LINE
NAME
| {Display PXYRS template}
|
|
Mark One Only
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1)
(2)
RIP
Yes
No
@
Page 246 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Wrapup
Mark One Only
I need to continue the interview with [fill TEMP2+].
Is [fill TEMP2+] available now?
(1)
(2)
LF2SELF
Yes [fill RIPFIL]
No
@
Mark One Only
Could you or someone else in the household answer
these questions for [fill NAMEFIL].
(1)
(2)
(4)
LF2SELF2
Yes, (take proxy interview)
No
TYPE-Z -- not available during entire interviewing period
@
WHYTYPZ2
Mark One Only
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
WHYSP2
Mark One Only
Enter other TYPE-Z reason.
@
Mark One Only
ASK IF NECESSARY
Who will be answering for [fill NAMEFIL]?
LFPROXY2
| HOUSEHOLD ROSTER
| LINE
NAME
| Display PXYRS template
@
Mark One Only
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1)
(2)
RIP2
Yes
No
@
Mark One Only
I need to continue the interview with [fill SHEHEFIL].
Is [fill SHEHEFIL] available now?
(1)
(2)
LF3SELF
Yes [fill RIPFIL]
No
@
Wednesday, August 22, 2007
Page 247 of 314
Survey:
Section: Wrapup
Items Booklet
Mark One Only
Could you or someone else in the household answer
these questions for [fill NAMEFIL]?
(1)
(2)
(4)
LF3SELF2
Yes, (take proxy interview)
No
TYPE-Z -- not available during entire interviewing period
@
WHYTYPZ3
Mark One Only
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
WHYSP3
Mark One Only
Enter other TYPE-Z reason.
@
Mark One Only
ASK IF NECESSARY
Who will be answering for
[fill NAMEFIL]?
@
LFPROXY3
| HOUSEHOLD ROSTER
| LINE
NAME
| Display PXYRS template
|
|
Mark One Only
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1)
(2)
RIP3
Yes
No
@
Mark One Only
Would it be possible for me to complete the interview
for [fill NAMEFIL] now?
(1)
(2)
(4)
TRYAGAIN
Yes
No
TYPE-Z -- not available during entire interviewing period
@
Mark One Only
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
WHYTYPZ4
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Page 248 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Wrapup
WHYSP4
Mark One Only
Enter other TYPE-Z reason.
@
Mark One Only
ASK IF NECESSARY
Who will be answering for [fill NAMEFIL]?
@
LFPROXY4
| HOUSEHOLD ROSTER
| LINE
NAME
| Display PXYRS2 template
|
Mark One Only
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1)
(2)
RIP4
Yes
No
@
Mark One Only
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1)
(2)
RIP5
Yes
No
@
Mark One Only
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND
ENTERED THE INFORMATION WE NEED. ENTER "NO" AND CONTINUE.
MISNEED
THE INFORMATION BELOW IS MISSING FROM THIS INTERVIEW.
IS THIS INFORMATION AVAILABLE NOW?
(1)
(2)
Yes - Collect missing items
No - Exit case
{display names and fills, as on MISITCB}
@
Wednesday, August 22, 2007
Page 249 of 314
Survey:
Section: Missing
Items Booklet
Page 250 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND
ENTERED THE INFORMATION WE NEED. TRANSMIT THE CASE AS IS.
MISITCB
The last time that I spoke with [fill SOMEONEYOUFIL]
I was told I could call back for a few pieces of information.
I would like to follow up now. I notice that we are missing-{Display people with CB eq <1>}
[fill A_CALLBACK(<1>)]
[fill A_CALLBACK(<2>)]
[fill A_CALLBACK(<3>)]
[fill A_CALLBACK(<4>)]
[fill A_CALLBACK(<5>)]
[fill A_CALLBACK(<6>)]
[fill A_CALLBACK(<7>)]
[fill A_CALLBACK(<8>)]
[fill A_CALLBACK(<9>)]
[fill A_CALLBACK(<10>)]
[fill A_CALLBACK(<11>)]
[fill A_CALLBACK(<12>)]
[fill A_CALLBACK(<13>)]
PRESS ENTER TO CONTINUE
@
MISITKNOW
Mark One Only
Is this information available now?
(1)
(2)
Yes
No
@
Mark One Only
ASK IF NECESSARY: With whom am I speaking?
ENTER LINE NUMBER
@
MISITRESP
| Line
First Name
| display template HHROS2
|
|
|
Mark One Only
The next questions are about the income [TEMPNAME]
received from [HISHER] job with [EMPNAM].
MEASYWAY
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL][fill HOURFIL]annual income amounts,
if that would be easier. What would be easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
Monthly totals
Weekly/Biweekly/Bimonthly>]
Hourly pay rates>/<>]
Annual amount
Some other way
@
Wednesday, August 22, 2007
Page 251 of 314
Survey:
Section: Missing
Multiple Entry
[if MEASYWAY offpath]The next questions are about the income [fill
TEMPNAME] received from [fill HISHER] job with [fill EMPNAM].[endif]
Items Booklet
MMONTHLY
How much [fill RECEIVFIL] BEFORE deductions from
[fill JOBBIZFIL]...?
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[if APPENDEMP ne <1> and HHSTATRIP ne <3>]ENTER (L) FOR SAME AS LAST
INTERVIEW
[fill MONTH5FIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
{popup: MMONTHLY5_ERR or MMONTHLY4_ERR or MMONTHLY3_ERR or MMONTHLY2_ERR or MMONTHLY1_ERR}
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MMONTHLY5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MMONTHLY4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MMONTHLY3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MMONTHLY2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MMONTHLY1_ERR
Page 252 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
MBIGMONTH5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MMONTHLY@5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGMONTH4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MMONTHLY@4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGMONTH3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MMONTHLY@3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGMONTH2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MMONTHLY@2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGMONTH1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MMONTHLY@1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Since [fill MONTHXFIL],
[fill PAYCKVARYFIL]?
(1)
(2)
MVARY
The same
Varied
@
Wednesday, August 22, 2007
Page 253 of 314
Survey:
Section: Missing
Items Booklet
Enter Number
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
MSAME
[fill ENTERVFIL]
[fill ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
MPAYAPRX
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGSAME
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill MSAME], IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
That comes out to about $[fill PAYHOURFIL] per month.
Does that sound about right?
(1)
(2)
MCALCPYVR
Yes
No
@
Enter Number
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount before all
taxes and deduction?
MSAMECHK
$@
Page 254 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Multiple Entry
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL] from [fill EMPNAM]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
RECORD EACH PAYCHECK SEPARATELY, IF POSSIBLE.
[fill MONTH5FIL][fill PAYDAYFIL5]
[fill SORRYFIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
[fill PAYDAYFIL4]
@44
@45
[fill MONTH3FIL]
@31
@32
@33
[fill PAYDAYFIL3]
@34
@35
[fill MONTH2FIL]
@21
@22
@23
[fill PAYDAYFIL2]
@24
@25
MP1M
[fill MONTH1FIL] [fill PAYDAYFIL1]
@11
@12
@13
@14
@15
[fill ERRORFIL]
{popup: MP1M5_ERR or MP1M4_ERR or MP1M3_ERR or MP1M2_ERR or MP1M1_ERR}
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
MP1M1_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
MP1M2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
MP1M3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
MP1M4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
MP1M5_ERR
Mark One Only
DO NOT READ TO RESPONDENT
MMTOT5VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MTOTAL5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 22, 2007
Page 255 of 314
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
Items Booklet
MMTOT4VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MTOTAL4], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MMTOT3VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MMTOT2VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MTOTAL2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MMTOT1VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when [fill TEMPNAME] received additional checks?
MEXTRA1
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Page 256 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Enter Number
The next questions are about the income [fill TEMPNAME] received
from [fill HISHER] job with [fill EMPNAM]
MPYRAT
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill ATJOBFIL]?
READ IF NECESSARY: Do not include your overtime rate here.
at overtime rates will be collected later.
Income earned
ENTERLFIL
$@ per hour
Mark One Only
[fill SORRYFIL]
Can you give me an approximate amount?
MHRAPRX
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGHOUR
THE HOURLY RATE ENTERED, $[fill MPYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill HISHER] job with [fill EMPNAM] [fill ISWASFIL]
$[fill MPYRAT].
MRATECHG
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
Same pay rate throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill MPYRAT] an hour pay rate first show up in
[fill PTEMPNAME] paycheck?
MSTRTPAY
MONTH: @MTH
DAY:
@DAY
Enter Number
What was [fill PTEMPNAME] hourly pay rate before that?
[fill ENTERLFIL]
MPYRAT2
$@ per hour
Wednesday, August 22, 2007
Page 257 of 314
Survey:
Section: Missing
Items Booklet
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
MHRAPRX2
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGHOUR2
THE HOURLY RATE ENTERED, $[fill MPYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Earlier you stated that [fill TEMPNAME] usually worked
[fill JOBHRS] hours per week. At [fill PYRAT] per hour, that
works out to about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right for [fill PTEMPNAME] gross income?
(1)
(2)
MCALCHRVR
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income BEFORE
deductions from [fill EMPNAM] [fill WEEKFIL] at that
[fill MPYRAT] pay rate?
MESTHR1
$@
Mark One Only
$[fill MPYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1)
(2)
MCALCHRV2
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income BEFORE
deductions from [fill EMPNAM] [fill WEEKFIL] at that
[fill MPYRAT2] pay rate?
MESTHR2
$@
Enter Number
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
with [fill EMPNAM] [fill JOBENDFIL]
MAMOUNT1
[fill ENTERLFIL]
$@
Page 258 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a
couple thousand dollars or so?
MAPXAMT1
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGAMOUNT1
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
[fill HASWASFIL] [fill HISHER] annual salary for the whole
time [fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
MSAMEAMT1
Same annual salary throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill PAYANNFIL] annual salary first show up
in [fill PTEMPNAME] paycheck?
MSTRTANN1
MONTH: @MTH
DAY: @DAY
Enter Number
What was [fill PTEMPNAME] annual salary before that?
MAMOUNT2
[fill ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
MAPXAMT2
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGAMOUNT2
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 259 of 314
Survey:
Section: Missing
Mark One Only
That $[fill PAYANN2FIL] annual salary, divided by 12 months, works out
to be about $[fill PAYANN1FIL]. Does that sound about right
for a gross monthly amount?
Items Booklet
MCALCANN1
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross
monthly income from [fill EMPNAM] at that annual salary rate?
MESTANN1
$@
Mark One Only
And for [fill HISHER] salary before that...
$[fill PAYANN1FIL] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
MCALCANN2
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average
gross monthly income from [fill EMPNAM] at that
annual salary rate?
MESTANN2
$@
Multiple Entry
Let's try [fill ANOTHERFIL).
How much [fill RECEIVFIL] BEFORE deductions from
[fill EMPNAM]?
MTRYMNTH
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill MONTHXFIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 260 of 314
MTRYMTH5_ERR
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MTRYMTH4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MTRYMTH3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MTRYMTH2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MTRYMTH1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTRYMTH5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MTRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTRYMTH4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MTRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTRYMTH3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MTRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 261 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTRYMTH2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MTRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTRYMTH1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MTRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Since [fill MONTH1STFIL], did [fill TEMPNAME] receive
any tips, bonuses, cash or montery awards, overtime pay,
or commissions from [fill JOBBIZFIL]?
MANYTIPS
(1) Yes
(2) No
@
Mark One Only
Did the income amounts we just talked about include all of
[fill PTEMPNAME] (tips, bonuses, cash awards, overtime pay,
or commissions) from [fill JOBBIZFIL]?
MTIPS
(1) Yes
(2) No
@
Multiple Entry
How much [fill RECEIVFIL] in (tips, bonuses, cash awards, overtime
pay, or commissions) [fill JOBBIZFIL]...?
READ IF NECESSARY: Your best estimate here is fine.
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill MONTH5FIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
@14
@15
[fill MONTH1FIL]
@11
@12
@13
[fill ERRORFIL]
Page 262 of 314
MTIPSAMT
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTIP5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill TIPTOTAL5],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTIP4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill TIPTOTAL4],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTIP3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill TIPTOTAL3],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTIP2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill TIPTOTAL2],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGTIP1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill TIPTOTAL1],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 263 of 314
Survey:
Section: Missing
Items Booklet
Multiple Entry
The next questions are about the income [fill TEMPNAME] received from
all of [fill HISHER] [fill JOBFIL]. What [fill ISWASFIL] the total
amount of income, BEFORE taxes and other deductions, that [fill TEMPNAME]
[fill HAVHAS] received from [fill JOBEMPFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51
@52
@53
@54
@55
MCONTING
How about [fill MONTH4]?
@41
@42
@43
@44
@45
And [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
Mark One Only
DO NOT READ TO RESPONDENT
MBIGCON5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill CONTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGCON4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill CONTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGCON3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill CONTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBIGCON2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill CONTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 264 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
MBIGCON1
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill CONTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
MTAKEHOME
Mark One Only
[fill REGPAYFIL] the amounts you gave
me [fill HISHER] take-home pay, or were they [fill HISHER]
gross pay BEFORE any taxes and other deductions were taken out?
H
(1)
(2)
(3)
Take-home pay (net, after deductions)
Gross (total) pay (before deductions)
No deductions (gross pay = net pay)
@
Mark One Only
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available, such
as pay stubs, that would show the gross amount?
MGETGROSS
(1) Yes
(2) No
@
Multiple Entry
What were the gross pay amounts in [fill MONTH5]?
MGROSSPAYM5
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M5_2]
$[fill P1M5_3]
$[fill P1M5_4]
$[fill P1M5_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MGROSSM5VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH5],
$[fill GTOTAL5], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 22, 2007
Page 265 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
DO NOT READ TO RESPONDENT
MALLGROSSM5
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH4]?
MGROSSPAYM4
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M4_2]
$[fill P1M4_3]
$[fill P1M4_4]
$[fill P1M4_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MGROSSM4VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH4],
$[fill GTOTAL4], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MALLGROSSM4
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH3]?
MGROSSPAYM3
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M3_2]
$[fill P1M3_3]
$[fill P1M3_4]
$[fill P1M3_5]
Page 266 of 314
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
MGROSSM3VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH3],
$[fill GTOTAL3], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MALLGROSSM3
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH2]?
MGROSSPAYM2
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M2_2]
$[fill P1M2_3]
$[fill P1M2_4]
$[fill P1M2_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MGROSSM2VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH2],
$[fill GTOTAL2], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MALLGROSSM2
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Wednesday, August 22, 2007
Page 267 of 314
Survey:
Section: Missing
Items Booklet
Multiple Entry
What were the gross pay amounts in [fill MONTH1]?
MGROSSPAYM1
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill P1M1_2]
$[fill P1M1_3]
$[fill P1M1_4]
$[fill P1M1_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MGROSSM1VER
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH1],
$[fill GTOTAL1], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MALLGROSSM1
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
What was the gross annual amount?
MGROSSPAYANN
$@
Mark One Only
The next questions are about the income
[fill TEMPNAME] received from [fill ALLBUS].
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL] [fill HOURFIL]quarterly, or annual income amounts,
if that would be easier. What's easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
(6)
MBEASYWAY
Monthly totals
Weekly/Biweekly/Bimonthly paychecks>]
Hourly pay rates>/<>]
Quarterly amount
Annual amount
Some other way
@
Page 268 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Multiple Entry
[fill THENEXTQFIL]
How much income [fill RECEIVFIL] from this business BEFORE taxes and
other deductions...?
[NOTEFIL]
H
[fill ENTERLFIL]
[fill MONTH5FIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill SORRYFIL]
MBMONTHLY
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBMONTHLY5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBMONTHLY4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBMONTHLY3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBMONTHLY2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBMONTHLY1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGMONTH5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MBMONTHLY@5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 22, 2007
Page 269 of 314
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
Items Booklet
MBBIGMONTH4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MBMONTHLY@4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGMONTH3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MBMONTHLY@3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGMONTH2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MBMONTHLY@2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGMONTH1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MBMONTHLY@1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
Since [fill MONTHXFIL],
[fill PAYCKVARYFIL]?
MBVARY
(1) The same
(2) Varied
@
Enter Number
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
MBSAME
[fill ENTERVFIL]
[fill ENTERLFIL]
$@
Page 270 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
MBPAYAPRX
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGSAME
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill MBSAME], IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
That comes out to about $[fill BPAYMONFIL] per month.
Does that sound about right?
(1)
(2)
MBCALCPYVR
Yes
No
@
Enter Number
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount before all
taxes and deductions?
MBSAMECHK
$@
Multiple Entry
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL]
from [fill ALLBUS]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill MONTH5FIL][fill PAYDAYFIL5]
[fill SORRYFIL]
@51
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
[fill PAYDAYFIL4]
@44
@45
[fill MONTH3FIL]
@31
@32
@33
[fill PAYDAYFIL3]
@34
@35
[fill MONTH2FIL]
@21
@22
@23
[fill PAYDAYFIL2]
@24
@25
[fill MONTH1FIL]
@11
@12
@13
[fill ERRORFIL]
[fill PAYDAYFIL1]
@14
@15
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 22, 2007
MBP1M
MBP1M5_ERR
Page 271 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBP1M4_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBP1M3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBP1M2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBP1M1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
MBMTOT5VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BMTOTAL5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBMTOT4VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BMTOTAL4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBMTOT3VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BMTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(2) PROCEED
@
Page 272 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
MBMTOT2VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BMTOTAL2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBMTOT1VER
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BMTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(2) PROCEED
@
Mark One Only
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when [fill TEMPNAME] received additional checks?
MBEXTRA1
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Enter Number
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill FROMBIZFIL]?
MBPYRAT
READ IF NECESSARY: Do not include your overtime rate here.
Income earned at overtime rates will be collected later.
[fill ENTERNFIL]
[fill ENTERLFIL]
$@ per hour
Mark One Only
[fill SORRYFIL]
Can you give me an approximate amount?
MBHRAPRX
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGHOUR
THE HOURLY RATE ENTERED, $[fill MBPYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 273 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill ALLBUS] [fill ISWASFIL]
$[fill MBPYRAT].
MBRATECHG
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill BUSSTRTFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1)
(2)
Same pay rate throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill MBPYRAT] an hour pay rate first show up
in [fill PTEMPNAME] paycheck?
MBSTRTPAY
MONTH: @MTH
DAY: @DAY
Enter Number
What was [fill PTEMPNAME] hourly pay rate before that?
[fill ENTERLFIL]
MBPYRAT2
$@ per hour
Enter Number
[fill SORRYFIL]
Can you give me an approximate amount?
MBHRAPRX2
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGHOUR2
THE HOURLY RATE ENTERED, $[fill MBPYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Earlier you stated that [fill TEMPNAME] usually worked
[fill HRSBS] hours per week. At $[fill MBPYRAT], that works out to
about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right?
(1)
(2)
MBCALCHRVR
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income
BEFORE deductions from [fill ALLBUS] [fill WEEKFIL]
at that [fill MBPYRAT] pay rate?
MBESTHR1
$@
Page 274 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
$[fill MBPYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1)
(2)
MBCALCHRV2
Yes
No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] income
BEFORE deductions from [fill ALLBUS] [fill WEEKFIL]
at [fill MBPYRAT2] pay rate?
MBESTHR2
$@
Enter Number
What was [fill PTEMPNAME] income before taxes
and personal deductions from [fill ALLBUS]
for the most recent quarter (or the most recent quarter
that you can tell me about)?
MBQTRAMT
[fill ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate quarterly salary amount -within a couple thousand dollars or so?
MBAPXQTR
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGQTR
THE QUARTERLY RATE ENTERED, $[fill MBQTRAMT], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Multiple Entry
And when did that quarter close?
MBQTRMNTH
(What was the last month and year of the quarter that
the [fill QTRAMTFIL] dollars applies to?
MONTH:
YEAR:
@MTH
@YEAR
Enter Number
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
annual salary with [fill ALLBUS] [fill BIZENDFIL]
MBAMOUNT1
[fill ENTERLFIL]
$@
Wednesday, August 22, 2007
Page 275 of 314
Survey:
Section: Missing
Items Booklet
Enter Number
MBAPXAMT1
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a
couple of thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGAMT1
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
[fill HASWASFIL] [fill HISHER] [fill CURRENTFIL] for the whole time
[fill BUSSTRTFIL], or did [fill HESHE] salary change
[fill SINCETHENFIL]?
(1)
(2)
MBSAMEAMT1
Same [fill CURRENTFIL] throughout; NO raise/decrease
RAISE/DECREASE
@
Multiple Entry
When did that $[fill PAYANN1FIL] annual salary first show up in
[fill PTEMPNAME] paycheck?
MBSTRTANN1
MONTH: @MTH
DAY: @DAY
Enter Number
What was [fill PTEMPNAME] annual salary before that?
MBAMOUNT2
[fill ENTERLFIL]
$@
Enter Number
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
MBAPXAMT2
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGAMT2
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 276 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
That $[fill PAYANN2FIL] annual salary, divided by 12 months,
works out to about $[fill PAYANN1FIL]. Does that sound
about right for a gross monthly amount?
MBCALCANN1
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross
monthly income from [fill ALLBUS] at that annual salary rate?
MBESTANN1
$@
Mark One Only
And for [fill HISHER] salary before that...
$[fill PAYANN1FIL] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
MBCALCANN2
(1) Yes
(2) No
@
Enter Number
What is your best estimate of [fill PTEMPNAME] average
gross monthly income from [fill ALLBUS] at that annual salary rate?
MBESTANN2
$@
Multiple Entry
Let's try [fill ANOTHERFIL].
How much [fill RECEIVFIL] BEFORE deductions from
[fill ALLBUS]?
MBTRYMNTH
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill MONTHXFIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBTRYMTH5_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBTRYMTH4_ERR
Wednesday, August 22, 2007
Page 277 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBTRYMTH3_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBTRYMTH2_ERR
Mark One Only
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
MBTRYMTH1_ERR
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGTRY5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MBTRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGTRY4
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MBTRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGTRY3
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MBTRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGTRY2
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MBTRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Page 278 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGTRY1
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MBTRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Mark One Only
Other than [fill HISHER] regular income, since [fill MONTH1] 1st,
did [fill TEMPNAME] receive any tips, bonuses, overtime pay,
or commissions from [fill HISHER] work with [fill ALLBUS]?
MBANYTIPS
(1) Yes
(2) No
@
Mark One Only
Did the income amounts we just talked about include all of
[fill PTEMPNAME] tips, bonuses, overtime pay, or commissions
from [fill ALLBUS]?
MBTIPS
(1) Yes
(2) No
@
Multiple Entry
How much [fill RECEIVFIL] in tips, bonuses, overtime pay,
or commissions [fill FROMBIZFIL]?
READ IF NECESSARY: Your best estimate here is fine.
ENTER
ENTER
[fill
@51
MBTIPSAMT
(N) FOR NONE OR NO MORE
(S) FOR SAME AS PREVIOUS AMOUNT
MONTH5FIL]
@52
@53
@54
@55
[fill MONTH4FIL]
@41
@42
@43
@44
@45
[fill MONTH3FIL]
@31
@32
@33
@34
@35
[fill MONTH2FIL]
@21
@22
@23
@24
@25
@14
@15
[fill MONTH1FIL]
@11
@12
@13
[fill ERRORFIL]
Mark One Only
DO NOT READ TO RESPONDENT
MBBIGTIP5
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BTIPTOTAL5],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
Wednesday, August 22, 2007
Page 279 of 314
Survey:
Section: Missing
Items Booklet
MBBIGTIP4
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BTIPTOTAL4],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
MBBIGTIP3
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BTIPTOTAL3],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
MBBIGTIP2
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BTIPTOTAL2],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
MBBIGTIP1
Mark One Only
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BTIPTOTAL1],
IF UNUSUALLY [fill LGSMFIL].
(1)
(P)
BACK UP AND CORRECT
Proceed
@
MBTAKEHOME
Mark One Only
Just to be sure -- were the amounts you gave me [fill HISHER]
take-home pay, or were they [fill HISHER] gross pay BEFORE any
taxes and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Mark One Only
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available,
such as pay stubs, that would show the gross amount?
MBGETGROSS
(1) Yes
(2) No
@
Page 280 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Multiple Entry
What were the gross pay amounts in [fill MONTH5]?
MBGROSSPAYM5
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M5_2]
$[fill BP1M5_3]
$[fill BP1M5_4]
$[fill BP1M5_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MBGROSSM5VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH5],
$[fill BGTOTAL5], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBALLGROSSM5
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH4]?
MBGROSSPAYM4
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M4_2]
$[fill BP1M4_3]
$[fill BP1M4_4]
$[fill BP1M4_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MBGROSSM4VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH4],
$[fill BGTOTAL4], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 22, 2007
Page 281 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
DO NOT READ TO RESPONDENT
MBALLGROSSM4
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH3]?
MBGROSSPAYM3
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M3_2]
$[fill BP1M3_3]
$[fill BP1M3_4]
$[fill BP1M3_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MBGROSSM3VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH3],
$[fill BGTOTAL3], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBALLGROSSM3
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH2]?
MBGROSSPAYM2
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M2_2]
$[fill BP1M2_3]
$[fill BP1M2_4]
$[fill BP1M2_5]
Page 282 of 314
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
DO NOT READ TO RESPONDENT
MBGROSSM2VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH2],
$[fill BGTOTAL2], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBALLGROSSM2
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
What were the gross pay amounts in [fill MONTH1]?
MBGROSSPAYM1
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill GROSSFIL]
$[fill BP1M1_2]
$[fill BP1M1_3]
$[fill BP1M1_4]
$[fill BP1M1_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
DO NOT READ TO RESPONDENT
MBGROSSM1VER
THE NEW TOTAL GROSS AMOUNTS ENTERED FOR [fill MONTH1],
$[fill BGTOTAL1], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
DO NOT READ TO RESPONDENT
MBALLGROSSM1
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
What was the gross annual amount?
MBGROSSPAYANN
$@1
Wednesday, August 22, 2007
Page 283 of 314
Survey:
Section: Missing
Items Booklet
MBALLGROSSANN
Mark One Only
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS NOW GROSS AMOUNTS?
(1)
(2)
Yes, all amounts are gross
No, some net amounts remain
@
MOINCB
Mark One Only
Since [fill MONTH1] 1st, did [fill TEMPNAME] receive any [fill OTHERFIL]
income from [fill ALLBUS]?
(1)
(2)
Yes
No
@
MOINCAMT
Multiple Entry
What was the total amount of other income [fill HESHE] received from
[fill ALLBUS]
ENTER
ENTER
[fill
@51
(N) FOR NONE OR NO MORE
(S) FOR SAME AS PREVIOUS AMOUNT
MONTHXFIL]?
@52
@53
@54
@55
[fill MONTH4FIL]?
@41
@42
@43
@44
@45
[fill MONTH3FIL]?
@31
@32
@33
@34
@35
fill MONTH2FIL]?
@21
@22
@23
@24
@25
[fill MONTH1FIL]?
@11
@12
@13
@14
[fill ERRORFIL]
@15
MLSTB
Mark One Only
HAVE YOU ASKED ANOTHER PERSON IN THIS HOUSEHOLD ABOUT
THE NET PROFIT OR LOSS FROM [FILL ALLBUS]
(1) YES
(2) NO
@
MPRFTB
Multiple Entry
For [fill ALLBUS], what was [fill YOURSHAREFIL]
the net profit or loss [fill BIZDATESFIL] Net profit
or loss is the difference between gross receipts
and expenses.
H
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount:
$@1
OR
Net loss amount:
Page 284 of 314
$@2
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
MANNPRFT
Multiple Entry
Can you give me an annual figure?
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount:
$@1
OR
Net loss amount:
$@2
Mark One Only
Does that [fill PRFTLOSSFIL] include [fill PTEMPNAME] own income
from this business (that we talked about earlier), or do we need to
add [fill HISHER] income to the [fill PRFTLOSSFIL] to get a total
net profit or loss?
(1)
(2)
MBPRFTBCHK
Salary/draw is included in the net profit/loss amount
Add salary/draw to net profit/loss amount to get total
net profit/loss
@
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME] jointly with
[fill SPOUSEFIL].
What is the easiest way for you to tell
me about [fill SHAREFIL] the interest or
dividend income [fill ANDSPKIDFIL]
received from those jointly held
[fill ASNAME]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
None of these
@
Wednesday, August 22, 2007
MJINTSP_PD
|JOINT WITH:
|{display names marked in JTWHO}
|{star small children's names}
|
|
|
|
|
|
|
|
|
|
|
H |
|
|
|
|
|
|
|
Page 285 of 314
Survey:
Section: Missing
Items Booklet
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
[fill HOWMUCHFIL2]
by these joint [fill ASNAME]?
MJTINTSP
\
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL1]
|JOINT WITH:
|{display names marked in JTWHO}
|{star small children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Multiple Entry
[fill HOWMUCHFIL] interest or dividend
income [fill WASFIL] produced by these
joint [fill ASNAME]...
MJTINTSP2
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
H |
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
|
[if I_ASSTCODE ne <> and HHSTATRIP ne <3>]|
ENTER (L) FOR SAME AS LAST INTERVIEW
|
|
in [fill MONTH4]?
|
@41
@42
@43
|
|
How about in [fill MONTH3]?
|
@31
@32
@33
|
|
And [fill MONTH2]?
|
@21
@22
@23
|
|
And [fill MONTH1]?
|
@11
@12
@13
|
|
4-Month Total: $[fill JNTINTSP]
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
MBIGAST1
BACKUP AND CORRECT
Proceed
@
Page 286 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 10 dollars,
between 10 and 25 dollars, between 25
and 50 dollars, or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the annual amount less than
25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more
than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
MJCATSP1Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
MJCATSP1Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATSP2Q
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATSP2Y
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 50 dollars,
|
between 50 and 150 dollars, between 150
|
and 500 dollars, or more than 500 dollars?|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Wednesday, August 22, 2007
Page 287 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 150 dollars,
between 150 and 500 dollars, between 500
and 1,500 dollars, or more than 1,500
dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
MJCATSP3Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
MJCATSP3Y
Mark One Only
ASSET TYPE: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME] jointly with
**READ NAMES**.
What is the easiest way for you to tell
me about the interest or dividend income
from those joint [fill ASNAME]?
READ ANSWER CATEGORIES IF NECESSRAY
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5)
DO NOT READ--
@
Page 288 of 314
None of these
MJINTCH_PD
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
H |
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
by these joint [fill ASNAME]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL2]
Multiple Entry
How much interest or dividend income was
produced by these joint [fill ASNAME]?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
@44
@45
How about in [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
4-Month Total: $[fill JNTINTCH]
MJTINTCH
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MJTINTCH2
|JOINT WITH:
|{display names marked in JTWHO}
H |{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
MBIGAST2
BACKUP AND CORRECT
Proceed
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATCH1Q
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 10 dollars,
|
between 10 and 25 dollars, between 25 and |
50 dollars, or more than 50 dollars?
|
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Wednesday, August 22, 2007
Page 289 of 314
Survey:
Section: Missing
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the annual amount less than
25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more
than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Items Booklet
MJCATCH1Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATCH2Q
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATCH2Y
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 50 dollars,
|
between 50 and 150 dollars, between 150
|
and 500 dollars, or more than 500 dollars?|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 150 dollars,
between 150 and 500 dollars, between 500
and 1,500 dollars, or more than 1,500
dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Page 290 of 314
MJCATCH3Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
MJCATCH3Y
Mark One Only
ASSET TYPE: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME] jointly with
***READ NAMES***.
What is the easiest way for you to tell
me about the share of the interest or
dividend income [fill TEMPNAME]
[fill ANDSPKIDFIL] received from these
jointly held [fill ASNAME]?
READ ANSWER CATEGORIES IF NESESSARY
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ--None of these
@
MJTOTHINT_PD
|JOINT WITH:
|{display names marked in JTWHO}
|{star childrens' names}
|
|
|
|
|
|
|
H |
|
|
|
|
|
|
|
MJTOTHINT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
by these joint
[fill ASNAME]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL3]
Wednesday, August 22, 2007
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Page 291 of 314
Survey:
Section: Missing
Items Booklet
Multiple Entry
What was [fill PTEMPNAME]
[fill ANDSPKIDFIL] share of the interest
or dividend income produced by these
joint [fill ASNAME]?
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
@44
@45
How about in [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
4-Month Total: $[fill JNTOTINT]
MJTOTHINT2
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MBIGAST3
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 10 dollars,
between 10 and 25 dollars,
between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than
25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more
than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
Page 292 of 314
MJCATOT1Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
MJCATOT1Y
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
Wednesday, August 22, 2007
Items Booklet
Mark One Only
ASSET TYPE: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than
50 dollars, between 50 and 150 dollars,
between 150 and 500 dollars, or more
than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Survey:
Section: Missing
MJCATOT2Q
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
|
|
|
|
|
|
|
|
|
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATOT2Y
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATOT3Q
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MJCATOT3Y
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
150 dollars, between 150 and 500 dollars, |
between 500 and 1,500 dollars, or more
|
than 1,500 dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Wednesday, August 22, 2007
Page 293 of 314
Survey:
Section: Missing
Items Booklet
MEXCL_CD
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill ASNAME] [fill OWNNAMEFIL].
Are these CDs included in [fill PTEMPNAME] [fill IRA401FIL] account,
or [fill DODOES] [fill HESHE] own them separately from any retirement
account -- or both?
H
(1)
(2)
(3)
All CDs are included in IRA/Keogh/401k/403b/thrift accounts
All CDs are owned separately from retirement accounts
Both -- some are included in retirement accounts
and some are owned separately
@
MOINT_PD
Mark One Only
[fill INCOMENOWFIL]
[fill EARLIERFIL] What is the easiest way for you to tell me about
[fill PTEMPNAME] interest or dividend income from those
[fill ASNAME]?
READ ANSWER CATEGORIES IF NECESSARY
H
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ-- None of these
@
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL] by these [fill ASNAME]?
MOINT
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL4]
Page 294 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
MOINT2
Multiple Entry
What was the total amount of interest or dividend income
[fill TEMPNAME] earned from these [fill ASNAME]...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill OWNINT]
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
MBIGAST4
BACKUP AND CORRECT
Proceed
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MOCAT1Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than 10 dollars,
between 10 and 25 dollars, between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MOCAT1Y
[fill SORRYFIL]
Is the annual amount less than 25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more than 150
dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Wednesday, August 22, 2007
Page 295 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MOCAT2Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIl] amount [fill SINCEFIL] less than 50
dollars, between 50 and 150 dollars, between 150 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MOCAT2Y
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between 100 and 500 dollars,
between 500 and 1500 dollars, or more than 1500 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $1499.99
$1500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MOCAT3Q
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than 150 dollars,
between 150 and 500 dollars, between 500 and 1,500 dollars,
or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Mark One Only
ASSET TYPE: [fill C_ASNAME]
MOCAT3Y
[fill SORRYFIL]
Is the annual amount less than 500 dollars, between 500 and 1,500
dollars, between 1,500 and 5,000 dollars, or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $1,499.99
$1,500 to $4,999.99
$5,000 or more
@
Page 296 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
MJTANYWSP
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME2] jointly with
***READ NAMES***.
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
What kind of dividends do [fill YOUTHEYFIL]
[fill BOTHALLFIL] get from these joint
|
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends
|
credited against a margin account or
|
automatically reinvested?
|
H |
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
ASK IF NECESSARY: Just to be sure,
[fill TEMPNAME] and [fill SPOUSEFIL]
have received no dividends of any kind
from these joint [fill ASNAME2] since
[fill MONTH1] 1st -- is that correct?
(1)
(2)
Yes; correct;
no dividends received
No; incorrect;
DID RECEIVE dividends
@
Mark One Only
What is the easiest way for you to tell
me about [fill SHAREFIL] the dividend
income [fill ANDSPKIDFIL] received from
those jointly held [fill ASNAME2]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ -- None of these
@
Wednesday, August 22, 2007
MNODIVSP
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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MJTDIVSP_PD
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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H |
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Page 297 of 314
Survey:
Section: Missing
Items Booklet
MJTDIVSP
Multiple Entry
[fill SHAREFIL]
[fill INCLUDEFIL] |[fill ISWASFIL]
[fill YOURTHEIRFIL][SHARE2FIL]
[fill CREDITEDFIL] dividend income
fill PRODUCEDFIL]
by all these joint [fill ASNAME2]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@3
$@5
$@2
$@4
$@6
Total: $[TOTALFIL5]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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H |
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MJTDIVSP2
Multiple Entry
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
[fill INCLUDEFIL] was [fill YOURTHEIRFIL] |{star children's names}
[fill CREDITEDFIL] dividend
|
income produced by all these joint
|
[fill ASNAME2]...
|
H |
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
|
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41
@42
@43
|
How about in [fill MONTH3]?
|
@31
@32
@33
|
And [fill MONTH2]?
|
@21
@22
@23
|
And [fill MONTH1]?
|
@11
@12
@13
|
4-Month Total: $[fill JNTDIVSP]
|
MBIGAST5
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
BACKUP AND CORRECT
Proceed
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars,
between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Page 298 of 314
MJDIVSP1Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250
dollars, between 250 and 1,000 dollars,
between 1,000 and 2,500 dollars, or more
than 2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
MJDIVSP1Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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MJDIVSP2Q
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount
[fill SINCEFIL] less than 25 dollars,
between 25 and 100 dollars,
between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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MJDIVSP2Y
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the annual amount less than 100
dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Wednesday, August 22, 2007
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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Page 299 of 314
Survey:
Section: Missing
Items Booklet
MJTANYWCH
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME2] jointly with
***READ NAMES***.
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
What kind of dividends do [fill YOUTHEYFIL]|
[fill BOTHALLFIL] get from these joint
|
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends
|
credited against a margin account or
|
automatically reinvested?
|
H |
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
ASK IF NECESSARY: Just to be sure,
[fill TEMPNAME] and ***READ NAMES***
have received no dividends of any kind
from these joint [fill ASNAME2] since
[MONTH1] 1st -- is that correct?
(1)
(2)
Yes; correct;
no dividends received
No; incorrect;
DID RECEIVE dividends
MNODIVCH
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
|
|
|
|
|
|
@
Mark One Only
What is the easiest way for you to tell
me about the dividend income received
from those jointly held [fill ASNAME2]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ -- None of these
@
Multiple Entry
[fill INCLUDEFIL] [fill CREDITEDFIL]
dividend income [fill ISWASFIL]
[fill PRODUCEDFIL]
by all these joint [fill ASNAME2]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[TOTALFIL7]
Page 300 of 314
MJTDIVCH_PD
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
H |
|
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MJTDIVCH
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
H |
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|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Multiple Entry
[fill INCLUDEFIL] [fill CREDITEDFIL]
dividend income was produced by all
these joint [fill ASNAME2]…
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
@44
@45
How about in [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
4-Month Total: $[fill JNTDIVCH]
MJTDIVCH2
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names)
|
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|
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
MBIGAST6
BACKUP AND CORRECT
Proceed
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars,
between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
MJDIVCH1Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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|
MJDIVCH1Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
[fill SORRYFIL]
Is the annual amount less than 250
|
dollars, between 250 and 1,000 dollars,
|
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Wednesday, August 22, 2007
Page 301 of 314
Survey:
Section: Missing
Items Booklet
MJDIVCH2Q
Mark One Only
ASSET TYPE: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
|
|
|
|
|
|
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|
|
|
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount
[fill SINCEFIL] less than 25 dollars,
between 25 and 100 dollars,
between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
MJDIVCH2Y
Mark One Only
ASSET TYPE: STOCKS
[fill SORRYFIL]
Is the annual amount less than 100
dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
|
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MJTOTHANY
Mark One Only
Earlier I recorded that [fill TEMPNAME]
owned [fill ASNAME2] jointly with
***READ NAMES***.
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
What kind of dividends do these joint
|
[fill ASNAME2] produce? Do they produce |
dividend checks, or are the dividends
|
credited against a margin account or
|
automatically reinvested?
|
H |
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
ASK IF NECESSARY: Just to be sure,
these joint [fill ASNAME2] produced no
dividends of any kind since [MONTH1] 1st
-- is that correct?
(1)
(2)
Yes; correct;
no dividends received
No; incorrect;
DID RECEIVE dividends
@
Page 302 of 314
MNODIVOTH
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
What is the easiest way for you to tell
me about the share of the dividend
income [fill TEMPNAME]
[fill ANDSPKIDFIL] received from
those joint [fill ASNAME2]?
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
(5)
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ -- None of these
@
MJTOTHDIV_PD
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
|
|
H |
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|
|
|
MJTOTHDIV
Multiple Entry
[fill SHAREFIL]
[fill INCLUDEFIL] [fill ISWASFIL]
[fill YOURTHEIRFIL]
[fill CREDITEDFIL]
dividend income
[fill PRODUCEDFIL]
by all these joint [fill ASNAME2]?
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@3
$@5
$@2
$@4
$@6
Total: $[TOTALFIL9]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
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|
H |
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MJTOTHDIV2
Multiple Entry
[fill SHAREFIL]
[fill INCLUDEFIL] was
[fill YOURTHEIRFIL]
[fill CREDITEDFIL]
dividend income produced
by all these joint [fill ASNAME2]...
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41
@42
@43
@44
@45
How about in [fill MONTH3]?
@31
@32
@33
@34
@35
And [fill MONTH2]?
@21
@22
@23
@24
@25
And [fill MONTH1]?
@11
@12
@13
@14
@15
4-Month Total: $[fill JAMTDVOT]
Wednesday, August 22, 2007
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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|
H |
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Page 303 of 314
Survey:
Section: Missing
Items Booklet
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
MBIGAST7
BACKUP AND CORRECT
Proceed
@
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount
[fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars,
between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250
dollars, between 250 and 1,000 dollars,
between 1,000 and 2,500 dollars, or more
than 2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount
[fill SINCEFIL] less than 25 dollars,
between 25 and 100 dollars,
between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Page 304 of 314
MJDIVOT1Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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MJDIVOT1Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
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|
MJDIVOT2Q
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
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|
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
INCOME SHARE FOR: [fill TEMPNAME]
[fill ANDSPKIDFIL]
ASSET TYPE: STOCKS
[fill SORRYFIL]
Was the annual amount less than 100
dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
MJDIVOT2Y
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
|
|
|
|
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|
MEXCLUDE
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill SOMEFIL] [fill FNDSTCK1FIL][fill INNAMEFIL]
Are these [fill FNDSTCK1FIL] included in
[fill IRA401FIL] or [fill DODOES] [fill HESHE]
own them separately from any retirement account -- or both?
H
(1)
(2)
(3)
All shares are included in IRA/Keogh/401k/
thrift accounts
All shares are owned separately from retirement accounts
Both -- some are included in retirement accounts
and some are owned separately
@
Mark One Only
[fill EARLIERFIL]
MOWNTYPE
What kind of dividends [fill DODOES] [fill TEMPNAME] get from these
[fill FNDSTCK1FIL]? [fill C_DODOES] [fill HESHE] get dividend checks, or
are the dividends credited against a margin account or automatically
reinvested?
(1)
(2)
(3)
(4)
Dividend CHECKS
CREDITED or AUTOMATICALLY REINVESTED dividends
Both
Neither; no dividends received
@
Mark One Only
ASK IF NECESSARY:
Just to be sure, these [fill ASNAME2] produced no dividends
of any kind since [fill MONTH1] 1st -- is that correct?
(1)
(2)
MNODIVOWN
Yes; correct; no dividends received
No; incorrect; DID RECEIVE dividends
@
Wednesday, August 22, 2007
Page 305 of 314
Survey:
Section: Missing
Items Booklet
MOWNDIV_PD
Mark One Only
[fill INCOMENOWFIL]
[fill INCOMENOWFIL2]
[fill INCOMENOWFIL3]
What is the easiest way for you to tell me about [fill YOURNAMEFIL]
dividend income from [fill ASNAME2] [fill OWNNAMEFIL]
READ ANSWER CATEGORIES IF NECESSARY
H
(1)
(2)
(3)
(4)
(5)
@
4-month total
Monthly amounts
Quarterly amount
Annual amount
DO NOT READ -- None of these
MOWNDIV
Multiple Entry
[fill ANOTHERFIL]
[fill INCLUDEFIL]
[fill CREDITEDFIL] dividend income [fill ISWASFIL]
[fill PRODUCEDFIL]
by the [fill ASNAME2] [fill HESHE] owned
[fill INNAMEFIL]?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL11]
MOWNDIV2
Multiple Entry
[fill INCLUDEFIL] [fill CREDITEDFIL] dividend income did
[fill TEMPNAME] receive from the [fill NONRETFIL] [fill ASNAME2]
[fill HESHE] owned in [fill HISHER] own name...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41
@42
@43
How about in [fill MONTH3]?
@31
@32
@33
And [fill MONTH2]?
@21
@22
@23
And [fill MONTH1]?
@11
@12
@13
4-Month Total: $[fill OWNADV]
Mark One Only
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1)
(P)
MBIGAST8
BACKUP AND CORRECT
Proceed
@
Page 306 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Missing
Mark One Only
ASSET TYPE: MUTUAL FUNDS
MODIV1Q
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount[fill SINCEFIL] less than
100 dollars, between 100 and 400 dollars, between 400 and
1,000 dollars, or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
ASSET TYPE: MUTUAL FUNDS
MODIV1Y
[fill SORRYFIL]
Is the annual amount less than 250 dollars, between 250 and
1,000 dollars, between 1,000 and 2,500 dollars, or more than
2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2499.99
$2,500 or more
@
Mark One Only
ASSET TYPE: STOCKS
MODIV2Q
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount [fill SINCEFIL] less than
25 dollars, between 25 and 100 dollars, between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Mark One Only
ASSET TYPE: STOCKS
MODIV2Y
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between 100 and
500 dollars, between 500 and 1,000 dollars, or more than
1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Wednesday, August 22, 2007
Page 307 of 314
Survey:
Section: Missing
Items Booklet
MPRIMNTH
Multiple Entry
[fill C_HAVHAS] [fill TEMPNAME] been covered [fill EITHERFIL]
at any time in this month?
(1)
(2)
@5
Yes
No
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
H
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
[fill
[fill
[fill
[fill
(1) Yes (2)
MONTH1]? @1
MONTH2]? @2
MONTH3]? @3
MONTH4]? @4
No
Mark One Only
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND
ENTERED THE INFORMATION WE NEED. TRANSMIT THE CASE AS IS.
MIAA
THE INFORMATION BELOW IS STILL MISSING FROM THIS INTERVIEW.
DO YOU WANT TO:
(1)
(2)
Hold this case for additional callbacks
Transmit the case as is - NO CALLBACKS
[display names and list of missing info, similar to MISITCB, but only
display things still missing at this point.]
@
Page 308 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Returns
Mark One Only
I need to continue the interview with [fill NAME(L_NO)].
Is [fill NAME(L_NO)] available now?
(1)
(2)
RTSELF
Yes
No
@
Mark One Only
Could you or someone else in the household answer these questions for
[fill NAME(L_NO)]?
(1)
(2)
(4)
RTSELF2
Yes, (take proxy interview)
No
TYPE-Z -- not available during entire interviewing period
@
Mark One Only
WHYTYPZ5
Enter the TYPE-Z reason for
[fill NAME(L_NO)].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Mark One Only
Enter other TYPE-Z reason.
WHYSP5
@
Mark One Only
RTPROXY
HOUSEHOLD ROSTER
LINE
NAME
ASK IF NECESSARY
Who will be answering for [fill NAME(L_NO)]?
@
Wednesday, August 22, 2007
Page 309 of 314
Survey:
Section: Back
Items Booklet
FIN
Mark One Only
This case is not completed.
ENTER (X) TO EXIT THE INTERVIEW
@
Mark One Only
ASK IF NECESSARY:
To whom should future correspondence
be addressed?
@
LTRADDR
|LINE NAME
|Display PXYRS3 template
|
|
|
Mark One Only
Since households included in this survey are interviewed
again in 4 months, we may attempt to conduct the followup
interview by telephone.
TELHHD
Is there a telephone in this house/apartment?
(1)
(2)
Yes
No
@
Mark One Only
Is there a telephone elsewhere on which people in
this household can be contacted?
(1)
(2)
TELAVL
Yes
No
@
Mark One Only
Where is this phone located?
TELWHR
@
Multiple Entry
What is the telephone number where
you would like to be called?
TELPHN1
Area Code: @AR1
Number: @NUM1
EXT: @EXT1 (IF NO EXTENSION, PRESS ENTER)
What type of telephone is it?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Home
Work
Cellular or Digital
Beeper/Pager/Answering Service
Public (Pay phone)
Toll Free
Other (Specify)
@TELTYP1
{pop-up} What was that?
@7
Page 310 of 314
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Back
Mark One Only
Is there a second telephone number where you can be contacted?
(1)
(2)
TELHHD2
Yes
No
@
Multiple Entry
What is the second telephone number where you would like to
be called?
TELPHN2
Area Code: @AR2
New Number: @NUM2
EXT: @EXT2 (IF NO EXTENSION, PRESS ENTER)
What type of telephone is it?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Home
Work
Cellular or Digital
Beeper/Pager/Answering Service
Public (Pay phone)
Toll Free
Other (Specify)
@TELTYP2
{pop-up} What was that?
@7
BSTTI
Multiple Entry
When is the best time to contact you?
DO NOT READ CATEGORIES
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Morning (9am-12 noon)
Noon/lunchtime (11am-1pm)
Afternoon (12 noon-4pm)
Suppertime/early evening/dinnertime(4pm-7pm)
Evening (6pm-9pm)
Anytime (9am-9pm)
Late evening/night (7pm-9pm)
Daytime (9am-4pm)
After 5pm
Other, specify
@1
{pop-up}
ENTER SPECIFIC BEST TIME TO CALL
@2
PHONEO
Mark One Only
Is a telephone interview acceptable?
(1)
(2)
Yes
No
@
Mark One Only
DO NOT READ TO RESPONDENT
ENTER THE LINE NUMBER OF
PERSON YOU ARE SPEAKING WITH
RIGHT NOW.
@NOW
Wednesday, August 22, 2007
WHO
|LN NAME
|Display HH members ages 15+
|
|
|
|
|
Page 311 of 314
Survey:
Section: Back
Items Booklet
Multiple Entry
Is there a close relative or friend who would know
how to reach [fill /<[REFPER]>]
if we are unable to contact [fill //]?
(0) NO CONTACT PERSON INFORMATION AVAILABLE
ENTER (H) FOR STATE ABBREVIATIONS
FIRST
@CFNAME
MIDDLE
@CMNAME
LAST
@CLNAME
CPRSN1
|TYPE OF TELEPHONE
|(1) Home
|(2) Work
|(3) Cellular/Digital
|(4) Beeper/Pager/
|
Answering Service
|(5) Public/Pay Phone
|(6) Toll Free
|(7) Other(Specify)
RELATIONSHIP TO [YOU/[REFPER]>:
@CREL
STREET ADDRESS: @ADR1
STREET ADDRESS: @ADR2
CITY: @PO
STATE: @ST
ZIP CODE: @ZP5 @ZP4
(N) NO TELEPHONE NUMBER AVAILABLE
TELEPHONE NUMBER: @AR @NUM EXT:
pop-up
@EXT
TYPE: @TELTYP1
Multiple Entry
Is there another person who would know how to reach
[fill YOUREPERFIL]?
(0) NO 2nd CONTACT PERSON
ENTER (H) FOR STATE ABBREVIATIONS
FIRST
@CFNAME
MIDDLE
@CMNAME
LAST
@CLNAME
RELATIONSHIP TO [YOU/[REFPER]:
@CREL
STREET ADDRESS: @ADR1
STREET ADDRESS: @ADR2
CITY: @PO
STATE: @ST
ZIP CODE: @ZP5 @ZP4
(N) NO TELEPHONE NUMBER AVAILABLE
TELEPHONE NUMBER: @AR @NUM
EXT:
pop-up
@EXT
CPRSN2
|TYPE OF TELEPHONE
|(1) Home
|(2) Work
|(3) Cellular/Digital
|(4) Beeper/Pager/
|
Answering Service
|(5) Public/Pay Phone
|(6) Toll Free
|(7) Other(Specify)
TYPE: @TELTYP1
Multiple Entry
Is there a close relative or friend who would know
how to reach [fill /<[REFPER]>]
if we are unable to contact [fill //]?
(0) NO CONTACT PERSON INFORMATION AVAILABLE
(1) SAME AS HOUSEHOLD CONTACT #1
H
(2) SAME AS HOUSEHOLD CONTACT #2
FIRST
MIDDLE
LAST
@CFNAME
@CMNAME
@CLNAME
CPRSN3
|TYPE OF TELEPHONE
|(1) Home
|(2) Work
|(3) Cellular/Digital
|(4) Beeper/Pager/
|
Answering Service
|(5) Public/Pay Phone
|(6) Toll Free
|(7) Other(Specify)
RELATIONSHIP TO [YOU/[REFPER]>:
@CREL
STREET ADDRESS: @ADR1
STREET ADDRESS: @ADR2
CITY: @PO
STATE: @ST
ZIP CODE: @ZP5 @ZP4
(N) NO TELEPHONE NUMBER AVAILABLE
TELEPHONE NUMBER: @AR @NUM EXT:
pop-up
Page 312 of 314
@EXT
TYPE: @TELTYP1
Wednesday, August 22, 2007
Items Booklet
Survey:
Section: Back
Multiple Entry
ENTER (R) FOR SPECIFIC ITEMS BELOW IF THEY ARE REFUSED
BCINFO3
Name of person providing noninterview status:
Firstname: @FN Lastname: @LN
Title of contact person (relative, neighbor, etc.): @CPRELA
Contact person's address:
Street name: @R1
Street name: @R2
City: @PO
State: @ST
Telephone Number: Area: @AR
Zip Code: @ZP5 @ZP4
Number: @NUM
Extension: @EXT
Mark One Only
ARE YOU READY TO TRANSMIT THIS CASE?
(1)
(2)
TRANS
Yes
No
@
NOWTYPEA
Mark One Only
DO NOT READ TO RESPONDENT
THIS IS NOW A TYPE A[fill REASONFIL]
PRESS "ENTER" TO CONTINUE
@
Multiple Entry
No survey data were collected for
[fill NAMEFIL].
Enter the reason that best describes why
[fill HISHER]'s survey data were not collected.
(1)
(2)
(3)
(4)
WHYTYPZ6
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@1
{pop-up}SPECIFY: @SP
CALLBACK
Mark One Only
I'd like to schedule a return
visit to finish the interview.
What DATE AND TIME would be best
to visit again to
[fill CONDUCTFIL]?
PROBE: May I come back later today?
TODAY IS: [fill CDATE_C]
@
Wednesday, August 22, 2007
|HOUSEHOLD MEMBERS STILL NEEDING
|TO BE INTERVIEWED
|Display CBLST template
|
|
|
|
|
|
|
|
Page 313 of 314
Survey:
Section: Back
Items Booklet
THANKCB
Mark One Only
Thank you for your help.
I will come back at the time suggested.
REVISIT DATE: [fill CALLBACK]
PRESS "ENTER" TO CONTINUE
@
Mark One Only
Thank you for your cooperation. Since this is a survey
that measures the economic changes of people over time,
we contact respondents periodically for anywhere from
one to four years. I will call on you again in four
months, which will be in [fill TEMP]. Also, my office
may check to see if I have done my job properly.
Therefore, you may receive a call in the next several
weeks checking on my work. Thank you again.
THANKYOU
PRESS "ENTER" TO END INTERVIEW
@
VISITCNT
Mark One Only
DO NOT READ TO RESPONDENT
How many times have you attempted personal contact
(actually visited the address)?
@
MODECOLL
Mark One Only
DO NOT READ TO RESPONDENT
Was the majority of this interview done by
telephone interview, or by personal interview?
(1)
(2)
Telephone interview
Personal interview
@
Mark One Only
DO NOT READ TO RESPONDENT
Identify the person who responded to
the majority of this interview.
ENTER LINE NUMBER
@
OTHNAME1
|LN NAME
|(include HH members)
|
|
|
|
|
|
Mark One Only
DO NOT READ TO RESPONDENT
SPAN1
Did you conduct any of this household's interview in Spanish?
(1)
(2)
Yes
No
@
Page 314 of 314
Wednesday, August 22, 2007
| File Type | application/pdf |
| File Title | N:\SIPP96\PANL2008\ItemsBooklets\rptItemsBooklet.snp |
| Author | okon0001 |
| File Modified | 2007-08-22 |
| File Created | 2007-08-22 |