Wave 11 Topical Mo Wave 11 Topical Modules Booklet

Items Booklet for
Specification:
Section: Retirement TM

PR1_PR090

Mark One Only
Was [fill HISHER] primary source of work related income during the
last 4 months from [fill HISHER] job or from [fill HISHER] business?
(1)
(2)

Job
Business

@

PR3_PR110

Mark One Only
I just need to verify some information. Thinking about the location
where [fill HESHE] [fill TEMP1], about how many people are employed
there by [fill JBNAME]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

less than 10
10 to 24
25 to 49
50 to 99
100 to 249
250 to 499
500 to 999
1,000 or more

@

PR4_PR120

Mark One Only
About how many people are employed by
[fill JBNAME] at all locations?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

less than 10
10 to 24
25 to 49
50 to 99
100 to 249
250 to 499
500 to 999
1,000 or more

@

PR4A_PR121

Mark One Only
I just need to verify some information.
employed by [fill JBNAME]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

About how many people are

less than 10
10 to 24
25 to 49
50 to 99
100 to 249
250 to 499
500 to 999
1,000 or more

@

Monday, June 13, 2011

Page 1 of 24

Survey:
Section: Retirement TM

Items Booklet

Enter Number

PR5_PR130

How many weeks during the year [fill DODOES] [fill HESHE] usually
work at [fill JBNAME]? Include paid vacation and sick leave as
work time.
@ Weeks
Multiple Entry

PR6_PR140

How long [fill HAVHAS] [fill HESHE] been working for
[fill JBNAME]?
@1 Number
ENTER "1" FOR MONTHS OR "2" FOR YEARS
(1)
(2)

Months
Years

@2

Mark One Only

PR7_PR150

Now I'd like to ask about retirement plans offered on this job,
not Social Security, but plans that are sponsored by [fill HISHER]
[fill JOBUSA].
This includes regular pension plans as well as
other kinds of retirement plans like thrift and savings plans,
401(k) or 403(b) plans, and deferred profit-sharing and
stock plans.
Does [fill HISHER] [fill JOBUSA] have any kind of pension or retirement
plans for anyone in [fill HISHER] company or organization?
(1)
(2)

Yes
No

@
Mark One Only

PR8_PR160

[fill C_AREIS] [fill HESHE] included in such a plan?
(1)
(2)

Yes
No

@

Page 2 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Multiple Entry

PR9_PR170

Why [fill AREIS] [fill HESHE] not included?
ENTER ALL THAT APPLY
ENTER "N" AFTER LAST ENTRY
[fill PR9_1:b](01) No one in my type of job
[fill PR9_8:b](08) Employer doesn't contribute,
is allowed in the plan
or contribute enough
[fill PR9_2:b](02) Don't work enough hours,
[fill PR9_9:b](09) Don't plan to be in job long enough
weeks or months per year
[fill PR9_10:b](10) Don't need it
[fill PR9_3:b](03) Haven't worked long enough
[fill PR9_11:b](11) Have an IRA or other pension plan
for this employer
coverage
[fill PR9_4:b](04) Started job too close to
[fill PR9_12:b](12) Spouse has pension plan
retirement date
[fill PR9_13:b](13) Haven't thought about it
[fill PR9_5:b](05) Too young
[fill PR9_14:b](14) Some other reason
[fill PR9_6:b](06) Can't afford to contribute
[fill PR9_7:b](07) Don't want to tie up money
@1
Enter Text

PR9_ERR

"Don't Know and/or Refused" response not permitted with other answers
Enter (B) to backup
@
Mark One Only

PR10_PR180

Is the plan something like a 401(k) plan, where workers contribute
to the plan and their contributions are tax deferred?
(1)
(2)

Yes
No

@

Enter Number

PR11_PR190

Some workers participate in more than one retirement plan. For
example, they might have a regular pension plan and also have
some kind of retirement savings plan.
How many different pension or retirement plans [fill DODOES]
[fill HESHE] have on this [fill JOBUS]?
@ Number of plans

Monday, June 13, 2011

Page 3 of 24

Survey:
Section: Retirement TM

Items Booklet

PR12_PR200

Mark One Only
SHOW FLASHCARD W
[if PR11_PR190 gt <1> or PR11_PR190 eq or PR11_PR190 eq ]
The following question is about the plan [fill HESHE] would consider
to be [fill HISHER] most important retirement plan on this job.[endif]
There are several types of retirement plans.
In the first type, [fill HISHER] benefit is defined by a formula
usually involving [fill HISHER] earnings and years on the job.
In the second type of plan, contributions made by [fill HIMHER] and/or
[fill HISHER] employer go into an individual account for [fill HIMHER].
The third type of plan shares some characteristics with the above two
plans. In this type of plan, [fill HISHER] employer contributes a value
equal to a percent of each of [fill HISHER] earnings each year and there
is a rate of return on that contribution. This type of plan is sometimes
called a cash balance plan.
Which type of plan [fill AREIS] [fill HESHE] in?
[r]H[n]
(1)
(2)
(3)

Plan based on earnings and years on the job
Individual account plan
Cash Balance Plan

@

PR13_PR210

Mark One Only
What is [fill HISHER] second most important plan on this job?
(SHOW FLASHCARD W)
[r]H[n]
(1)
(2)
(3)

Plan based on earnings and years on the job
Individual account plan
Cash Balance Plan

@

Mark One Only

PR14_PR220

The following series of questions refer to [fill HISHER] [fill IMPORTANT]
plan.
[fill C_DODOES] [fill HESHE] contribute any money to this plan,
for example, through payroll deductions?
(1)
(2)

Yes
No

@
Mark One Only

PR14A_PR220A

In some plans like 401(k) plans the money [fill HESHE] [fill TEMP1]
is tax-deferred. Are [fill HISHER] contributions to this plan
tax-deferred?
(1)
(2)

Yes
No

@

Page 4 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Mark One Only

PR14B_PR220B

[If PR14_PR220 eq <>]
The following series of questions refer to [fill HISHER] [fill IMPORTANT]
plan.
[endif]
If [fill HESHE] [fill WASWERE] to leave [fill HISHER] [fill JOBUSB] now
or within the next few months, could [fill HESHE] eventually receive
some benefits from this plan when [fill HESHE] [fill TEMP1] retirement age?
(1)
(2)

Yes
No

@
Mark One Only

PR14C_PR220C

If [fill HESHE] left [fill HISHER] [fill JOBUSB] now, could [fill HESHE]
get a lump-sum payment from this plan when [fill HESHE] left?
(1)
(2)

Yes
No

@
Enter Number

PR15_PR230

How many years [fill HAVHAS] [fill HESHE] been included in this plan?
@

Years
Mark One Only

PR16_PR231

Will [fill HISHER] benefits from this plan be either increased or
decreased because [fill HESHE] [fill TEMP1] in the Social Security
program?
(1)
(2)
(3)

Yes
No
Do not participate in Social Security

@

Enter Number

PR17_PR232

How much has [fill HISHER] [fill JOBUSB] contributed to [fill HISHER]
plan within the last year?
$@
Enter Number

PR18_PR233

As of the end of [fill MONTH4], what was the total amount of money in
[fill HISHER] account?
$@

Monday, June 13, 2011

Page 5 of 24

Survey:
Section: Retirement TM

Items Booklet

Mark One Only

PR19_PR234

What is [fill HISHER] best estimate of the amount in [fill HISHER] account?
READ ALL CATEGORIES:
(1)
(2)
(3)
(4)
(5)
(6)

Less than $5,000
$5,000 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 or more

@
Mark One Only

PR20_PR240

The following series of questions refer to [fill HISHER] second most
important pension plan.
[fill C_DODOES] [fill HESHE] contribute any money to this plan,
for example, through payroll deductions?
(1)
(2)

Yes
No

@
Mark One Only

PR20A_PR240A

In some plans like 401(k) plans the money [fill HESHE] [fill TEMP1]
is tax-deferred. Are [fill HISHER] contributions to this plan tax-deferred?
(1)
(2)

Yes
No

@

Mark One Only

PR20B_PR240B

[If PR20_PR240 eq <>]
The following series of questions refer to [fill HISHER] second most
important pension plan.
[endif]
If [fill HESHE] [fill WASWERE] to leave [fill HISHER] [fill JOBUSB] now
or within the next few months, could [fill HESHE] eventually receive
some benefits from this plan when [fill HESHE] [fill TEMP1] retirement age?
(1)
(2)

Yes
No

@
Mark One Only

PR20C_PR240C

If [fill HESHE] left [fill HISHER] [fill JOBUSB] now, could [fill HESHE]
get a lump-sum payment from this plan when [fill HESHE] left?
(1)
(2)

Yes
No

@

Page 6 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Enter Number

PR21_PR250

How many years [fill HAVHAS] [fill HESHE] been included in this plan?
@ Years
Mark One Only

PR22_PR251

Will [fill HISHER] benefits from this plan be either increased or
decreased because [fill HESHE] [fill TEMP1] in the Social Security program?
(1)
(2)
(3)
@

Yes
No
Do not participate in Social Security

Enter Number

PR23_PR252

How much has [fill HISHER] [fill JOBUSB] contributed to [fill HISHER]
plan within the last year?
$@
Enter Number

PR24_PR253

As of the end of [fill MONTH4], what was the total amount of money in
[fill HISHER] account?
$@
Mark One Only

PR25_PR254

What is [fill HISHER] best estimate of the amount in [fill HISHER] account?
READ ALL CATEGORIES:
(1)
(2)
(3)
(4)
(5)
(6)

Less than $5,000
$5,000 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 or more

@

Mark One Only

PR26_PR260

I'd like to make sure about a particular type of retirement plan
that allows workers to make tax deferred contributions. For example,
[fill HESHE] might choose to have [fill HISHER] employer put part of
[fill HISHER] salary into a retirement savings account and [fill HESHE]
[fill DODOES] not have to pay taxes on this money until [fill HESHE]
[fill TEMP1]. These plans are called by different names,
including 401(k) plans, pre-tax plans, salary reduction plans and
403(b) plans.
Does [fill HISHER] [fill JOBUSB] offer a plan like this to anyone in [fill HISHER]
company or organization?
(1)
(2)

Yes
No

@

Monday, June 13, 2011

Page 7 of 24

Survey:
Section: Retirement TM

Items Booklet

Mark One Only

PR27_PR270

[fill C_AREIS] [fill HESHE] participating in this plan?
(1)
(2)

Yes
No

@
Multiple Entry

PR28_PR280

Why [fill AREIS] [fill HESHE] not included?
ENTER ALL THAT APPLY
ENTER "N" AFTER LAST ENTRY.
[fill PR28_1:b](01) No one in my type of job
[fill PR28_8:b](08) Employer doesn't contribute,
is allowed in the plan
or contribute enough
[fill PR28_2:b](02) Don't work enough hours,
[fill PR28_9:b](09) Don't plan to be in job long
enough
weeks or months per year
[fill PR28_10:b](10) Don't need it
[fill PR28_3:b](03) Haven't worked long enough
[fill PR28_11:b](11) Have an IRA or other pension
plan
for this employer
coverage
[fill PR28_4:b](04) Started job too close to
[fill PR28_12:b](12) Spouse has pension plan
retirement date
[fill PR28_13:b](13) Haven't thought about it
[fill PR28_5:b](05) Too young
[fill PR28_14:b](14) Some other reason
[fill PR28_6:b](06) Can't afford to contribute
[fill PR28_7:b](07) Don't want to tie up money
@1
Enter Text

PR28_ERR

"Don't Know and/or Refused" response not permitted with other answers
Enter (B) to backup
@

Mark One Only

PR28A_PR281

Does [fill HISHER] employer provide a matching contribution, or contribute
to the plan in any other way?
(1)
(2)

Yes
No

@
Mark One Only

PR29_PR290

[fill C_DODOES] [fill HESHE] expect to start participating in this plan within the
next few years?
(1)
(2)

Yes
No

@

Page 8 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Multiple Entry

PR30_PR300

[if PR14A_PR220A eq <1> and PR20A_PR240A eq <1>]
Referring to [fill HISHER] most important plan, [endif]
How much [fill DODOES] [fill HESHE] contribute toward this plan?
ENTER (N) IF RESPONDENT MAKES NO CONTRIBUTIONS.
$ @1
Per: (1)
(2)
(3)
(4)
(5)

Week
Biweekly
Month
Quarter
Year

@2
OR
@3

Percent of Salary

Mark One Only

PR31_PR310

Does [fill HISHER] [fill JOBUSB] make contributions
into this plan?
(1)
(2)

Yes
No

@
Mark One Only

PR32_PR320

Does the amount that [fill HISHER] [fill JOBUSB] contributes to the plan
depend entirely, partly, or not at all on the amount [fill HESHE]
[fill TEMP1]?
(1)
(2)
(3)

Depends entirely
Depends partly
Not at all

@
Multiple Entry

PR33_PR330

How much does [fill HISHER] [fill JOBUSB] actually contribute to the plan?
$ @1
Per: (1)
(2)
(3)
(4)
(5)

Week
Biweekly
Month
Quarter
Year

@1A
OR
@2

Percent of Salary

OR
(6)
(7)

Contributions out of profits
Contribution varies

@3

Monday, June 13, 2011

Page 9 of 24

Survey:
Section: Retirement TM

Items Booklet

PR34_PR340

Mark One Only
[fill C_AREIS] [fill HESHE] able to choose how any of the money in the plan is
invested?
(1)
(2)

Yes
No

@
Mark One Only

PR35_PR350

[fill C_AREIS] [fill HESHE] able to choose how all of the money is invested, or just
part of it?
(1)
(2)

All of the money
Part of the money

@

PR36_PR360

Multiple Entry
How are the current contributions to this account being invested?
READ ALL CATEGORIES. ENTER ALL THAT APPLY.
ENTER "N" AFTER LAST ENTRY
[fill
[fill
[fill
[fill
[fill
[fill
[fill
[fill

PR36_1:b](1)
PR36_2:b](2)
PR36_3:b](3)
PR36_4:b](4)
PR36_5:b](5)
PR36_6:b](6)
PR36_7:b](7)
PR36_8:b](8)

Company stock of [fill HISHER] employer
Stock funds
Corporate bonds or bond funds
Long term interest bearing securities
Diversified stock and bond funds
Government securities
Money market funds
Other investments

@1

Enter Text

PR36_ERR

"Don't Know and/or Refused" response not permitted with other answers
Enter (B) to backup
@
Mark One Only

PR37_PR370

Of the types of investments just mentioned, which type is where
the largest share of current contributions are being invested?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)

Employer company stock
Stock funds
Corporate bonds or bond funds
Long term interest bearing securities
Diversified stock and bond funds
Government securities
Money market funds
Other investments
Evenly split between types reported

@

Page 10 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Enter Number

PR38_PR380

As of the end of [fill MONTH4], what was the total amount of money in
[fill HISHER] account?
$@
Mark One Only

PR39_PR390

What is [fill HISHER] best estimate of the amount in [fill HISHER] account?
READ ALL CATEGORIES.
(1)
(2)
(3)
(4)
(5)
(6)

Less than $5,000
$5,000 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 or more

@

Mark One Only

PR40_PR391

[fill C_HAVHAS] [fill HESHE] ever taken out any money from [fill HISHER]
plan in the form of a loan?
(1)
(2)

Yes
No

@
Mark One Only

PR41_PR392

Does [fill HISHER] plan permit [fill HIMHER] to take out a loan?
(1)
(2)

Yes
No

@
Enter Number

PR42_PR393

What is the current outstanding balance due from that loan?
$@
Mark One Only

PR43_PR394

What is [fill HISHER] best estimate of the amount of the loan?
READ ALL CATEGORIES.
(1)
(2)
(3)
(4)
(5)
(6)

Less than $2,500
$2,500 to $5,000
$5,001 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 or more

@

Monday, June 13, 2011

Page 11 of 24

Survey:
Section: Retirement TM

Items Booklet

Mark One Only

PR44_PR400

[fill C_AREIS] [fill HESHE] participating in any pension or retirement plans offered
on any other jobs or businesses [fill HESHE] currently [fill HAVHAS]?
(1)
(2)

Yes
No

@
Mark One Only

PR45_PR410

[if RECNT5 lt <1>]
The next questions are about pension or retirement plans
offered by employers or unions. This includes regular pension
plans as well as other kinds of retirement plans, like thrift
and savings plans, 401(K) or 403(b) plans and deferred
profit-sharing and stockplans. Excluding Social Security
[else]
Other than Social Security or the plans we have already talked about
[endif]
[fill HAVHAS] [fill HESHE] ever been covered by a pension or retirement
plan on any previous jobs or businesses?
(1)
(2)

Yes
No

@

Mark One Only

PR46_PR420

Are there any previous plans from which [fill HESHE] [fill HAVHAS]
not yet received any benefits, but expect to receive them in the future?
(1)
(2)
@

Yes
No

Enter Number

PR47_PR430

How many years did [fill HESHE] work on the job from which [fill HESHE]
[fill TEMP1] to receive this pension?
@ Years
Enter Number

PR47A_PR431

In what year did [fill HESHE] leave that job?
@ Years
Mark One Only

PR48_PR440

Will the amount of [fill HISHER] retirement benefits from that plan be
determined by a formula such as one based on [fill HISHER] earnings and
years of service or will [fill HISHER] benefits be based on the total
amount of money held in an individual account for [fill HIMHER]?
(1) Based on a formula
(2) Based on the amount of money in account
@

Page 12 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Enter Number

PR49_PR450

As of the end of [fill MONTH4], what was the total amount of money
in [fill HISHER] account?
$@
Mark One Only

PR50_PR460

What is [fill HISHER] best estimate of the amount of money in
[fill HISHER] account?
READ ALL CATEGORIES.
(1)
(2)
(3)
(4)
(5)
(6)

Less than $5,000
$5,000 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 or more

@
Mark One Only

PR51_PR461

Could [fill HESHE] withdraw this money now, or will [fill HESHE]
have to wait until retirement age to get the money?
(1) Could withdraw money now
(2) Must wait until retirement
@
Mark One Only

PR52_PR470

[fill C_HAVHAS] [fill HESHE] ever received a lump-sum payment from
a pension or retirement plan from a previous job, including any
lump sums that may have been directly rolled over to another plan
or to an IRA?
(1)
(2)
@

Yes
No

Mark One Only

PR52A_PR471

Why did [fill HESHE] leave that job?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)

Laid off
Retired or old age
Child care problems
Other family obligations
Own illness
Own injury
School/training
Discharged/fired
Employer bankrupt
Employer sold business
Job temporary and ended
Quit to take another job
Slack work/business conditions
Unsatisfactory work arrangements

@

Monday, June 13, 2011

Page 13 of 24

Survey:
Section: Retirement TM

Items Booklet

Mark One Only

PR53_PR480

[fill C_HAVHAS] [fill HESHE] ever received survivor benefits in the form
of a lump-sum payment from someone else's pension or retirement plan?
(1)
(2)
@

Yes
No

Enter Number

PR54_PR490

Over the years, how many of these lump sum distributions,
including rollovers, [fill HAVHAS] [fill HESHE] received?
@ Number
Enter Number

PR55_PR500

[if PR54_PR490 gt <1> or PR54_PR490 eq or PR54_PR490 eq ]
Please answer the following questions about [fill HISHER] most recent lump
sum or rollover.
[endif]
In what year did [fill HESHE] receive this lump sum or rollover?
@ Year
Mark One Only

PR56_PR510

Did [fill HESHE] also receive any lump sum payments in 2011?
(1)
(2)
@

Yes
No

Mark One Only

PR57_PR520

[if PR56_PR510 eq <1>]
Was the lump sum [fill HESHE] received in 2011
[else]
[if PR56_PR510 eq <2>]
Was the lump sum [fill HESHE] received in 2012
[else]
Was the lump sum
[endif] [endif]
from a private employer or union plan,
from the military, from other Federal employee plans, or from a
State or Local government plan?
(1)
(2)
(3)
(4)
(5)

Private employer or union plan
Military plan
Other federal plans
State or local government
Other

@
Mark One Only

PR58_PR521

Did [fill HESHE] withdraw the money voluntarily, or did the plan require
[fill HIMHER] to withdraw it?
(1) Voluntarily
(2) Required to withdraw
@

Page 14 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Enter Number

PR59_PR530

What was the total amount of the lump sum or rollover?
$@
Mark One Only

PR60_PR540

What is [fill HISHER] best estimate of the lump sum or rollover amount?
READ ALL CATEGORIES.
(1)
(2)
(3)
(4)
(5)
(6)
@

Less than $5,000
$5,000 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 or more

Mark One Only

PR61_PR550

Did [fill HESHE] actually receive the money, or was it directly rolled
over into another plan or to an IRA?
(1) Actually received
(2) Directly rolled over
@
Mark One Only

PR62_PR560

After receiving the lump sum payment, did [fill HESHE] then roll any of
the money over into another retirement plan or into an IRA?
(1)
(2)
@

Yes
No

Mark One Only

PR63_PR570

Did [fill HESHE] roll it over into another plan on [fill HISHER] job,
an individual annuity, an IRA, or some other type of plan?
(1)
(2)
(3)
(4)

Plan on job
Individual annuity
IRA
Other

@
Mark One Only

PR64_PR571

Did [fill HESHE] roll over the entire amount or just part of it?
(1) Entire amount
(2) Partial amount
@

Monday, June 13, 2011

Page 15 of 24

Survey:
Section: Retirement TM

Items Booklet

Multiple Entry

PR65_PR580

People who receive lump sums may spend or invest the money in many
different ways. How did [fill HESHE] use the money from the lump sum [fill HESHE] received?
ENTER ALL THAT APPLY.
ENTER "N" AFTER LAST ENTRY.
[fill PR65_1:b](01) Invested in an IRA, annuity,
[fill PR65_8:b](08) Bought a car, boat, furniture,
or other retirement program
or other consumer items
[fill PR65_2:b](02) Put it into a savings account
or CDs
[fill PR65_9:b](09) Vacation, travel, or recreation
[fill PR65_3:b](03) Invested in other financial
[fill PR65_10:b](10) Paid expenses while laid off
instruments (stocks, mutual
[fill PR65_11:b](11) Moving or relocation expenses
funds, bonds, money market funds)[fill PR65_12:b](12) Medical or dental expenses
[fill PR65_4:b](04) Invested in land, other real
[fill PR65_13:b](13) Paid or saved for education
properties
[fill PR65_14:b](14) General or everyday expenses
[fill PR65_5:b](05) Invested in own or family
[fill PR65_15:b](15) Gave to family members or
business or farm
charities
[fill PR65_6:b](06) Used for housing (purchase,
[fill PR65_16:b](16) Paid taxes
paid off mortgage, home
[fill PR65_17:b](17) Saved for retirement expenses
improvements/repairs
[fill PR65_18:b](18) Saved or invested in other ways
[fill PR65_7:b](07) Paid bills, loans, or other debts[fill PR65_19:b](19) Spent in other ways
@1
Enter Text

PR65_ERR

"Don't Know and/or Refused" response not permitted with other answers
Enter (B) to backup
@
Multiple Entry

PR66_PR600

Earlier [fill HESHE] said [fill HESHE] received some pension or retirement income
other than Social Security during the period from
[fill MONTH1] through [fill MONTH4]. Will [fill HESHE] continue to receive these
benefits for the rest of [fill HISHER] life, or will it be just a limited
number of payments, or was it just a single lump sum payment?
ENTER ALL THAT APPLY.
ENTER "N" AFTER LAST ENTRY.
[fill PR66_1:b](1) Rest of life
[fill PR66_2:b](2) Limited number of payments
[fill PR66_3:b](3) Lump-sum payment
@1
Enter Text

PR66_ERR

"Don't Know and/or Refused" response not permitted with other answers
Enter (B) to backup
@
Mark One Only

PR67_PR610

Did [fill HESHE] receive this income from more than one pension plan?
(1)
(2)
@

Yes
No

Enter Number

PR68_PR620

How many different plans did [fill HESHE] receive this income from?
@

Page 16 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Mark One Only

PR69_PR640

[if PR67_PR610 eq <1> and PR66_A(<1>) eq ]
The following questions refer to the pension or retirement
plan that pays the largest amount of lifetime benefits.
[else]
[if PR66_A(<2>) eq ]
The following questions refer to the benefits [fill HESHE] [fill AREIS]
receiving in a limited number of payments.
[else]
[if PR66_A(<3>) eq ]
The following questions refer to the benefits [fill HESHE] received
as a lump-sum payment.
[endif] [endif] [endif]
Does this pension benefit come from a job or business that
[fill HESHE] held in the past, or does it come from a job or business held
by [fill HISHER] former spouse?
(1) Respondent's job
(2) Respondent's former spouse's job
(3) Other
@
Enter Number

PR70_PR650

In what year did [fill HESHE] begin receiving this pension?
@ Year
Mark One Only

PR71_PR660

Was the amount of this pension payment based on years of service
and pay, or on the amount of money held in an individual account
for [fill HIMHER]?
(1) Years of service and pay
(2) Amount in individual account
@
Mark One Only

PR72_PR670

Were reduced benefits taken in order to elect a survivor's option?
(1) Yes
(2) No
(3) No survivor's option offered
@
Mark One Only

PR73_PR680

Has the amount of [fill HISHER] pension ever increased for any reason?
(1)
(2)
@

Yes
No

Mark One Only

PR74_PR690

Does [fill HISHER] pension plan provide for automatic cost-of-living
adjustments known as COLA's?
(1)
(2)
@

Monday, June 13, 2011

Yes
No

Page 17 of 24

Survey:
Section: Retirement TM

Items Booklet

Mark One Only

PR75_PR700

Did the amount of [fill HISHER] pension payment ever decrease for any
reason?
(1)
(2)
@

Yes
No

Enter Number

PR76_PR710

How much did [fill HESHE] receive from this plan each month when
[fill HESHE] first began receiving the pension payment?
$@
Enter Number

PR77_PR720

How much [fill DODOES] [fill HESHE] currently receive EACH MONTH from this plan?
$@
Mark One Only

PR78_PR730

Now I have some questions about [fill HISHER] most recent lump sum payment.
Did this payment come from a job or business [fill HESHE] held in the past,
or did it come from a job or business held by [fill HISHER] former spouse?
(1) Respondent's former job
(2) Respondent's former spouse's job
(3) Other
@
Mark One Only

PR79_PR740

[fill C_HAVHAS] [fill HESHE] ever retired from a job or business?
(1)
(2)
@

Yes
No

Mark One Only

PR80_PR750

[fill C_HAVHAS] [fill HESHE] ever worked for pay as much as five years or more?
(1)
(2)
@

Page 18 of 24

Yes
No

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

PR81_PR751

Mark One Only
[if PR79_PR740 eq <1>]
Did [fill HESHE] retire from a job or from a business?
[else]
[if PR80_PR750 eq <1>]
Was [fill HISHER] longest employment on a job or in a business?
[else]
Did this pension benefit come from a job or from a business?
[endif] [endif]
(1) Job
(2) Business
@

PR82_PR760

Mark One Only
[if PR66_A(<1>) ne <> or PR66_A(<2>)
The next questions are about the job
pension or retirement income.
[else]
[if PR78_PR730 ne <>]
The next questions are about the job
most recent lump-sum payment.
[else]
[if PR79_PR740 eq <1>]
The next questions are about the job
[else]
[if PR80_PR750 eq <1>]
The next questions are about the job
longest.
[endif] [endif] [endif] [endif]

ne <> or PR66_A(<3>) ne <>]
from which [fill HESHE] received this

from which [fill HESHE] received this

from which [fill HESHE] retired.
on which [fill HESHE] worked the

What type of organization was that?
(1) A Government organization (including Armed Forces)
(2) A Private for profit Company
(3) A non-profit organization including tax-exempt and
charitable organizations
(4) A family business or farm?
@
Mark One Only

PR83_PR770

Was that Federal Government, State Government, Local Government,
or active duty Armed Forces?
(1)
(2)
(3)
(4)

Federal Government (civilian)
State Government
Local Government (county, city, township)
Active duty Armed Forces

@

Enter Text

PR84_PR780

What was the main function or activity of the government
organization that [fill HESHE] worked for ?
@

Monday, June 13, 2011

Page 19 of 24

Survey:
Section: Retirement TM

Items Booklet

Mark One Only

PR85_PR781

Did [fill HESHE] work as a paid or unpaid employee for the family business
or farm?
(1)
(2)

For pay
Unpaid worker

@
Enter Text

PR86_PR790

What kind of business or industry was that?
READ IF NECESSARY:
What did they make or do where [fill HESHE] worked?
@
Mark One Only

PR87_PR810

Was it mainly?
(1)
(2)
(3)
(4)
(5)

Manufacturing
Wholesale Trade
Retail Trade
Service
Some other kind of business?

@

Enter Text

PR88_PR820

What kind of work [fill WASWERE] [fill HESHE] doing on that job,
that is, what was [fill HISHER] occupation?
For example: Bookkeeper, Plumber, Press operator
@
Enter Text

PR89_PR830

What were [fill HISHER] usual activities or responsibilities on that job?
For example: Keeping account books, repairing pipes, operating
printing presses
@
Mark One Only

PR90_PR840

Did [fill HISHER] employer operate in more than one location?
(1)
(2)

Yes
No

@

Page 20 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Mark One Only

PR91_PR850

How many people were employed at the location where [fill HESHE] worked?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

less than 10
10 to 24
25 to 49
50 to 99
100 to 249
250 to 499
500 to 999
1,000 or more

@
Mark One Only
[if PR90_PR840 eq <1>
About how many people
at all locations?
[else]
[if PR90_PR840 eq <2>
About how many people
[endif] [endif]
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

PR92_PR860

and PR91_PR850 ne <8>]
were employed by that employer
or PR90_PR840 eq or PR90_PR840 eq ]
were employed by that employer?

less than 10
10 to 24
25 to 49
50 to 99
100 to 249
250 to 499
500 to 999
1,000 or more

@
Mark One Only

PR93_PR870

When [fill HESHE] worked for that employer, [fill WASWERE] [fill HESHE]
covered under a union or employee association contract?
(1)
(2)
@

Yes
No

Enter Number

PR94_PR880

How many hours per week did [fill HESHE] usually work at that job?
@ Hours
Enter Number

PR95_PR890

How many weeks during the year did [fill HESHE] usually work at that job?
Include paid vacation and sick leave as work time.
@ WEEKS
Enter Number

PR96_PR900

How many years did [fill HESHE] work at that job?
@ Years

Monday, June 13, 2011

Page 21 of 24

Survey:
Section: Retirement TM

Items Booklet

Enter Number

PR97_PR910

In what year did [fill HESHE] leave that job?
@ Year
Multiple Entry

PR98_PR920

When [fill HESHE] left that job, how much [fill WASWERE] [fill HESHE]
earning before deductions for taxes, etc?
$ @1
Per: (1)
(2)
(3)
(4)
@2

Week
Biweekly
Month
Year

Mark One Only

PR99_PR940

[fill C_AREIS] [fill HESHE] now covered by a health plan provided
through [fill HISHER] former employer?
(1)
(2)
@

Yes
No

Enter Text

PR100_PR950

[if PR66_A(<1>) ne <> or PR66_A(<2>) ne <> or PR66_A(<3>) ne <>]
The next questions are about the business from which [fill HESHE] received
this pension or retirement income.
[else]
[if PR78_PR730 ne <>]
The next questions are about the business from which [fill HESHE] received
this most recent lump-sum payment.
[else]
[if PR79_PR740 eq <1>]
The next questions are about the business from which [fill HESHE] retired.
[else]
[if PR80_PR750 eq <1>]
The next questions are about the business which [fill HESHE] operated for
the longest time.
[endif] [endif] [endif] [endif]
What kind of business was that?
READ IF NECESSARY: What did the business do or make?
@
Mark One Only

PR101_PR951

Was this business mainly...
(1)
(2)
(3)
(4)
(5)

Manufacturing
Wholesale Trade
Retail Trade
Service
Some other kind of business?

@

Page 22 of 24

Monday, June 13, 2011

Items Booklet

Survey:
Section: Retirement TM

Enter Text

PR102_PR952

What kind of work [fill WASWERE] [fill HESHE] doing at that business,
that is, what was [fill HISHER] occupation?
For example: Sales manager, dentist, farmer
@
Enter Text

PR103_PR953

What were [fill HISHER] usual activities or responsibilities at that
business?
For example: Managing sales, repairing teeth, farming
@
Mark One Only

PR104_PR954

What was the maximum number of people [fill HESHE] employed, including
[fill SELF], who worked at this business at any one time?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

less than 10
10 to 24
25 to 49
50 to 99
100 to 249
250 to 499
500 to 999
1,000 or more

@
Mark One Only

PR105_PR955

Was this business incorporated?
(1)
(2)
@

Yes
No

Enter Number

PR106_PR956

How many hours per week did [fill HESHE] usually work at that business?
@ Hours
Enter Number

PR107_PR957

How many weeks during the year did [fill HESHE] usually work at that
business? Include paid vacation and sick leave as work time.
@ WEEKS
Enter Number

PR108_PR958

How many years did [fill HESHE] work at that business?
@ Years

Monday, June 13, 2011

Page 23 of 24

Survey:
Section: Retirement TM

Items Booklet

Enter Number

PR109_PR959

In what year did [fill HESHE] leave that business?
@ Year
Multiple Entry

PR110_PR960

When [fill HESHE] left that business, how much [fill WASWERE] [fill HESHE]
earning before deductions for taxes, etc?
$ @1
Per: (1)
(2)
(3)
(4)
@2

Week
Biweekly
Month
Year

Mark One Only

PR111_PR970

[fill C_AREIS] [fill HESHE] now covered by a health plan provided
through [fill HISHER] former business?
(1)
(2)
@

Yes
No

Mark One Only

PR112_PR980

Compared to the standard of living [fill HESHE] had in [fill HISHER]
early fifties, would [fill HESHE] say that [fill HISHER] current
standard of living is...
READ ALL CATEGORIES.
(1)
(2)
(3)
(4)
(5)

Much better
Somewhat better
About the same
Somewhat worse
Much worse

@

Page 24 of 24

Monday, June 13, 2011