Attachment A - Disability Questions

Attachment A - Disability_Questions_04042012.docx

Current Population Survey Disability Supplement

Attachment A - Disability Questions

OMB: 1220-0186

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Attachment A


CPS Disability Supplement Questions

Question number

Question wording

Response options

Who will receive the question

Intro

This month we would like to learn more about how people in different circumstances deal with labor market challenges.



1

Previously, you mentioned that (you/Name) had difficulty _________. How [(has this difficulty)/(have these difficulties)] affected (your/his/her) ability to complete current work duties? Would you say this has caused no difficulty, a little difficulty, moderate difficulty, or severe difficulty?

1. No difficulty
2. A little difficulty
3. Moderate difficulty
4. Severe difficulty
5. Don't Know
6. Refused

Disability and Employed

2

[(Have you)/(Has Name)] EVER worked for pay at a job or business?

1. Yes
2. No
3. Don't Know
4. Refused

Disability and Not in the Labor Force or Unemployed

3

Earlier it was reported that (you/Name) had difficulty ____. Did (you/he/she) ever leave or lose a job because of reasons related to (this difficulty/these difficulties)?

1. Yes
2. No
3. Don't Know
4. Refused

1. Q2 = 1 OR Disability and Employed

4

The purpose of this next question is to identify barriers to employment faced by persons with difficulties. Do you consider any of the following a barrier to employment for (you/Name)? (Read each answer category, wait for respondent to answer yes or no. Check box if yes.)

1. Lack of education or training


2. Lack of job counseling
3. Lack of transportation
4. Loss of government assistance
5. Need for special features at the job


6. Employer or coworker attitudes

7. (Fill with one or more of the 6 difficulties as identified in the basic CPS, e.g., “Your difficulty hearing”)


8. Other-specify (do not read)

9. None (do not read)
10. Don't Know (do not read)
11. Refused (do not read)

Disability and Not in Labor Force or Unemployed

5

If [(this barrier)/(these barriers)] could be removed, would (you/Name) be able to work?

1. Yes
2. No
3. Don't Know
4. Refused

Q4=1-6, 8

6

The purpose of this next question is to find out if (you have/Name has) taken advantage of any of the following sources that help people prepare for work or advance on the job. In the past 5 years, [(Have you)/(Has Name)] received assistance from: (Read and mark all that apply.)

1. Vocational Rehabilitation Centers
2. One Stop Career Centers
3. Ticket to Work Program
4. Assistive Technology Act Program
5. Center for Independent Living for Individuals with Disabilities
6. Client Assistance Program
7. Any other employment assistance program

1. Yes
2. No

3. Haven’t heard of this program
4. Don't Know
5. Refused
6. No Assistance


Disability

7

How helpful was (this source)? Would you say it was not at all helpful, a little helpful, somewhat helpful, or very helpful?

1. Not at all helpful
2. A little helpful
3. Somewhat helpful
4. Very helpful
5. Don't Know
6. Refused

Q6=1 for each option

8

Have (you/NAME) ever requested any change in your current workplace to help you do your job better? For example, changes in work policies, equipment, or schedules.

1. Yes
2. No
3. Don't Know
4. Refused

Employed

9

What change did (you/Name) request? (Read and mark all that apply.)

1. New or modified equipment
2. Physical changes to the workplace
3. Policy changes to the workplace
4. Changes in work tasks, job structure or schedule
5. Changes in communication or information sharing
6. Changes to comply with religious beliefs
7. Accommodations for family or personal obligations

8. Training
9. Other changes
10. Don't Know
11. Refused

Q8=1

10

Was the change granted?

1. Yes
2. No
3. Partially
4. Don't Know
5. Refused

Q8=1

11

How [(do you)/(does Name)] typically commute to work? (Do not read answer categories, mark all that apply.)

1. Bus
2. Specialized bus or van service for people with disabilities
3. Train/subway
4. Taxi
5. Own vehicle
6. Passenger in a friend or family member's car
7. Carpool
8. Bicycle
9. Walk
10. Other
11. Work from home
12. Don't Know
13. Refused

Employed

12

(Do you/Does Name) do any work at home for (your/his/her) job or business?

1. Yes
2. No
3. Don't Know
4. Refused

Employed

13

[When (you/he/she) (work/works) at home, how/How] many hours per week (do/does) (you/he/she) usually work at home as part of this job?

1. Free Response ___
2. Hours vary

3. Don’t Know

4. Refused

Q12=1

14

Are those hours worked at home usually considered paid work hours?

1. Yes
2. No
3. Don't Know
4. Refused

Q12=1

15

(Do/Does) (you/he/she) have a formal arrangement with (your/his/her) employer to be paid for the work that (you/he/she) (do/does) at home, or (were/was) (you/he/ she) just taking work home from the job?

1. Paid
2. Taking work home

3. Don’t Know

4. Refused

Q12=1

16

What are the reasons why (you work/Name works) at home? (Do not read answer categories, mark all that apply.)

1. Less commuting
2. Reduce expenses for transportation, food, clothing, etc.
3. Coordinate work schedule with work and family needs
4. More control over own life
5. Illness, disability, health reasons
6. Mandated by employer to reduce employer costs
7. Managed by employer to meet local transportation management and pollution abatement requirement
8. More productive

9. Self employed/Business at home
10. Other
11. Don't Know
12. Refused

Q12=1

17

(Do/Does) (you/Name) have flexible work hours that allow (you/him/her) to vary or make changes in the time [(you begin and end)/(he begins and ends)/(she begins and ends)] work?

1. Yes
2. No
3. Don't Know
4. Refused

Employed

18

Some people are in temporary jobs that last only for a limited time or until the completion of a project. Is your job temporary?

1. Yes
2. No
3. Don't Know
4. Refused

Employed

19

There are a variety of programs designed to provide financial assistance to people. In the PAST YEAR did (you/Name) receive assistance from any of the following programs? (Read and mark all that apply.)

1. Workers Compensation
2. Social Security Disability Income
3. Supplemental Security Income
4. Veterans Disability compensation
5. Disability Insurance Payments
6. Other disability payments
7. Medicaid
8. Medicare

9. Other

1. Yes
2. No
3. Don't Know
4. Refused

All

20

Some financial assistance programs include limitations on the amount of work you can do. Did (this program/any of these programs) cause you to work less than you would otherwise?

1. Yes
2. No
3. Don't Know
4. Refused

Q19=1-9


2


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File TitleDecember 1, 2008
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