National Household Food Acquisition and Purchase Survey -- Respondents

APPENDIX Q
FINAL HOUSEHOLD INTERVIEW AND HAND CARDS

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Final Interview
INTRODUCTION
I have your address listed as (READ FROM CONTACT SHEET). Is that your exact address?
(1) YES, CONTINUE
(2) NO, WRONG ADDRESS QUICK EXIT
In this interview I’ll ask you about your household’s eating habits, dietary needs, health status, income and nonfood expenditures. This information is
important to understanding your household’s food acquisitions. Taking part in this study is completely voluntary. You can skip any question you do not wish
to answer or that makes you feel uncomfortable. Remember, we are required by law to use your information for statistical research only and to keep it
confidential. The law prohibits us from giving anyone any information that may identify you or your family. Your responses will not affect any benefits or
services you may receive from any government agency, now or in the future. It will take about 40 minutes to answer these questions. I’d like to begin now
unless you have any questions for me. May I begin?
(1) YES, CONTINUE
(2) NO, RESCHEDULE ALTERNATE TIME
(3) NO, DECLINE TO TAKE PART/REFUSAL
SECTION A
A1

During the past 7 days, how many times did (you/ you or someone
else in your family) prepare food for dinner or supper at home?
Include times spent putting the ingredients together for a meal, but
do not include heating up leftovers.
NUMBER: ____________ (Range 0-20)
(0) NEVER
(r) REFUSED
(d) DON'T KNOW

A1a

How often do you shop with a grocery list?
(1) Never
(2) Seldom
(3) Sometimes
(4) Most of the time
(5) Almost always
(r) REFUSED
(d) DON'T KNOW

IF HH SIZE >1, ASK A2
A2 During the past 7 days, how many meals did all or most of
your family sit down and eat together? THIS INCLUDES
MEALS EATEN AWAY FROM HOME.
NUMBER: ____________ (Range 0-30)
(r) REFUSED
(d) DON'T KNOW
A3

During the past 7 days, did any guests come to your home for
meals or snacks?
(1) YES  GO TO A3a
(0) NO
GO TO B1
(r) REFUSED
(d) DON'T KNOW

Final Interview – GRID A3b
A3a

How many days last week did guests come to your home for a meal or snack?
NUMBER: ____________ (Range 0-7)
(r) REFUSED
GO TO B1
(d) DON'T KNOW

INTERVIEWER: FILL GRID IF A3a > 0
A3b
Which day(s) did guests
come to your home last
week?

Day of Week

CHECK (√) ALL DAYS
THAT GUESTS
VISITED.

IF A3b=√
A3c
On (DAY FROM A3b) what meals or snack
did your guests have at your home?
B=BREAKFAST D=DINNER
L= LUNCH
S=SNACK

A3d
How many guests came to your house
on (DAY FROM A3b) for (MEAL
FROM A3c)?
ENTER # GUESTS

(1) SUNDAY
(2) MONDAY
(3) TUESDAY
(4) WEDNESDAY
(5) THURSDAY
(6) FRIDAY
(7) SATURDAY
(r) REFUSED
(d) DON’T KNOW

A3e

Did any guests come to your home for any other meals or snacks during the past 7 days?
(1) YES  UPDATE A3b-A3d ABOVE
(0) NO
(r) REFUSED
GO TO B1
(d) DON'T KNOW

Final Interview – Section B
SECTION B
B1

Thinking only about yourself, in general, how healthy is your overall
diet? Would you say . . .
(1) Excellent
(2) Very good
(3) Good
(4) Fair
(5) Poor
(r) REFUSED
(d) DON'T KNOW
IF HH SIZE >1, ASK B2
B2 In general, how healthy is your family’s overall diet? Would you
say . . . IF NEEDED: When we say “family” we mean all of the
members of your household.
(1) Excellent
(2) Very good
(3) Good
(4) Fair
(5) Poor
(r) REFUSED
(d) DON'T KNOW

I am going to read a series of statements. Tell me whether you agree or
disagree with each one of them.
B3a It costs too much for (me/my family) to eat healthy foods.
PROMPT: Do you agree or disagree?
(1) AGREE
(r) REFUSED
(2) DISAGREE (d) DON'T KNOW

B3b I’m too busy to take the time to prepare healthy foods.
PROMPT: Do you agree or disagree?
(1) AGREE
(r) REFUSED
(2) DISAGREE
(d) DON'T KNOW
B3c I don't think healthy foods taste good.
PROMPT: Do you agree or disagree?
(1) AGREE
(r) REFUSED
(2) DISAGREE
(d) DON'T KNOW
IF HH SIZE >1, ASK B3d
B3d People in my family don't think healthy foods taste good.
PROMPT: Do you agree or disagree?
(1) AGREE
(r) REFUSED
(2) DISAGREE (d) DON'T KNOW
B3e The things that (I/my family) eat and drink now are healthy so there is
no reason for (me/us) to make changes.
PROMPT: Do you agree or disagree?
(1) AGREE
(r) REFUSED
(2) DISAGREE
(d) DON'T KNOW
B4 Next I’m going to ask a few questions about the nutritional guidelines
recommended for Americans by the federal government. Have you
heard of MyPlate?
(1) YES  GO TO B4a
(0) NO
GO TO B5
(r) REFUSED
(d) DON'T KNOW
B4a

Have you tried to follow the MyPlate guidelines?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

Final Interview – Section B
B5

Have you heard of MyPyramid?
(1) YES  GO TO B6
(0) NO
GO TO B5a
(r) REFUSED
(d) DON'T KNOW
B5a

Have you heard of the Food Pyramid or the Food Guide
Pyramid?
(1) YES  GO TO B6a
(0) NO
GO TO B10
(r) REFUSED
(d) DON'T KNOW

B6

Have you looked up the MyPyramid plan for a
(man/woman) your age on the internet?
(1) YES  GO TO B6a
(0) NO
(r) REFUSED
GO TO B10
(d) DON'T KNOW

B6a

Have you tried to follow the MyPyramid Plan or Pyramid
plan recommended for you?
(1) YES
(0) NO
(r) REFUSED
(d) DON'T KNOW

INTERVIEWER:
BREAK IN QUESTION NUMBERS.
NEXT QUESTION IS B10, NEXT COLUMN.

B10

Do you think you eat the right amount of fruits and vegetables now,
or do you think you should eat more?
(1) EAT RIGHT AMOUNT
(2) SHOULD EAT MORE
(3) SHOULD EAT LESS
(r) REFUSED
(d) DON'T KNOW

B11

“The “Nutrition Facts panel” of a food label is everything on this
page. SHOW HAND CARD OF NUTRIENT PANEL. When
choosing between different food items at the grocery store, how
often do you use the Nutrition Facts panel to help you decide which
item to buy? Would you say always, most of the time, sometimes,
rarely, or never?
(1) ALWAYS
(2) MOST OF THE TIME
(3) SOMETIMES
(4) RARELY
(5) NEVER
(6) NEVER SEEN
(r) REFUSED
(d) DON'T KNOW

B12

In the past two months, have you participated in any events,
lectures or demonstrations about how to shop for or prepare
nutritious food and meals?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

B13

In the past two months, have you searched the internet for
nutritional information or information about how to shop for or
prepare nutritious foods and meals?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

Final Interview – Section C

INTERVIEWER: ASK QUESTION.

Person #

C1
Do you
consider
yourself to
be a
vegetarian?

YES

1

NO

2

REF.

3

D.K.

4
5

IF HH SIZE > 1
C2
Do you consider
any members of
your household to
be vegetarian?

YES → C2a
NO
REF.
D.K.

C2b

C2a
Who is
that?
PROBE:
Anyone
else?
CHECK
(√) ALL
THAT
APPLY

C2b
(Are you/Is
anyone in your
household)
lactose
intolerant?

IF C2b=1:
C2c
Who is that?
PROBE:
Anyone else?
CHECK (√)
ALL THAT
APPLY

YES
NO
REF.
D.K.

C3
(Do you/Does
anyone in your
household) have
any food allergies?
IF NEEDED: A
food allergy is a
reaction causing a
skin rash, hives,
difficulty breathing,
wheezing, or itching
of the eyes, mouth,
throat or skin.

C3
YES → C3a

D.K.

IF C3a = √:

C3a
Who has food
allergies?
PROBE:
Anyone else?
CHECK (√)
ALL THAT
APPLY

C3b
SHOW HAND
CARD
What foods (are
you/is NAME)
allergic to?
ENTER CODE

C4
(Are you/Is anyone in
your household) on any
kind of diet, either to lose
weight or for some other
health-related reason?
IF NEEDED: Examples
of special diets include
diet for weight loss, low
carbohydrate, high
protein, Atkins, low
cholesterol, gluten-free,
low sodium, diabetic diet,
etc.

IF C4=1:
C4a
Who is that?
PROBE:
Anyone else?

CHECK (√)
ALL THAT
APPLY

YES→ C4a

NO
REF.

IF C3=1:

C4

NO
REF

D1

DK

6
7
C3b. FOOD ALLERGIES?
(10) WHEAT (GLUTEN)
(19) OTHER
(11) COW’S MILK
(r))REFUSED
(12) EGGS
(d) DON’T KNOW
(13) FISH
(14) SHELLFISH (SHRIMP, CRAB, OR LOBSTER)
(15) CORN
(16) PEANUT
(17) OTHER NUTS
(18) SOY PRODUCTS

Final Interview – Section D

INTERVIEWER: ASK QUESTION FOR EACH PERSON, THEN GO TO NEXT QUESTION.

Person #

D1
In general, would
you say
(your/NAME)
health is
excellent, very
good, good, fair,
or poor?

1

ENTER
CODE.

D2
(Do you/does anyone who lives here)
smoke cigarettes, cigars, or pipes, or
chews tobacco?

D2a
Who smokes
or chews
tobacco?
CHECK ALL
THAT
APPLY

YES GO TO D2a
NO
REFUSED

IF D2=1:

GO TO
D3

The next questions are about the height and weight of each member of your household. I’ll start
by asking about height.
D3
How tall (are you/NAME) without shoes?
IF AGE < 2 YRS: How tall is (NAME) when lying down
and measured from head to toe?

ENTER POUNDS OR
KILOGRAMS

ENTER # (IN FEET & INCHES
OR METERS OR CENTIMETERS)
FEET

INCHES

METERS

D4_Weight
How much (do you/does NAME)
weigh without clothes or shoes?

CENTIMETERS

LBS

DON’T KNOW

2
3
4
5
6
7
D3. HEIGHT
(r) REFUSED
(D) DON’T KNOW

D4_Weight. WEIGHT
(r) REFUSED
(D) DON’T KNOW

KG

Final Interview – Section E
SECTION E
These next questions are about the food eaten in your household in the last 30
days, and whether you were able to afford the food you need.
E1 Which of these statements best describes the food eaten in your household
in the last 30 days?
(1) Enough of the kinds of food (I/we) want to eat
(2) Enough, but not always the kinds of food (I/we) want to eat
(3) Sometimes not enough to eat
(4) Often not enough to eat
(r) REFUSED
(d) DON’T KNOW
Now I’m going to read you several statements that people have made about their
food situation. For these statements, please tell me whether the statement was
often true, sometimes true, or never true for (you/your household) in the last 30
days.
E2

E3

The first statement is “(I/We) worried whether (my/our) food would run
out before (I/we) got money to buy more.” Was that often true, sometimes
true, or never true for (you/your household) in the last 30 days?
(1) OFTEN TRUE
(r) REFUSED
(2) SOMETIMES TRUE
(d) DON’T KNOW
(3) NEVER TRUE
“The food that (I/we) bought just didn’t last, and (I/we) didn’t have
money to get more.” Was that often, sometimes, or never true for
(you/your household) in the last 30 days?
(1) OFTEN TRUE
(r) REFUSED
(2) SOMETIMES TRUE
(d) DON’T KNOW
(3) NEVER TRUE

E4

“(I/We) couldn’t afford to eat balanced meals.” PROMPT: Was that often,
sometimes, or never true for (you/your household) in the last 30 days?
(1) OFTEN TRUE
(r) REFUSED
(2) SOMETIMES TRUE
(d) DON’T KNOW
(3) NEVER TRUE

IF (E1=3 or 4) or (E2=1 or 2) or (E3=1 or 2) or (E4=1 or 2) CONTINUE.
OTHERWISE GO TO SECTION F.
E5
In the last 30 days did (you/you or other adults in your household) ever
cut the size of your meals or skip meals because there wasn't enough
money for food?
(r) REFUSED
(1) YES  GO TO E5a
E6
(d) DON’T KNOW
(0) NO  GO TO E6
E5a

In the last 30 days, how many days did this happen?
#DAYS: ____________ (Range 1-30)
(r) REFUSED
(d) DON’T KNOW

YES NO
E6 In the last 30 days, did you ever eat less than
you felt you should because there wasn't
enough money for food?
E7 In the last 30 days, were you ever hungry but
didn't eat because there wasn't enough money
for food?
E8 In the last 30 days, did you lose weight
because there wasn't enough money for food?
E9 In the last 30 days, did (you/you or other
adults in your household) ever not eat for a
whole day because there wasn't enough
GO TO
money for food?

REF

DK

E9a

E9a

In the last 30 days, how many
days did this happen?

#DAYS: ____________ (Range 1-30)
(r) REFUSED

(d) DON’T KNOW

Final Interview – Section F

SECTION: Section F
The next questions are about your household income and expenses. This information is important for understanding the money that you have available to spend on
food. I’ll ask you to read the information that you put on your worksheet to make sure that I don’t read anything incorrectly. This will also help you think about
anything you missed. Did you have any questions about the worksheet before we begin?
F0

Did you complete the income and expenses worksheet that I left with you at the beginning of the week?
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW
INTERVIEWER: GO TO GRID F1.

Final Interview – Section F

INTERVIEWER: ASK F1-F8 FOR EACH PERSON AGE 16 AND OLDER, THEN MOVE TO NEXT PERSON.
SEE CODES FOR AMOUNT & HOW OFTEN.
F1
Did (you/
NAME)
have

INTERVIEWER: IF F1=NO, SKIP F2-F6 AND GO TO NEXT PERSON

any
income

IF NEEDED: How often is that received?

Person #

last
month?

F2 How much did (you/NAME) receive in earnings
from work last month?
F2
AMOUNT

F2a
HOW
OFTEN

ENTER
CODE

1
2
3
4
5
6
7
ANY INCOME
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW

F2b
Is that take-home
pay or the amount
before taxes are
taken out?
ENTER CODE

F3
How much did (you/NAME)
receive in unemployment
compensation last month?

F3a
HOW
OFTEN

F3
AMOUNT

F4
How much did (you/NAME)
receive from welfare, child
support, or alimony last
month?
F4
AMOUNT

F4a
HOW
OFTEN

F5
How much did (you/NAME) receive from

retirement and disability income last
month?

F5
AMOUNT

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

AMOUNT
(0) NONE
(r) REFUSED
(d) DON’T KNOW

HOW OFTEN
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK
(4) EVERY WEEK OR WEEKLY
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

F2b. TAKE-HOME PAY?
(1) TAKE-HOME PAY
(2) AMOUNT BEFORE TAXES
(r) REFUSED
(d) DON’T KNOW

F5a
HOW
OFTEN

F5b
What was the
source of that
income?
ENTER CODE

F5b. SOURCE OF RETIREMENT INC
(1) SOCIAL SECURITY RETIREMENT BENEFITS (SSA)
(2) SOCIAL SECURITY DISABILITY RELIEF (SSDI)
(3) PENSIONS
(4) BLACK LUNG BENEFITS
(5) WORKERS COMPENSATION
(6) SSI
(7) OTHER RETIREMENT INCOME
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section F
INTERVIEWER: ASK F1-F8 FOR EACH PERSON AGE 16 AND OLDER THEN MOVE TO NEXT PERSON.
SEE CODES FOR AMOUNT & HOW OFTEN.
F5c
How much did (you/NAME) receive in

F6
How much other

income did (you/NAME) receive last month?

investment income last month?
F5c2
HOW
OFTEN

Person #

F5c1
AMOUNT

1
2
3
4
5
6
7

F5c3
What was the
source of that
income?

F6
AMOUNT

F6a
HOW OFTEN

F7, F8
Let me make sure that the information I have about
(your / NAME’s) income is correct. I have recorded
(READ ALL TYPES OF INCOME AND AMOUNTS
FROM F1-F6).

F6b
What was the source of
that income?

F7
Is this correct?

ENTER CODE

IF ‘NO’ CORRECT
GRID

ENTER CODE

F8
Is anything missing? Did (you
/ NAME) have any other
income last month from
sources not listed above?
IF ‘YES’ CORRECT GRID

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

$_________.____

AMOUNT

HOW OFTEN

F5c3. INCOME SOURCE

F6b. INCOME SOURCE

F7. CORRECT?

(0) NONE
(r) REFUSED
(d) DON’T KNOW

(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK
(4) EVERY WEEK OR WEEKLY
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

(1) RENTAL PROPERTIES
(2) INTEREST
(3) CAPITAL GAINS
(4) TRUST FUND PAYMENTS
(5) OTHER INVESTMENT INCOME
(r) REFUSED
(d) DON’T KNOW

(1) STRIKE BENEFITS
(2) FUEL ASSISTANCE
(3) ROOMERS, LODGERS, OR TENANTS
(4) EDUCATIONAL GRANTS
(5) INSURANCE SETTLEMENT PAYMENTS
(6) VETERANS AFFAIRS BENEFITS
(7) LOTTERY WINNINGS
(8) TRUST FUND PAYMENT
(9) EMPLOYMENT BONUSES
(r) REFUSED
(d ) DON’T KNOW

(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW

F8. ANYTHING
MISSING
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section F and G
F9

(Do you/Does your household) have $2,000 or more in cash, checking
accounts, saving accounts, money markets, or other assets that are easily
converted to cash? INTERVIEWER: WE WANT TO KNOW IF
TOTAL LIQUID ASSETS ARE $2000 OR MORE.
(1) YES  GO TO F9a
(0) NO
(r) REFUSED
(d) DON’T KNOW

F9a

GO TO SECTION G

(Do you/Does your household) have $3,000 or more in cash,
checking accounts, saving accounts, money markets, or other
assets that are easily converted to cash? INTERVIEWER: WE
WANT TO KNOW IF TOTAL LIQUID ASSETS ARE $3000
OR MORE.
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW

SECTION: Section G
The next questions are about your household expenses last month. Household expenses do not include business expenses, so you should not include
business expenses in your responses.
INTERVIEWER: READ QUESTIONS IN FIRST COLUMN, RECORD RESPONSES IN COLUMNS TO THE RIGHT OF EACH QUESTION.
QUESTION
G1
(Do you/Does your household) rent or own
your home?

G1a

G1c

How much did (you/your household)
pay for (rent/mortgage) last month?

Is this public housing – that is, is it owned by a
local public housing authority or other public
agency?
DO NOT INCLUDE MILITARY HOUSING.

RESPONSE
(1) RENT
GO TO G1a
(2) OWN
(3) OTHER, DO NOT PAY FOR HOUSING
(r) REFUSED
(d) DON’T KNOW

$ ____________. ____
(r) REFUSED
(d) DON’T KNOW
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW

IF OWN HOME (G1=2) GO TO G2, ELSE GO TO G1d

GO TO G1c

G1b. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section G
QUESTION
G1d Is the rent here subsidized by the Federal, State,
or Local government? By that I mean, is the
government paying part of the cost? DO NOT
INCLUDE MILITARY HOUSING.
G2

How much do (you/your household) pay for
homeowners or renters insurance?

RESPONSE
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW
$ ____________. ____  GO TO G2a
(0) NOTHING

(1) ALREADY REPORTED W/OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

IF OWN HOME (G1=2) ASK G3, OTHERWISE GO TO G5
G3
How much (do you/does your household) pay
$ ____________. ____  GO TO G3a
for real estate or property tax?
(0) NOTHING

G5

(Do you/does anyone in your household) own
or lease a car or truck?

G5a

How many vehicles (do you/does your
household) own or lease?

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW
(1) YES, OWN
GO TO G5a
(2) YES, LEASE
(3) OWN AND LEASE
(0) NO
GO TO G6
(R) REFUSED
(D) DON’T KNOW

G2a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G3a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G6a.HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G12a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

NUMBER: ____________

(R) REFUSED
(D) DON’T KNOW

G6

G12

Last month, how much did (you/your
household) pay for public transportation or
vehicle rentals?

$ ____________. ____  GO TO G6a

How much did (you/your household) pay for
electricity last month?

$ ____________. ____  GO TO G12a

(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section G
QUESTION
G13 How much did (you/your household) pay for
gas, oil, wood, or other heating fuels last month?

RESPONSE
$ ____________. ____  GO TO G13a
(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

G14

G15

G16

G17

G18

How much (do you/does your household) pay
for sewer maintenance and/or garbage
collection?

How much (do you/does your household) pay
for health insurance? Please include payments
for health insurance that are automatically
deducted from your pay.
Last month, how much did (you/ your
household) pay for health insurance co-pays?
These are payments that you make to physicians
or hospitals when your insurance pays most of
the bill.

$ ____________. ____  GO TO G14a
(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

$ ____________. ____  GO TO G15a
(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

$ ____________. ____  GO TO G16a
(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

Last month, how much did (you/your
household) pay for physician or hospital bills
not paid by insurance?

$ ____________. ____  GO TO G17a

Last month, how much did (you/your
household) pay for prescription drugs?

$ ____________. ____  GO TO G18a

(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

G13a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G14a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G15a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G16a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G17a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G18a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section G
QUESTION
IF (G16>0) or (G17>0) or (G18>0), ASK G18b:
G18b Last month, how much of (your/your
household’s) out-of-pocket medical
expenses were spent for household
members who are older than age 59 or
are disabled?
G19

Last month, how much did (you/your
household) pay for child care?

RESPONSE

$ ____________. ____
(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

$ ____________. ____  GO TO G19a
(0) NOTHING

(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW

G20

Last month, how much did (you/your
household) pay in child support?

G21

Last month, how much did (you/your
household) pay for adult care?

G22

Over the past month, has your household had
any unusually large and unexpected expenses
that affected your spending on food during the
study week?

$ ____________. ____  GO TO G20a
(0) NOTHING
(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW
$ ____________. ____  GO TO G21a
(0) NOTHING
(1) ALREADY REPORTED W/ OTHER EXPENSE
(r) REFUSED
(d) DON’T KNOW
(1) YES
(0) NO
(R) REFUSED
(D) DON’T KNOW

G19a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G20a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

G21a. HOW OFTEN?
(1) PER MONTH OR MONTHLY
(2) TWICE PER MONTH
(3) EVERY OTHER WEEK

(4) EVERY WEEK
(5) PER YEAR OR ANNUALLY
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section H
My next questions are about major life events
H1 Has there been a change in the number of people living in your
household over the past 3 months?
(1) YES
(0) NO
(r) REFUSED
GO TO H2
(d) DON'T KNOW
H1a

H2

What caused that change? CIRCLE ALL THAT APPLY.
(1) BIRTH OF CHILD
(2) NEW STEP, FOSTER OR ADOPTED CHILD
(3) SEPARATION OR DIVORCE
(4) DEATH OF HOUSEHOLD MEMBER
(5) MARRIAGE
(6) NEW PARTNER
(7) A CHILD, PARENT, OTHER RELATIVE MOVING
IN OR OUT OF THE HOUSEHOLD
(8) OTHER
(r) REFUSED
(d) DON’T KNOW

Have you (or anyone in your family) been diagnosed with a major illness
or disability in the past 3 months?
(1) YES
(0) NO
(r) REFUSED
GO TO H3
(d) DON'T KNOW
H2a

Was that someone in your household or someone outside your
household?
(1) HOUSEHOLD MEMBER(S)
(2) FAMILY MEMBER(S) OUTSIDE HOUSEHOLD
(3) BOTH HOUSEHOLD MEMBERS AND NON-

HOUSEHOLD MEMBERS
(r) REFUSED
(d) DON’T KNOW
H3

(Have you/Has anyone in your household) changed jobs in the past 3
months?
(1) YES  GO TO H3a
(0) NO
(r) REFUSED
GO TO H4
(d) DON'T KNOW
H3a

Who was that?
NAME: ___________________
(r) REFUSED

(d) DON’T KNOW

H3b

(Do you/Does NAME) now earn more, less, or about the
same as before changing jobs?
(1) MORE
(r) REFUSED
(2) LESS
(d) DON’T KNOW
(1) ABOUT THE SAME

H3a

Anyone else (change jobs)?
NAME: ___________________
(r) REFUSED

H3b

(d) DON’T KNOW

(Do you/Does NAME) now earn more, less, or about the
same as before changing jobs?
(1) MORE
(r) REFUSED
(2) LESS
(d) DON’T KNOW
(1) ABOUT THE SAME

Final Interview – Section H
H4

Which of the following best describes (your/your household’s) financial
condition?
(1) Very comfortable and secure
(2) Able to make ends meet without much difficulty
(3) Occasionally have some difficulty making ends meet
(4) Tough to make ends meet but keeping your head above water
(5) In over your head

Next I'll read a list of financial practices. Please tell me whether your
household does them never, rarely, sometimes, usually, or always
H4a How often (do you/does your household) review your bills for
accuracy?
(1) Never
(6) NOT APPLICABLE
(2) Rarely
(r) REFUSED
(3) Sometimes
(d) DON’T KNOW
(4) Usually
(5) Always
H4b

H4c

How often (do you/does your household) pay your bills on time?
(1) Never
(6) NOT APPLICABLE
(2) Rarely
(r) REFUSED
(3) Sometimes
(d) DON’T KNOW
(4) Usually
(5) Always
How often (do you/does your household) pay more than the
“minimum payment” due on your credit card bills?
(1) Never
(6) NOT APPLICABLE
(2) Rarely
(r) REFUSED
(3) Sometimes
(d) DON’T KNOW
(4) Usually
(5) Always

INTERVIEWER: IF QUESTION H4=1 OR 2 SKIP TO SECTION I,
OTHERWISE CONTINUE
Next are questions about difficulties people sometimes have in meeting their
essential household expenses for such things as mortgage or rent payments,
utility bills, or important medical care.
H5a

During the past 6 months, has there been a time when (you/your
household member) could not pay your mortgage or rent, electricity or
gas utilities, or important medical expenses?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

H5b

In the past 6 months, (were you/was your household) evicted from a
home or apartment for not paying the rent or mortgage?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

H5c

In the past 6 months, has there been a time when (you/your
household) could not pay the full amount of the gas, oil, or electricity
bills?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

H5d

During the last 6 months, (have you/has anyone in your household)
used a cash advance service on any of your credit cards?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW
(2) NOT APPLICABLE

H5e

In the last 6 months, (have you/has anyone in your household) used a
payday loan or other high interest rate loan?
(1) YES
(r) REFUSED
(0) NO
(d) DON'T KNOW

Final Interview – Section I

INTERVIEWER: ASK QUESTION FOR EACH PERSON, THEN MOVE TO NEXT COLUMN.

READ: My last questions are about your current and previous residence.

Person #

I1
In what month and year did
(you/NAME) move into this
(house/apartment/mobile
home)?
ENTER 1 FOR ALWAYS
LIVED HERE

Month
(1-12)

IF I1a = 1:

IF NAME DID NOT LIVE IN CURRENT HOME SINCE BIRTH:

I1a
So (you/NAME)
lived here since birth
- is that correct?

I2
Was (your/NAME’s)
previous home also located
in (THIS STATE), or was it
in some other state?

IF I2 = 0:
I2a
What state was that?
ENTER STATE OR
CODE

Year
(1910-2011)

I3
If I2=1:
Were you born in
(THIS STATE)?
If I2=0:
Were you born in
(I2a STATE)?

IF I3=0:
I3a
Where (were
you/was NAME)
born?

ENTER STATE OR
CODE

I4
ASK IF I3=72:
(Are you /Is NAME) a U.S.
citizen? PROBE: We are not
interested in your immigration
status. We are asking about
citizenship because it helps to
determine whether people are
eligible for (STATE SNAP
PROGRAM).

1
2
3
4
5
6
7
I1. MOVE-IN DATE
(1) ALWAYS LIVED HERE
(r) REFUSED
(d) DON’T KNOW

I1a. SINCE BIRTH?
(1) YES
(0) NO
(r) REFUSED
(d) DON’T KNOW

I2. PREVIOUS STATE
(1) YES, SAME STATE
(0) NO, NOT SAME STATE
(r) REFUSED
(d) DON’T KNOW

I2a. STATE?
STATE ABBREV
(66) NOT IN U.S.
(r) REFUSED
(d) DON’T KNOW

I3. BIRTH STATE?
STATE ABBREV
(72) NOT IN U.S.
(r) REFUSED
(d) DON’T KNOW

I4. U.S. CITIZEN?
(1) YES
(2) NO
(r) REFUSED
(d) DON’T KNOW

Final Interview – Section I
INTERVIEWER: ASK I5 IF HOUSEHOLD DID NOT INITIAL THE BOX ON THE CONSENT FORM, OTHERWISE CLOSE
I5
When you signed the consent form at the beginning of the week you did not initial the section to allow us to obtain information from state agencies
about your receipt of food program benefits. Any data that we obtain will be kept strictly confidential. Do we have your permission to obtain your
administrative data from state agencies?
(1) YES
(0) NO
CLOSE

That completes your final interview. Thank you for taking the time to answer these questions.

NUTRITION PANEL

Final
Interview
Question
B11

When choosing between different food items, how
often do you use the Nutrition Facts panel to help
you decide which item to buy?

ALLERGENS
What foods is _____ allergic to?
CODE DESCRIPTION
10

Wheat (gluten)

11

Cow’s milk

12

Eggs

13

Fish

14

Shellfish (example: shrimp, crab, or lobster)

15

Corn

16

Peanut

17

Other nut

18

Soy products

19

Other, not listed above

Final
Interview
Question
C3b