MEPS-HC Core Interview

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

Attachment 47 -- HC Income Section

MEPS-HC Core Interview

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

Document [doc]

Download: doc | pdf

MEPS FAMES P12R5/P13R3/P14R1 Income (IN) Section

December 8, 2008

Income (IN) Section

BOX_00A

=======

----------------------------------------------------

| THE IN SECTION IS ASKED IN ROUNDS 3 AND 5 ONLY. IF|

| IT IS ROUND 1, 2, OR 4, CONTINUE TO THE NEXT |

| SECTION. |

----------------------------------------------------

BOX_00A

=======

----------------------------------------------------

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PERS.FULLNAME |

----------------------------------------------------

IN01

====

For the next questions, it might be useful to have out some of

the family’s financial records, such as a copy of the family’s

tax forms or materials used to complete the tax form, such as

year end bank statements, financial summaries, pay stubs,

W-2 forms, and the like.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| NOTE: FOR ALL DOLLAR AMOUNT RANGE CHECKS, ALLOW |

| THE ENTRY OF WHOLE DOLLAR AMOUNTS ONLY; DO NOT |

| COLLECT CENTS. |

----------------------------------------------------

LOOP_01

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK BOX_00 - END_LP01 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_01 DETERMINES WHICH RU |

| MEMBERS HAVE FILED OR WILL FILE A FEDERAL INCOME |

| TAX FORM FOR THE CALENDAR YEAR. IF A JOINT RETURN|

| WAS OR WILL BE FILED, THE LOOP DETERMINES WHO IS |

| THE SECONDARY FILER. THIS LOOP CYCLES ON PERSONS |

| WHO MEET THE FOLLOWING CONDITION: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

BOX_00

======

----------------------------------------------------

| IF PERSON BEING LOOPED ON IS FLAGGED AS |

| ‘SECONDARY FILER ON JOINT FEDERAL TAX RETURN’, GO |

| TO END_LP01 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH IN02 |

----------------------------------------------------

IN02

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Has (PERSON) filed a {YEAR} Federal income tax return?

YES .................................... 1 {IN04}

NO ..................................... 2 {IN03}

REF ................................... -7 {IN03}

DK .................................... -8 {IN03}

HELP AVAILABLE FOR DEFINITION OF TAX RETURN.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN03

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Will (PERSON) file a {YEAR} Federal income tax return?

YES .................................... 1 {IN04}

NO ..................................... 2 {END_LP01}

REF ................................... -7 {END_LP01}

DK .................................... -8 {END_LP01}

HELP AVAILABLE FOR DEFINITION OF TAX RETURN.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN04

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

What {was/will be} (PERSON)’s filing status ...

single; ................................ 1 {IN06}

married filing joint return; ........... 2 {IN05}

married filing separately; ............. 3 {IN06}

head of household with qualifying

person; or ........................... 4 {IN06}

qualifying widow(er) with dependent

children? ............................ 5 {IN06}

REF ................................... -7 {IN06}

DK .................................... -8 {IN06}

[Code One]

HELP AVAILABLE FOR DEFINITION OF RESPONSE CATEGORIES.

----------------------------------------------------

| DISPLAY ‘was’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘will be’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

| FLAG PERSON BEING LOOPED ON AS ‘PRIMARY FILER ON |

| FEDERAL TAX RETURN’. |

----------------------------------------------------

IN05

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Who is the other taxpayer that (PERSON) is filing jointly with?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code One]

HELP AVAILABLE FOR DEFINITION OF ‘FILING JOINTLY’.

----------------------------------------------------

| FLAG PERSON SELECTED AT IN05 AS ‘SECONDARY FILER |

| ON JOINT FEDERAL TAX RETURN’. |

----------------------------------------------------

| CONTINUE WITH IN06 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. SELECT ALLOWED. |

| |

| 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT |

| DISALLOWED. |

| |

| 3. DISPLAY ‘PERSON NOT IN RU’ AS THE LAST ENTRY |

| ON THE ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITIONS: |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON IS NOT ALREADY FLAGGED AS A ‘PRIMARY |

| FILER ON FEDERAL TAX RETURN’ |

| - PERSON IS NOT ALREADY FLAGGED AS A ‘SECONDARY |

| FILER ON FEDERAL TAX RETURN’ |

----------------------------------------------------

IN06

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Did/Will} (PERSON) claim any dependents on (PERSON)’s Federal tax

return?

YES .................................... 1 {IN07}

NO ..................................... 2 {IN09}

REF ................................... -7 {IN09}

DK .................................... -8 {IN09}

HELP AVAILABLE FOR DEFINITION OF DEPENDENTS.

----------------------------------------------------

| DISPLAY ‘Did’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘Will’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

IN07

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Who {is/will be} listed as (PERSON)’s dependents?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| DISPLAY ‘is’ IF IN02 IS CODED ‘1’ (YES). DISPLAY |

| ‘will be’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

| CONTINUE WITH BOX_IN07 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

| |

| 3. DISPLAY ‘PERSON(S) NOT IN RU’ AS THE LAST ENTRY|

| ON THE ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITIONS: |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON IS NOT A JOINT FILER (I.E., PERSON WAS |

| NOT SELECTED AT IN05) |

| - PERSON IS NOT CURRENTLY BEING LOOPED ON. |

----------------------------------------------------

BOX_IN07

========

----------------------------------------------------

| IF ‘PERSON(S) NOT IN RU’ SELECTED AT IN07, |

| CONTINUE WITH IN08 |

----------------------------------------------------

| OTHERWISE, GO TO IN09 |

----------------------------------------------------

IN08

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

How many of the dependents that are being claimed on (PERSON)’s

Federal income tax return live outside of this household?

[Enter Number of Dependents] ........... {IN09}

REF .................................... -7 {IN09}

DK ..................................... -8 {IN09}

HELP AVAILABLE FOR DEFINITION OF HOUSEHOLD.

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 1-10 |

----------------------------------------------------

IN09

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Did/Will} (PERSON) file on the long form 1040, the short

form 1040A, or the short form 1040EZ?

Long form 1040 ......................... 1 {IN10}

Short form 1040A ....................... 2 {IN17}

Short form 1040EZ ...................... 3 {END_LP01}

OTHER .................................. 91 {IN10}

REF .................................... -7 {END_LP01}

DK ..................................... -8 {END_LP01}

[Code One]

----------------------------------------------------

| DISPLAY ‘Did’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘Will’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

IN10

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Did/Will} (PERSON) itemize deductions or take the standard

deduction?

Itemized Deductions .................... 1 {IN14}

Standard Deduction ..................... 2 {END_LP01}

REF .................................... -7 {END_LP01}

DK ..................................... -8 {END_LP01}

[Code One]

HELP AVAILABLE FOR DEFINITION OF ITEMIZED AND STANDARD

DEDUCTIONS.

----------------------------------------------------

| DISPLAY ‘Did’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘Will’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

IN11

====

OMITTED.

IN12

====

OMITTED.

IN13

====

OMITTED.

IN14

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

About how much {was/will be} the total of all the itemized

deduction expenses?

[Enter $ Amount] ....................... {IN15}

REF .................................... -7 {IN15}

DK ..................................... -8 {IN15}

----------------------------------------------------

| DISPLAY ‘was’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘will be’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH |

| ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT |

| ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-200,000 |

----------------------------------------------------

IN15

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Did/Will} (PERSON) claim a deduction for health insurance premiums?

YES .................................... 1 {IN17}

NO ..................................... 2 {IN17}

NOT APPLICABLE ......................... 3 {IN17}

REF ................................... -7 {IN17}

DK .................................... -8 {IN17}

[Code One]

HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE

DEDUCTION.

----------------------------------------------------

| DISPLAY ‘Did’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘Will’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

IN16

====

OMITTED.

IN17

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{Did/Will} (PERSON) receive earned income credits?

YES .................................... 1 {END_LP01}

NO ..................................... 2 {END_LP01}

NOT APPLICABLE ......................... 3 {END_LP01}

REF ................................... -7 {END_LP01}

DK .................................... -8 {END_LP01}

[Code One]

HELP AVAILABLE FOR DEFINITION OF EARNED INCOME CREDITS.

----------------------------------------------------

| DISPLAY ‘Did’ IF IN02 IS CODED ‘1’ (YES). DISPLAY|

| ‘Will’ IF IN03 IS CODED ‘1’ (YES). |

----------------------------------------------------

END_LP01

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO |

| MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION|

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_01 AND CONTINUE WITH LOOP_02 |

----------------------------------------------------

BOX_01

======

OMITTED.

LOOP_02

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK BOX_01A - END_LP02 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION |

| ON TAXABLE INCOME FOR EACH RU MEMBER WHO IS 16 |

| YEARS OF AGE OR OLDER OR HAS FILED OR WILL FILE A |

| FEDERAL TAX RETURN FOR THIS CALENDAR YEAR. THIS |

| LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS- |

| ROSTER WHO MEETS THE FOLLOWING CONDITION: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

IN17A

=====

OMITTED.

BOX_01A

=======

----------------------------------------------------

| IF PERSON BEING LOOPED ON IS FLAGGED AS A ‘PRIMARY|

| FILER ON FEDERAL TAX RETURN’, GO TO IN18 |

----------------------------------------------------

| IF PERSON BEING LOOPED ON IS FLAGGED AS A |

| ‘SECONDARY FILER ON A JOINT FEDERAL TAX RETURN’, |

| GO TO END_LP02 |

----------------------------------------------------

| OTHERWISE (I.E., PERSON IS NOT FLAGGED AS EITHER |

| ‘PRIMARY FILER ON FEDERAL TAX RETURN’ OR A |

| ‘SECONDARY FILER ON A JOINT FEDERAL TAX RETURN’, |

| THAT IS, IN03 IS CODED ‘2’ (NO), ‘-7’ (REFUSED) |

| OR ‘-8’ (DON’T KNOW)), CONTINUE WITH BOX_01B |

----------------------------------------------------

BOX_01B

=======

----------------------------------------------------

| IF PERSON BEING LOOPED ON IS 16 YEARS OF AGE OR |

| OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH |

| IN18 |

----------------------------------------------------

| OTHERWISE (I.E., PERSON IS LESS THAN 16 YEARS OF |

| AGE (OR IN AGE CATEGORIES 1-3) AND IN03 IS CODED |

| ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)), |

| GO TO END_LP02 |

----------------------------------------------------

| NOTE: THE PURPOSE OF BOX_01A AND BOX_01B IS TO |

| SKIP OUT PERSONS ALREADY FLAGGED AS SECONDARY |

| FILERS AND PERSONS YOUNGER THAN 16 YEARS OF AGE |

| WHO HAVE NOT ALREADY REPORTED THAT THEY HAVE FILED|

| OR WILL FILE A FEDERAL INCOME TAX RETURN. |

----------------------------------------------------

| NOTE: PERSONS REPORTING THAT THEY HAVE FILED OR |

| WILL FILE A 1040A SHORT FORM (IN09=2) OR A 1040EZ |

| FORM (IN09=3) RECEIVE THE WAGES, INTEREST, |

| DIVIDENDS, IRA, PENSIONS, UNEMPLOYMENT, AND SOCIAL|

| SECURITY TAXABLE INCOME ITEMS. |

| |

| PERSONS REPORTING THAT THEY HAVE FILED OR WILL |

| FILE A 1040 LONG FORM, OTHER TYPE OF FORM, OR |

| REFUSED OR DON’T KNOW THE TYPE OF FORM (IN09=1, |

| 91, -7, -8) RECEIVE ALL THE TAXABLE INCOME |

| QUESTIONS. |

| |

| PERSONS REPORTING THAT THEY HAVE NOT AND WILL NOT |

| FILE ANY FEDERAL TAX RETURN (IN03=2, -7, -8) AND |

| ARE 16 YEARS OF AGE OR OLDER ALSO RECEIVE ALL THE |

| TAXABLE INCOME QUESTIONS. |

----------------------------------------------------

IN18

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

{People get money from many different sources, such as wages and

salaries, social security, and interest on savings. The next few

questions ask about different sources of income that (READ NAME(S)

ABOVE) received in {YEAR}. It would be useful to have out any tax

materials that you may have.}

{Now let’s talk about (READ NAME(S) ABOVE).}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

wages or salary, tips, commissions, or bonuses?

[Enter $ Amount] ....................... {BOX_IN18}

REF .................................... -7 {IN19}

DK ..................................... -8 {IN18A}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| DISPLAY ‘People get money from many different |

| sources, such as wages and salaries, social |

| security, and interest on savings. The next few |

| questions ask about different sources of income |

| that (READ NAME(S) ABOVE) received in {YEAR}. It |

| would be useful to have out any tax materials that|

| you may have.’ IF FIRST CYCLE THROUGH LOOP_02. |

| OTHERWISE, USE NULL DISPLAY. |

----------------------------------------------------

| DISPLAY ‘Now let’s talk about (READ NAME(S) |

| ABOVE):’ IF NOT FIRST CYCLE THROUGH LOOP_02. IF |

| FIRST CYCLE THROUGH LOOP_02, USE A NULL DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-300,000 |

----------------------------------------------------

BOX_IN18

========

----------------------------------------------------

| IF AMOUNT OTHER THAN ZERO ENTERED AT IN18 AND IN04|

| IS CODED ‘2’ (MARRIED FILING JOINT RETURN), |

| CONTINUE WITH IN18OV |

----------------------------------------------------

| OTHERWISE, GO TO IN19 |

----------------------------------------------------

IN18OV

======

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

What percentage of this amount was received by (PRIMARY FILER)?

[Enter Percent] ........................ {IN19}

REF .................................... -7 {IN19}

DK ..................................... -8 {IN19}

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 0-100 |

----------------------------------------------------

IN18A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1.

Looking at this card, which range best estimates how much money

was received [from wages or salary, tips, commissions, or

bonuses in {YEAR}]?

1 - 5,000 ............................... 1 {IN19}

5,001 - 10,000 .......................... 2 {IN19}

10,001 - 15,000 ......................... 3 {IN19}

15,001 - 25,000 ......................... 4 {IN19}

25,001 - 50,000 ......................... 5 {IN19}

50,001 - 100,000 ........................ 6 {IN19}

100,001 OR MORE ......................... 7 {IN19}

REF .................................... -7 {IN19}

DK ..................................... -8 {IN19}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN19

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much did (READ NAME(S) ABOVE) receive in taxable

interest from savings accounts, bonds, NOW accounts, money market

accounts, or similar types of investments?

{IF NECESSARY, SAY: If any interest from a joint account, include

only the amount that would be (READ NAME(S) ABOVE)’s portion.}

[Enter $ Amount] ....................... {IN20}

REF .................................... -7 {IN20}

DK ..................................... -8 {IN19A}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| DISPLAY ‘IF NECESSARY, SAY ... ABOVE).’ IF IN04 |

| IS NOT CODED ‘2’ (MARRIED, FILING JOINT RETURN) |

| OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED ‘2’ |

| (MARRIED, FILING JOINT RETURN), USE A NULL |

| DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

BOX_IN19

========

OMITTED.

IN19OV

======

OMITTED.

IN19A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [in interest from savings accounts, bonds, NOW

accounts, money market accounts, or similar types of

investments in {YEAR}]?

1 - 100 ................................. 1 {IN20}

101 - 500 ............................... 2 {IN20}

501 - 1,000 ............................. 3 {IN20}

1,001 - 5,000 ........................... 4 {IN20}

5,001 - 15,000 .......................... 5 {IN20}

15,001 OR MORE .......................... 6 {IN20}

REF .................................... -7 {IN20}

DK ..................................... -8 {IN20}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN19B

=====

OMITTED.

BOX_02

======

OMITTED.

IN20

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

dividends?

{IF NECESSARY, SAY: If any dividends from a joint source, include

only the amount that would be (READ NAME(S) ABOVE)’s portion.}

[Enter $ Amount] ....................... {BOX_02A}

REF .................................... -7 {BOX_02A}

DK ..................................... -8 {IN20A}

HELP AVAILABLE FOR DEFINITION OF DIVIDENDS.

----------------------------------------------------

| DISPLAY ‘IF NECESSARY, SAY ... portion.’ IF IN04 |

| IS NOT CODED ‘2’ (MARRIED, FILING JOINT RETURN) |

| OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED ‘2’ |

| (MARRIED, FILING JOINT RETURN), USE A NULL |

| DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: $0-$100,000 |

----------------------------------------------------

IN20A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from dividends in {YEAR}]?

1 - 100 ................................. 1 {BOX_02A}

101 - 500 ............................... 2 {BOX_02A}

501 - 1,000 ............................. 3 {BOX_02A}

1,001 - 5,000 ........................... 4 {BOX_02A}

5,001 - 15,000 .......................... 5 {BOX_02A}

15,001 OR MORE .......................... 6 {BOX_02A}

REF .................................... -7 {BOX_02A}

DK ..................................... -8 {BOX_02A}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

BOX_02A

=======

----------------------------------------------------

| IF IN09 IS CODED ‘2’ (SHORT FORM 1040A), OR ‘3’ |

| (SHORT FORM 1040EZ) GO TO IN25 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH IN21 |

----------------------------------------------------

IN21

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

refunds of state or local income taxes?

{IF NECESSARY, SAY: If any money from a joint return, include

only the amount that would be (READ NAME(S) ABOVE)’s portion.}

[Enter $ Amount] ....................... {IN22}

REF .................................... -7 {IN22}

DK ..................................... -8 {IN21A}

HELP AVAILABLE FOR DEFINITION OF INCOME TAX REFUNDS.

----------------------------------------------------

| DISPLAY ‘IF NECESSARY, SAY ... ABOVE).’ IF IN04 |

| IS NOT CODED ‘2’ (MARRIED, FILING JOINT RETURN) |

| OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED ‘2’ |

| (MARRIED, FILING JOINT RETURN), USE A NULL |

| DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

IN21A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from refunds of state or local taxes in {YEAR}]?

1 - 100 ................................. 1 {IN22}

101 - 500 ............................... 2 {IN22}

501 - 1,000 ............................. 3 {IN22}

1,001 - 5,000 ........................... 4 {IN22}

5,001 - 15,000 .......................... 5 {IN22}

15,001 OR MORE .......................... 6 {IN22}

REF .................................... -7 {IN22}

DK ..................................... -8 {IN22}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN22

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

alimony?

[Enter $ Amount] ....................... {IN23}

REF .................................... -7 {IN23}

DK ..................................... -8 {IN22A}

HELP AVAILABLE FOR DEFINITION OF ALIMONY.

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

IN22A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from alimony in {YEAR}]?

1 - 100 ................................. 1 {IN23}

101 - 500 ............................... 2 {IN23}

501 - 1,000 ............................. 3 {IN23}

1,001 - 5,000 ........................... 4 {IN23}

5,001 - 15,000 .......................... 5 {IN23}

15,001 OR MORE .......................... 6 {IN23}

REF .................................... -7 {IN23}

DK ..................................... -8 {IN23}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN23

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) earn or lose

from (his/her/their) own farm or non-farm business or practice?

{IF NECESSARY, SAY: If any money from a shared business, include

only the amount that would be (READ NAME(S) ABOVE)’s portion.}

[Enter $ Amount] ....................... {BOX_IN23}

REF .................................... -7 {IN24}

DK ..................................... -8 {IN23A}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| DISPLAY ‘IF NECESSARY, SAY ... ABOVE).’ IF IN04 |

| IS NOT CODED ‘2’ (MARRIED, FILING JOINT RETURN) |

| OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED ‘2’ |

| (MARRIED, FILING JOINT RETURN), USE A NULL |

| DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-300,000 |

----------------------------------------------------

BOX_IN23

========

----------------------------------------------------

| IF AMOUNT OTHER THAN ZERO ENTERED AT IN23, |

| CONTINUE WITH IN23OV1 |

----------------------------------------------------

| OTHERWISE, GO TO IN24 |

----------------------------------------------------

IN23OV1

=======

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

INTERVIEWER: WAS THE AMOUNT ENTERED EARNINGS OR LOSS?

EARNINGS ............................... 1 {BOX_IN23OV1}

LOSS ................................... 2 {BOX_IN23OV1}

[Code One]

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

BOX_IN23OV1

===========

----------------------------------------------------

| IF IN04 IS CODED ‘2’ (MARRIED FILING JOINT |

| RETURN), CONTINUE WITH IN23OV2 |

----------------------------------------------------

| OTHERWISE, GO TO IN24 |

----------------------------------------------------

IN23OV2

=======

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

What percentage of this amount was {received/lost} by

(PRIMARY FILER)?

[Enter Percent] ........................ {IN24}

REF .................................... -7 {IN24}

DK ..................................... -8 {IN24}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| IF IN23OV1 IS CODED ‘1’ (EARNINGS), DISPLAY |

| ‘received’. IF IN23OV1 IS CODED ‘2’ (LOSS), |

| DISPLAY ‘lost’. |

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 0-100 |

----------------------------------------------------

IN23A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was earned or lost [from (his/her/their) own farm or non-farm

business or practice in {YEAR}]?

1 - 100 ................................. 1 {IN23AOV}

101 - 500 ............................... 2 {IN23AOV}

501 - 1,000 ............................. 3 {IN23AOV}

1,001 - 5,000 ........................... 4 {IN23AOV}

5,001 - 15,000 .......................... 5 {IN23AOV}

15,001 OR MORE .......................... 6 {IN23AOV}

REF .................................... -7 {IN24}

DK ..................................... -8 {IN24}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN23AOV

=======

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT

EARNINGS OR LOSS?

EARNINGS ............................... 1 {IN24}

LOSS ................................... 2 {IN24}

[Code One]

IN24

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money was (READ NAME(S) ABOVE)’s net gain or

net loss from the sale of property or other assets, including the

sale of (his/her/their) home, if it was taxable?

{IF NECESSARY, SAY: If any money from a shared property or other

asset, include only the amount that would be (READ NAME(S) ABOVE)’s

portion.}

[Enter $ Amount] ....................... {BOX_IN24}

REF .................................... -7 {IN25}

DK ..................................... -8 {IN24A}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| DISPLAY ‘IF NECESSARY, SAY ... ABOVE).’ IF IN04 |

| IS NOT CODED ‘2’ (MARRIED, FILING JOINT RETURN) |

| OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED ‘2’ |

| (MARRIED, FILING JOINT RETURN), USE A NULL |

| DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-300,000 |

----------------------------------------------------

BOX_IN24

========

----------------------------------------------------

| IF AMOUNT OTHER THAN ZERO ENTERED AT IN24, |

| CONTINUE WITH IN24OV |

----------------------------------------------------

| OTHERWISE, GO TO IN25 |

----------------------------------------------------

IN24OV

======

INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A

NET LOSS?

NET GAIN ............................... 1 {IN25}

NET LOSS ............................... 2 {IN25}

[Code One]

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

IN24A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was earned or lost [from the sale of property or other assets,

including the sale of (his/her/their) home, if it was taxable,

in {YEAR}]?

1 - 100 ................................. 1 {IN24AOV}

101 - 500 ............................... 2 {IN24AOV}

501 - 1,000 ............................. 3 {IN24AOV}

1,001 - 5,000 ........................... 4 {IN24AOV}

5,001 - 15,000 .......................... 5 {IN24AOV}

15,001 OR MORE .......................... 6 {IN24AOV}

REF .................................... -7 {IN25}

DK ..................................... -8 {IN25}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN24AOV

=======

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT

NET GAIN OR NET LOSS?

NET GAIN ............................... 1 {IN25}

NET LOSS ............................... 2 {IN25}

[Code One]

IN25

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

payments from Individual Retirement Accounts, that is, IRA, Keogh,

or 401K accounts?

[Enter $ Amount] ....................... {IN26}

REF .................................... -7 {IN26}

DK ..................................... -8 {IN25A}

HELP AVAILABLE FOR DEFINITION OF IRA.

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

BOX_IN25

========

OMITTED.

IN25OV

======

OMITTED.

IN25A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from payments from IRA, Keogh, and 401K accounts

in {YEAR}]?

1 - 100 ................................. 1 {IN26}

101 - 500 ............................... 2 {IN26}

501 - 1,000 ............................. 3 {IN26}

1,001 - 5,000 ........................... 4 {IN26}

5,001 - 15,000 .......................... 5 {IN26}

15,001 OR MORE .......................... 6 {IN26}

REF .................................... -7 {IN26}

DK ..................................... -8 {IN26}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN26

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

private pensions, military retirement, other Federal government

employee pensions, state or local government employee pensions,

or annuities?

[Enter $ Amount] ....................... {BOX_02B}

REF .................................... -7 {BOX_02B}

DK ..................................... -8 {IN27}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-300,000 |

----------------------------------------------------

IN27

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1.

Looking at this card, which range best estimates how much money

was received [from private pensions, military retirement, other

Federal government employee pensions, state or local government

employee pensions, or annuities in {YEAR}]?

1 - 5,000 ............................... 1 {BOX_02B}

5,001 - 10,000 .......................... 2 {BOX_02B}

10,001 - 15,000 ......................... 3 {BOX_02B}

15,001 - 25,000 ......................... 4 {BOX_02B}

25,001 - 50,000 ......................... 5 {BOX_02B}

50,001 - 100,000 ........................ 6 {BOX_02B}

100,001 OR MORE ......................... 7 {BOX_02B}

REF .................................... -7 {BOX_02B}

DK ..................................... -8 {BOX_02B}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

BOX_02B

=======

----------------------------------------------------

| IF IN09 IS CODED ‘2’ (SHORT FORM 1040A) OR ‘3’ |

| (SHORT FORM 1040EZ), GO TO IN30 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH IN28 |

----------------------------------------------------

IN28

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive as a

net gain or loss from estates or trusts, partnerships,

S corporations, royalties, or from rental income?

{IF NECESSARY, SAY: If any money from a joint venture, include

only the amount that would be (READ NAME(S) ABOVE)’s portion.}

[Enter $ Amount] ....................... {BOX_IN28}

REF .................................... -7 {IN30}

DK ..................................... -8 {IN28A}

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

----------------------------------------------------

| DISPLAY ‘IF NECESSARY, SAY ... ABOVE).’ IF IN04 |

| IS NOT CODED ‘2’ (MARRIED, FILING JOINT RETURN) |

| OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED ‘2’ |

| (MARRIED, FILING JOINT RETURN), USE A NULL |

| DISPLAY. |

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-300,000 |

----------------------------------------------------

BOX_IN28

========

----------------------------------------------------

| IF AMOUNT OTHER THAN ZERO ENTERED AT IN28, |

| CONTINUE WITH IN28OV |

----------------------------------------------------

| OTHERWISE, GO TO IN30 |

----------------------------------------------------

IN28OV

======

INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A

NET LOSS?

NET GAIN ............................... 1 {IN30}

NET LOSS ............................... 2 {IN30}

[Code One]

HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

IN28A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was earned or lost [from estates or trusts, partnerships,

S corporations, royalties, or from rental income in {YEAR}]?

1 - 100 ................................. 1 {IN28AOV1}

101 - 500 ............................... 2 {IN28AOV1}

501 - 1,000 ............................. 3 {IN28AOV1}

1,001 - 5,000 ........................... 4 {IN28AOV1}

5,001 - 15,000 .......................... 5 {IN28AOV1}

15,001 OR MORE .......................... 6 {IN28AOV1}

REF .................................... -7 {IN30}

DK ..................................... -8 {IN30}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN28AOV1

========

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT

NET GAIN OR NET LOSS?

NET GAIN ............................... 1 {IN30}

NET LOSS ............................... 2 {IN30}

[Code One]

IN29

====

OMITTED.

BOX_IN29

========

OMITTED.

IN29OV1

=======

OMITTED.

BOX_IN29OV1

===========

OMITTED.

IN29OV2

=======

OMITTED.

IN29A

=====

OMITTED.

IN29AOV

=======

OMITTED.

IN30

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

unemployment compensation?

[Enter $ Amount] ....................... {IN31}

REF .................................... -7 {IN31}

DK ..................................... -8 {IN30A}

HELP AVAILABLE FOR DEFINITION OF UNEMPLOYMENT COMPENSATION.

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

BOX_IN30

========

OMITTED.

IN30OV

======

OMITTED.

IN30A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from unemployment compensation in {YEAR}]?

1 - 100 ................................. 1 {IN31}

101 - 500 ............................... 2 {IN31}

501 - 1,000 ............................. 3 {IN31}

1,001 - 5,000 ........................... 4 {IN31}

5,001 - 15,000 .......................... 5 {IN31}

15,001 OR MORE .......................... 6 {IN31}

REF .................................... -7 {IN31}

DK ..................................... -8 {IN31}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

BOX_03

======

OMITTED.

IN31

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

During {YEAR}, how much money did (READ NAME(S) ABOVE) receive from

Social Security and equivalent tier 1 Railroad Retirement benefits?

[Enter $ Amount] ....................... {END_LP02}

REF .................................... -7 {END_LP02}

DK ..................................... -8 {IN32}

HELP AVAILABLE FOR DEFINITION OF SOCIAL SECURITY.

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

BOX_IN31

========

OMITTED.

IN31OV

======

OMITTED.

IN32

====

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF SECONDARY FILER}

SHOW CARD IN-1.

Looking at this card, which range best estimates how much money

was received [from Social Security and equivalent tier 1

Railroad Retirement benefits in {YEAR}]?

1 - 5,000 ............................... 1 {END_LP02}

5,001 - 10,000 .......................... 2 {END_LP02}

10,001 - 15,000 ......................... 3 {END_LP02}

15,001 - 25,000 ......................... 4 {END_LP02}

25,001 - 50,000 ......................... 5 {END_LP02}

50,001 - 100,000 ........................ 6 {END_LP02}

100,001 OR MORE ......................... 7 {END_LP02}

REF .................................... -7 {END_LP02}

DK ..................................... -8 {END_LP02}

[Code One]

----------------------------------------------------

| FOR ‘NAME OF SECONDARY FILER’, DISPLAY THE |

| PERSON’S NAME SELECTED AT IN05 DURING LOOP_01 FOR |

| THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF|

| IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE|

| A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN33

====

OMITTED.

BOX_IN33

========

OMITTED.

IN33OV

======

OMITTED.

END_LP02

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_02 AND CONTINUE WITH IN34 |

----------------------------------------------------

IN34

====

During {YEAR}, did anyone in the family receive Worker’s

Compensation?

YES .................................... 1

NO ..................................... 2 {IN37}

REF ................................... -7 {IN37}

DK .................................... -8 {IN37}

HELP AVAILABLE FOR DEFINITION OF WORKER’S COMPENSATION.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A SINGLE PERSON RU, |

| AUTOMATICALLY CODE PERSON AS ‘RECEIVED WORKER’S |

| COMPENSATION’ AT IN35 AND GO TO LOOP_03 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, |

| CONTINUE WITH IN35 |

----------------------------------------------------

IN35

====

Who received Worker’s Compensation in {YEAR}?

PROBE: Anyone else receive Worker’s Compensation in {YEAR}?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| CONTINUE WITH LOOP_03 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED MEMBERS) |

----------------------------------------------------

LOOP_03

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK IN36 - END_LP03 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_03 DETERMINES HOW MUCH |

| MONEY WAS RECEIVED FROM WORKER’S COMPENSATION FOR |

| RU MEMBERS WHO RECEIVED WORKER’S COMPENSATION IN |

| THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH |

| PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE |

| FOLLOWING CONDITIONS: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON RECEIVED WORKER’S COMPENSATION IN THE |

| CALENDAR YEAR (SELECTED AT IN35) |

----------------------------------------------------

IN36

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

How much money did (PERSON) receive from Worker’s Compensation

[in {YEAR}]?

[Enter $ Amount] ....................... {END_LP03}

REF .................................... -7 {END_LP03}

DK ..................................... -8 {IN36A}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-50,000 |

----------------------------------------------------

IN36A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from Worker’s Compensation in {YEAR}]?

1 - 100 ................................. 1 {END_LP03}

101 - 500 ............................... 2 {END_LP03}

501 - 1,000 ............................. 3 {END_LP03}

1,001 - 5,000 ........................... 4 {END_LP03}

5,001 - 15,000 .......................... 5 {END_LP03}

15,001 OR MORE .......................... 6 {END_LP03}

REF .................................... -7 {END_LP03}

DK ..................................... -8 {END_LP03}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

END_LP03

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_03 AND CONTINUE WITH IN37 |

----------------------------------------------------

IN37

====

During {YEAR}, did anyone in the family receive Supplemental

Security Income, also known as S.S.I.?

YES .................................... 1

NO ..................................... 2 {IN41}

REF ................................... -7 {IN41}

DK .................................... -8 {IN41}

HELP AVAILABLE FOR DEFINITION OF S.S.I.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A SINGLE PERSON RU, |

| AUTOMATICALLY CODE PERSON AS ‘RECEIVED S.S.I.’ AT |

| IN38 AND GO TO LOOP_04 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, |

| CONTINUE WITH IN38 |

----------------------------------------------------

IN38

====

Who received Supplemental Security Income in {YEAR}?

PROBE: Anyone else receive S.S.I. in {YEAR}?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| CONTINUE WITH LOOP_04 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

LOOP_04

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK BOX_03A - END_LP04 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_04 DETERMINES HOW MUCH |

| MONEY WAS RECEIVED FROM SUPPLEMENTAL SECURITY |

| INCOME (S.S.I) FOR RU MEMBERS WHO RECEIVED S.S.I. |

| IN THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH |

| PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE |

| FOLLOWING CONDITIONS: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON RECEIVED SUPPLEMENTAL SECURITY INCOME IN |

| THE CALENDAR YEAR (SELECTED AT IN38) |

----------------------------------------------------

BOX_03A

=======

----------------------------------------------------

| IF PERSON IS LESS THAN 65 YEARS OLD OR IN AGE |

| CATEGORIES 1-8, CONTINUE WITH IN39 |

----------------------------------------------------

| OTHERWISE, GO TO IN40A |

----------------------------------------------------

IN39

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Did (PERSON) receive money from Supplemental Security Income

because of (PERSON)’s own disability or for some other reason?

DISABILITY .............................. 1 {IN40A}

SOME OTHER REASON ....................... 2 {IN40A}

REF .................................... -7 {IN40A}

DK ..................................... -8 {IN40A}

[Code One]

IN40A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

For how many months in {YEAR} did (PERSON) receive money from

Supplemental Security Income?

[Enter Number of Months] ................ {IN40B}

REF .................................... -7 {IN40B}

DK ..................................... -8 {IN40B}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 1-12 |

----------------------------------------------------

IN40B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On average, how much money did (PERSON) get per month [from

Supplemental Security Income in {YEAR}]?

[Enter $ Amount] ........................ {END_LP04}

REF .................................... -7 {END_LP04}

DK ..................................... -8 {IN40C}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-50,000 |

----------------------------------------------------

IN40C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD IN-2.

Looking at this card, which range best estimates how much money

was received per month [from Supplemental Security Income in

{YEAR}]?

1 - 250 ................................. 1 {END_LP04}

251 - 500 ............................... 2 {END_LP04}

501 - 750 ............................... 3 {END_LP04}

751 - 1,000 ............................. 4 {END_LP04}

1,001 OR MORE ........................... 5 {END_LP04}

REF .................................... -7 {END_LP04}

DK ..................................... -8 {END_LP04}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

END_LP04

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_04 AND CONTINUE WITH IN41 |

----------------------------------------------------

IN41

====

{SHOW CARD IN-2A.}

During {YEAR}, did anyone in the family receive any money from

public assistance, such as Temporary Assistance for Needy

Families, also known as TANF {or the program(s) listed on this

card}, or general assistance?

YES .................................... 1

NO ..................................... 2 {IN46}

REF ................................... -7 {IN46}

DK .................................... -8 {IN46}

HELP AVAILABLE FOR DEFINITION OF PUBLIC ASSISTANCE.

----------------------------------------------------

| DISPLAY ‘SHOW CARD IN-2A.’ AND ‘or the program(s) |

| listed on this card’ IF INTERVIEW STATE IS NOT DC,|

| IL, IN, IA, KS, MS, NE, NV, PA, OK, OR, OR VA. |

| OTHERWISE, USE A NULL DISPLAY. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A SINGLE PERSON RU, |

| AUTOMATICALLY CODE PERSON AS ‘RECEIVED PUBLIC |

| ASSISTANCE’ AT IN42 AND GO TO LOOP_05 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, |

| CONTINUE WITH IN42 |

----------------------------------------------------

IN42

====

Whose name was on the checks?

PROBE: Does anyone else receive a check from public

assistance in their name?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| CONTINUE WITH LOOP_05 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

LOOP_05

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK IN43 - END_LP05 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_05 DETERMINES WHO WAS |

| COVERED BY PUBLIC ASSISTANCE, WHETHER ANY OF THE |

| CHECKS INCLUDED MONEY FROM TANF AND HOW MUCH WAS |

| RECEIVED PER MONTH. THIS LOOP CYCLES ON EACH |

| PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE |

| FOLLOWING CONDITIONS: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON’S NAME WAS ON THE PUBLIC ASSISTANCE |

| CHECKS (SELECTED AT IN42) |

----------------------------------------------------

IN43

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

Sometimes checks from public assistance cover more than one person

in the family, even though only one person’s name is on the check.

Who is covered by (PERSON)’s checks from public assistance?

PROBE: Did (PERSON)’s checks cover anyone else?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| CONTINUE WITH IN44 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

| |

| 3. DISPLAY ‘PERSON NOT IN RU’ AS THE 2ND TO LAST |

| ENTRY ON THE ROSTER. |

| |

| 4. DISPLAY ‘CHECK ONLY COVERS (PERSON) IN HEADER’ |

| AS THE LAST ENTRY ON THE ROSTER. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITIONS: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON IS NOT SELECTED AS RECEIVING HIS OWN |

| PUBLIC ASSISTANCE CHECKS; THAT IS PERSON WAS NOT|

| SELECTED AT IN42 |

----------------------------------------------------

IN44

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

{SHOW CARD IN-2A.}

Did any of (PERSON)’s checks include money from Temporary

Assistance for Needy Families, also known as TANF {or the

program(s) listed on this card}?

YES .................................... 1 {IN45A}

NO ..................................... 2 {IN45A}

REF ................................... -7 {IN45A}

DK .................................... -8 {IN45A}

HELP AVAILABLE FOR DEFINITION OF TANF.

----------------------------------------------------

| DISPLAY ‘SHOW CARD IN-2A.’ AND ‘or the program(s) |

| listed on this card’ IF INTERVIEW STATE IS NOT DC,|

| GA, HI, IL, MS, NV, OK, SD. OTHERWISE, (IF |

| INTERVIEW STATE IS DC, GA, HI, IL, MS, NV, OK, SD)|

| USE A NULL DISPLAY. |

----------------------------------------------------

IN45A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

For how many months in {YEAR} did (PERSON) receive checks from

public assistance?

[Enter Number of Months] ................ {IN45B}

REF .................................... -7 {IN45B}

DK ..................................... -8 {IN45B}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 1-12 |

----------------------------------------------------

IN45B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On average, how much money did (PERSON) get per month [from

public assistance in {YEAR}]?

[Enter $ Amount] ........................ {END_LP05}

REF .................................... -7 {END_LP05}

DK ..................................... -8 {IN45C}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-50,000 |

----------------------------------------------------

IN45C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD IN-2.

Looking at this card, which range best estimates how much money

was received per month [from public assistance in {YEAR}]?

1 - 250 ................................. 1 {END_LP05}

251 - 500 ............................... 2 {END_LP05}

501 - 750 ............................... 3 {END_LP05}

751 - 1,000 ............................. 4 {END_LP05}

1,001 OR MORE ........................... 5 {END_LP05}

REF .................................... -7 {END_LP05}

DK ..................................... -8 {END_LP05}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

END_LP05

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_05 AND CONTINUE WITH IN46 |

----------------------------------------------------

IN46

====

During {YEAR}, did anyone in the family receive any money from

child support?

YES .................................... 1

NO ..................................... 2 {IN49}

REF ................................... -7 {IN49}

DK .................................... -8 {IN49}

HELP AVAILABLE FOR DEFINITION OF CHILD SUPPORT.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A SINGLE PERSON RU, |

| AUTOMATICALLY CODE PERSON AS ‘RECEIVED CHILD |

| SUPPORT’ AT IN47 AND GO TO LOOP_06 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, |

| CONTINUE WITH IN47 |

----------------------------------------------------

IN47

====

Who received child support in {YEAR}?

PROBE: Anyone else receive child support in {YEAR}?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

HELP AVAILABLE FOR DESCRIPTION OF WHO TO INCLUDE.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| CONTINUE WITH LOOP_06 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

LOOP_06

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK IN48A - END_LP06 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_06 DETERMINES HOW MUCH |

| MONEY WAS RECEIVED FROM CHILD SUPPORT FOR RU |

| MEMBERS WHO RECEIVED CHILD SUPPORT IN CALENDAR |

| YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU- |

| MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:|

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON RECEIVED CHILD SUPPORT IN CALENDAR YEAR |

| (SELECTED AT IN47) |

----------------------------------------------------

IN48A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

For how many months in {YEAR} did (PERSON) receive money from

child support?

[Enter Number of Months] ................ {IN48B}

REF .................................... -7 {IN48B}

DK ..................................... -8 {IN48B}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 1-12 |

----------------------------------------------------

IN48B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On average, how much money did (PERSON) get per month [from

child support in {YEAR}]?

[Enter $ Amount] ........................ {END_LP06}

REF .................................... -7 {END_LP06}

DK ..................................... -8 {IN48C}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

IN48C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD IN-2.

Looking at this card, which range best estimates how much money

was received per month [from child support in {YEAR}]?

1 - 250 ................................. 1 {END_LP06}

251 - 500 ............................... 2 {END_LP06}

501 - 750 ............................... 3 {END_LP06}

751 - 1,000 ............................. 4 {END_LP06}

1,001 OR MORE ........................... 5 {END_LP06}

REF .................................... -7 {END_LP06}

DK ..................................... -8 {END_LP06}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

END_LP06

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_06 AND CONTINUE WITH IN49 |

----------------------------------------------------

IN49

====

Not counting military retirement, during {YEAR}, did anyone in the

family receive any veteran’s payments such as education or

disability benefits?

YES .................................... 1

NO ..................................... 2 {IN52}

REF ................................... -7 {IN52}

DK .................................... -8 {IN52}

HELP AVAILABLE FOR DEFINITION OF VETERAN’S PAYMENTS.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A SINGLE PERSON RU, |

| AUTOMATICALLY CODE PERSON AS ‘RECEIVED VETERAN’S |

| PAYMENTS’ AT IN50 AND GO TO LOOP_07 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, |

| CONTINUE WITH IN50 |

----------------------------------------------------

IN50

====

Who received veteran’s payments such as education or

disability benefits [in {YEAR}]?

PROBE: Anyone else receive veteran’s payments in {YEAR}?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| CONTINUE WITH LOOP_07 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

LOOP_07

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK IN51 - END_LP07 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_07 DETERMINES HOW MUCH |

| MONEY WAS RECEIVED FROM VETERAN’S PAYMENTS FOR RU |

| MEMBERS WHO RECEIVED VETERAN’S PAYMENTS IN THE |

| CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON |

| THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING |
| CONDITIONS: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON RECEIVED VETERAN’S PAYMENTS IN THE |

| CALENDAR YEAR (SELECTED AT IN50) |

----------------------------------------------------

IN51

====

{PERSON'S FIRST MIDDLE AND LAST NAME}

How much money did (PERSON) receive from veteran’s payments such as

education or disability benefits in {YEAR}? [Do not include military

retirement.]

[Enter $ Amount] ....................... {END_LP07}

REF .................................... -7 {END_LP07}

DK ..................................... -8 {IN51A}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

IN51A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from veteran’s payments such as education or

disability benefits in {YEAR}]?

1 - 100 ................................. 1 {END_LP07}

101 - 500 ............................... 2 {END_LP07}

501 - 1,000 ............................. 3 {END_LP07}

1,001 - 5,000 ........................... 4 {END_LP07}

5,001 - 15,000 .......................... 5 {END_LP07}

15,001 OR MORE .......................... 6 {END_LP07}

REF .................................... -7 {END_LP07}

DK ..................................... -8 {END_LP07}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

END_LP07

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_07 AND CONTINUE WITH IN52 |

----------------------------------------------------

IN52

====

Besides what we have already talked about, during {YEAR}, did

anyone in the family receive any money from regular cash

contributions from people who do not live in this household?

YES .................................... 1

NO ..................................... 2 {IN55}

REF ................................... -7 {IN55}

DK .................................... -8 {IN55}

HELP AVAILABLE FOR DESCRIPTION OF REGULAR CASH

CONTRIBUTIONS AND HOUSEHOLD.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A SINGLE PERSON RU, |

| AUTOMATICALLY CODE PERSON AS ‘RECEIVED REGULAR |

| CASH CONTRIBUTIONS FROM OUTSIDE HOUSEHOLD’ AT |

| IN53 AND GO TO LOOP_08 |

----------------------------------------------------

| IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, |

| CONTINUE WITH IN53 |

----------------------------------------------------

IN53

====

Who received regular cash contributions from people who do not

live in this household [in {YEAR}]?

PROBE: Anyone else receive regular cash contributions, in {YEAR},

from people who do not live here?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| CONTINUE WITH LOOP_08 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| DISPLAY THE RU-MEMBERS-ROSTER FOR SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, EDIT, AND DELETE DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL CURRENT RU MEMBERS (INCLUDING PERSONS |

| WHO ARE DECEASED AND INSTITUTIONALIZED THIS ROUND |

| WHO ARE CURRENT ROUND 3 MEMBERS. |

----------------------------------------------------

LOOP_08

=======

----------------------------------------------------

| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, |

| ASK IN54A - END_LP08 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_08 DETERMINES HOW MUCH |

| MONEY WAS RECEIVED FROM REGULAR CASH |

| CONTRIBUTIONS FROM OUTSIDE THE HOUSEHOLD FOR RU |

| MEMBERS WHO RECEIVED THESE TYPES OF CONTRIBUTIONS |

| IN THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH |

| PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE |

| FOLLOWING CONDITIONS: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

| - PERSON RECEIVED REGULAR CASH CONTRIBUTIONS |

| FROM SOMEONE OUTSIDE OF THE HOUSEHOLD IN THE |

| CALENDAR YEAR (SELECTED AT IN53) |

----------------------------------------------------

IN54A

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

For how many months in {YEAR} did (PERSON) receive money from

regular cash contributions from people who do not live in this

household?

[Enter Number of Months] ................ {IN54B}

REF .................................... -7 {IN54B}

DK ..................................... -8 {IN54B}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 1-12 |

----------------------------------------------------

IN54B

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

On average, how much money did (PERSON) get per month [from

regular cash contributions from people who do not live in this

household, in {YEAR}]?

[Enter $ Amount] ........................ {END_LP08}

REF .................................... -7 {END_LP08}

DK ..................................... -8 {IN54C}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

IN54C

=====

{PERSON'S FIRST MIDDLE AND LAST NAME}

SHOW CARD IN-2.

Looking at this card, which range best estimates how much money

was received per month [from regular cash contributions from

people who do not live in this household, in {YEAR}]?

1 - 250 ................................. 1 {END_LP08}

251 - 500 ............................... 2 {END_LP08}

501 - 750 ............................... 3 {END_LP08}

751 - 1,000 ............................. 4 {END_LP08}

1,001 OR MORE ........................... 5 {END_LP08}

REF .................................... -7 {END_LP08}

DK ..................................... -8 {END_LP08}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

END_LP08

========

----------------------------------------------------

| CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER |

| THAT MEETS THE CONDITIONS STATED IN THE LOOP |

| DEFINITION. |

----------------------------------------------------

| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |

| END LOOP_08 AND CONTINUE WITH IN55 |

----------------------------------------------------

IN55

====

During {YEAR}, did anyone in the family receive food stamps?

YES .................................... 1 {IN56}

NO ..................................... 2 {IN59}

REF ................................... -7 {IN59}

DK .................................... -8 {IN59}

HELP AVAILABLE FOR DEFINITION OF FOOD STAMPS.

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

IN56

====

For how many months in {YEAR} were these food stamps received?

[Enter Months] ......................... {IN58}

REF ................................... -7 {IN58}

DK .................................... -8 {IN58}

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| HARD CHECK: |

| RANGE CHECK: 1-12 |

----------------------------------------------------

IN57

====

OMITTED.

IN58

====

What was the approximate monthly value of the stamps?

[Enter $ Amount] ....................... {IN59}

REF ................................... -7 {IN59}

DK .................................... -8 {IN59}

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-1,000 |

----------------------------------------------------

IN59

====

SHOW CARD IN-3.

This card lists some sources of income. Has anyone in the

family received any income, other than income we have already

talked about, such as income from sources listed on this card?

YES .................................... 1 {LOOP_09}

NO ..................................... 2 {BOX_04}

REF ................................... -7 {BOX_04}

DK .................................... -8 {BOX_04}

HELP AVAILABLE FOR DEFINITIONS OF SHOW CARD CATEGORIES.

LOOP_09

=======

----------------------------------------------------

| For each of the following: |

| |

| OTHER INCOME SOURCE CATEGORY 1 |

| OTHER INCOME SOURCE CATEGORY 2 |

| OTHER INCOME SOURCE CATEGORY 3 |

| OTHER INCOME SOURCE CATEGORY 4 |

| OTHER INCOME SOURCE CATEGORY 5 |

| |

| ask IN60 - END_LP09 |

----------------------------------------------------

| LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION |

| ABOUT OTHER SOURCES OF TAXABLE INCOME. THIS LOOP |

| CYCLES ON SOURCES OF TAXABLE INCOME LISTED AT |

| IN60. THE first cycle of this loop collects THE |

| the first source of TAXABLE INCOME. Subsequent |

| cycles of the loop are determined by the response |

| at IN63. If IN63 is coded '1' (YES), the loop |

| cycles again to collect the next SOURCE OF TAXABLE|

| INCOME. if IN63 is coded ‘2’ (no), ‘-7’ |

| (refused), or ‘-8’ (don’t know), the loop ends. |

----------------------------------------------------

IN60

====

SHOW CARD IN-3.

From which of the sources on this card did anyone in the family

receive income [that we have not yet talked about]?

WAGES AND SALARY ...................... 1 {BOX_03B}

FARM INCOME (OR LOSS) ................. 2 {BOX_03B}

BUSINESS INCOME (OR LOSS) ............. 3 {BOX_03B}

SOCIAL SECURITY/RAILROAD RETIREMENT ... 4 {BOX_03B}

PRIVATE, MILITARY, OR GOVERNMENT

PENSIONS ............................ 5 {BOX_03B}

INTEREST .............................. 6 {BOX_03B}

DIVIDENDS ............................. 7 {BOX_03B}

RENTAL INCOME (OR LOSS) ............... 8 {BOX_03B}

OTHER SOURCE .......................... 91 {IN60OV}

REF ................................... -7 {BOX_03B}

DK .................................... -8 {BOX_03B}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

IN60OV

======

OTHER:

[Other Specify] ......................... {BOX_03B}

REF .................................... –7 {BOX_03B}

DK ..................................... –8 {BOX_03B}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

BOX_03B

=======

-----------------------------------------------------

| IF SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS |

| ‘RECEIVED INCOME FROM IN60 SOURCE’ AT IN61 AND GO |

| TO IN62. OTHERWISE, CONTINUE WITH IN61 |

-----------------------------------------------------

IN61

====

{CATEGORY SELECTED AT IN60}

Who received income from (INCOME SOURCE) in {YEAR}?

PROBE: Anyone else receive income from (INCOME SOURCE) in {YEAR}?

[1. First Name, [Middle Name], Last name-65]

[2. First Name, [Middle Name], Last name-65]

[3. First Name, [Middle Name], Last name-65]

[Code All That Apply]

----------------------------------------------------

| FOR ‘DISPLAY CATEGORY SELECTED AT IN60.....’, |

| DISPLAY THE RESPONSE CATEGORY NAME SELECTED AT |

| IN60 DURING THE CURRENT LOOP. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| CONTINUE WITH IN62 |

----------------------------------------------------

| ROSTER DETAILS: |

| TITLE: RU_MEMBERS_1 |

| |

| COL # 1 HEADER: NAME |

| INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, |

| AND LAST NAMES (PERS.FULLNAME) |

----------------------------------------------------

| ROSTER DEFINITION: |

| THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR |

| SELECTION. |

----------------------------------------------------

| ROSTER BEHAVIOR: |

| 1. MULTIPLE SELECT ALLOWED. |

| |

| 2. ADD, DELETE, AND EDIT DISALLOWED. |

----------------------------------------------------

| ROSTER FILTER: |

| DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING |

| CONDITION: |

| |

| - PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED|

| AND INSTITUTIONALIZED RU MEMBERS) |

----------------------------------------------------

IN62

====

{CATEGORY SELECTED AT IN60}

What is the total amount received from (INCOME SOURCE), in {YEAR},

for {all of the people just mentioned/(PERSON)}?

[Enter $ Amount] ....................... {BOX_IN62}

REF ................................... -7 {IN63}

DK .................................... -8 {IN62A}

----------------------------------------------------

| FOR ‘DISPLAY CATEGORY SELECTED AT IN60.....’, |

| DISPLAY THE RESPONSE CATEGORY NAME SELECTED AT |

| IN60 DURING THE CURRENT LOOP. |

----------------------------------------------------

| DISPLAY ‘all of the people just mentioned’ IF A |

| MULTI-PERSON RU. OTHERWISE (I.E., SINGLE-PERSON |

| RU), DISPLAY ‘(PERSON)’. |

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

| BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS |

| WITH ‘00’ SO THAT FIELD ACCEPTS WHOLE DOLLAR |

| AMOUNT ONLY. |

----------------------------------------------------

| SOFT CHECK: |

| SOFT RANGE CHECK: 0-100,000 |

----------------------------------------------------

BOX_IN62

========

----------------------------------------------------

| IF AMOUNT OTHER THAN ZERO ENTERED AT IN62 AND |

| IN60 IS CODED ‘2’ (FARM INCOME OR LOSS), ‘3’ |

| (BUSINESS INCOME OR LOSS), ‘8’ (RENTAL INCOME OR |

| LOSS), OR ‘91’ (OTHER SOURCE), CONTINUE WITH |

| IN62OV |

----------------------------------------------------

| OTHERWISE, GO TO IN63 |

----------------------------------------------------

IN62OV

======

INCOME SOURCE: {DISPLAY CATEGORY SELECTED AT IN60.........}

INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A

NET LOSS?

NET GAIN ............................... 1 {IN63}

NET LOSS ............................... 2 {IN63}

[Code One]

IN62A

=====

INCOME SOURCE: {CATEGORY SELECTED AT IN60}

SHOW CARD IN-1A.

Looking at this card, which range best estimates how much money

was received [from (INCOME SOURCE) in {YEAR}]?

1 - 100 ................................. 1 {BOX_IN62A}

101 - 500 ............................... 2 {BOX_IN62A}

501 - 1,000 ............................. 3 {BOX_IN62A}

1,001 - 5,000 ........................... 4 {BOX_IN62A}

5,001 - 15,000 .......................... 5 {BOX_IN62A}

15,001 OR MORE .......................... 6 {BOX_IN62A}

REF .................................... -7 {BOX_IN62A}

DK ..................................... -8 {BOX_IN62A}

[Code One]

----------------------------------------------------

| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |

| AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR|

| YEAR OF PANEL FOR {YEAR}. IF ROUND 5, DISPLAY |

| SECOND CALENDAR YEAR OF PANEL FOR {YEAR}. |

----------------------------------------------------

BOX_IN62A

=========

----------------------------------------------------

| IF ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IS NOT |

| CODED AT IN62A AND IN60 IS CODED ‘2’ (FARM INCOME |

| OR LOSS), ‘3’ (BUSINESS INCOME OR LOSS), ‘8’ |

| (RENTAL INCOME OR LOSS), OR ‘91’ (OTHER SOURCE), |

| CONTINUE WITH IN62AOV |

----------------------------------------------------

| OTHERWISE, GO TO IN63 |

----------------------------------------------------

IN62AOV

=======

INCOME SOURCE: {DISPLAY CATEGORY SELECTED AT IN60.........}

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT

NET GAIN OR NET LOSS?

NET GAIN ............................... 1 {IN63}

NET LOSS ............................... 2 {IN63}

[Code One]

IN63

====

SHOW CARD IN-3.

Aside from what you already told me about, has anyone in the

family received any other income, such as income from another

source listed on this card?

YES .................................... 1 {END_LP09}

NO ..................................... 2 {END_LP09}

REF ................................... -7 {END_LP09}

DK .................................... -8 {END_LP09}

HELP AVAILABLE FOR DEFINITIONS OF SHOW CARD CATEGORIES.

END_LP09

========

----------------------------------------------------

| If in63 is coded '1' (YES), cycle to collect the |

| next OTHER income category. |

----------------------------------------------------

| Otherwise end LOOP_09, and continue with BOX_04 |

----------------------------------------------------

BOX_04

======

----------------------------------------------------

| GO TO NEXT QUESTIONNAIRE SECTION |

----------------------------------------------------

IN64

====

OMITTED.

30-85

File Type	application/msword
File Title	MEPS Income - P12R5/P13R3/P14R1
Subject	IN Supplemental Section Item Specifications
Author	Agency for Healthcare Research and Quality
Last Modified By	wcarroll
File Modified	2009-07-09
File Created	2009-07-09