Appendix P
12-Month Follow-up Survey
Appendix P
12-Month Follow-Up Survey
Updated 10.3.12
Table of Contents
Sample Member Identity Verification 4
A. Service Receipt (Participation) 5
Introduction
Thank you for taking the time to speak with me today. We are conducting interviews with people who agreed to be in a study about a program offered at [CBONAME] called [ETJDPRO/STEDPRO]. The study is called the [Enhanced Transitional Jobs Demonstration or ETJD/Subsidized and Transitional Employment Demonstration or STED] for short. It is funded by the U.S. Department of Labor and the U.S. Department of Health and Human Services and my company, [Abt SRBI/ Decision Information Resources, or DIR], is conducting this survey. You may have received a letter recently about the [ETJD/STED] study.
We need to talk with people who got into the program and those who did not. Your participation in this study will help policy-makers better understand how to help people find and keep jobs. This interview will include questions on your employment situation, your use of services, and your overall well being.
This interview should only take about 45 minutes. We will mail you a $40 gift card as a “thank you” for completing the interview.
All of your responses on this survey will be kept private; the research staff has been trained in protecting private information and your name will not appear in any written reports we produce. All of the study results will be reported for groups of individuals; no results will be analyzed or reported for individuals. Your responses to these questions are also completely voluntary. That means you may choose not to answer any question, or you may stop the interview if you wish, but we hope you don’t. Your responses to these questions will in no way affect your participation in the [ETJDPRO/STEDPRO] program or affect your receipt of any kinds of public benefits or services.
According to the Paperwork Reduction Act (PRA), an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-XXXX and it expires XX/XX/XXXX.
And finally, this interview might be monitored or recorded for quality control purposes. May we begin?
Sample Member Identity Verification
S1. Just to be sure I that I have brought up the correct record, could you please give me your date of birth?
BIRTH DATE: ___/___/____
MM/DD/YYYY
CATI: VALIDATE DOB FROM SAMPLE FILE; SAVE RESPONSE TO FILE AND AUTOMARK
DOB CONFIRMED 1 SKIP TO SECTION A
DOB NOT CONFIRMED 2
S2. Again, to confirm that I have brought up the correct record, could you please give me the last four digits of your social security number?
____________________________
CATIL VALIDATE LAST 4 SSN FROM SAMPLE FILE; SAVE RESPONSE TO FILE AND AUTOMARK.
SSN CONFIRMED 1 SKIP TO SECTION A
SSN NOT CONFIRMED 2
IF DOBCONF=2 and SSNCONF =2, DISPLAY: “Thank you for taking the time to answer these questions. The information you provided does not match our records. I will need to check with my supervisor to determine how to resolve this issue. If we are able to do so, I will give you a call back.”
During this interview I will be asking about the experiences you’ve had and services you may have received since [RAD]. This is the date you agreed to participate in the study. As a result, many of the questions I ask will refer to this date. Let’s begin.
A1.
I would like you to tell me about assistance you may have received since [RAD] from organizations and programs in your community to help you find or keep a job, or to help you deal with problems that interfered in your ability to work. For each type of help, I’d like to know whether you received help, where you got this help, and how much help you received. First…
CATI: A1, A2 AND A3 ARE ASKED TOGETHER FOR EACH TYPE OF HELP IN A1. IF A1 IS YES, FOLLOW WITH A2 AND A3. IF A1 IS NO, DK OR REF, GO TO NEXT A1 SUBITEM.
FOR A2, USE THE LIST BELOW TO CODE SOURCES OF HELP.
FOR A3, THE AMOUNT OF HELP RECEIVED IS FOR THE HELP TYPE SO IF MULTIPLE SOURCES ARE RECORDED IN A2, USE THE WORDING IN THE BRACKETS.
1 [LOCAL TJ PROGRAM ]
2 WELFARE OFFICE
3 PAROLE OFFICE
4 CHILD SUPPORT AGENCY
5 WORKFORCE CENTER (WIA)/ONE-STOP
6 UNEMPLOYMENT OFFICE OR EMPLOYMENT SERVICES PROGRAM
7 FOOD STAMPS PROGRAM/SNAP
8 OTHER, SPECIFY ____________________________________________
97 DON’T KNOW
98 REFUSED
|
|
|
Did you receive help with …
|
CATI: IF YES TO A1, ASK A2 & A3 |
|||
A2a-A2t. Where did you get this help? Where else? INTERVIEWER: CHECK ALL THAT APPLY |
A3a-A3t. How much help did you get [from all of these programs]? Would you say… |
|||
aA1a. …preparing a resume or filling out job applications? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
A2a. …preparing for job interviews? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
A3a. …looking for jobs, including subsidized jobs, or deciding what kinds of jobs to look for. |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
d. ...getting referrals to available jobs? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
e. ...setting up interviews for specific job openings? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
f. …assessing your skills for particular jobs? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
g. …planning your future career or educational goals? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
h. …figuring out how to get to/from work or to places where you looked for work? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
i.…paying for transportation to/from work or while looking for a job? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
j. …paying for work tools or uniforms? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
k. …paying your rent or for house repairs? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
l….finding a place to live or resolving problems related to your housing situation? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
CATI: ASK M-N IF R IS EX-OFFENDER. |
||||
m. …learning how to answer employers’ questions about your criminal history? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
n....legal issues related to your convictions, like cleaning up your rap sheet? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
CATI: ASK O-Q IF RESPONDENT IS NON-CUSTODIAL PARENT. |
||||
o. …modifying child support orders and/or arrears? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
|
|
|
|
|
p. …setting up a visitation with a child? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
q. …counseling or assistance about parenting, or other family-related issues? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
CATI: ASK R-T IF IF R IS CUSTODIAL PARENT. |
||||
r. …finding or making child care arrangements? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
s. …paying for child care? |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
t….getting or changing child support payments |
1 YES 2 NO 7 DK 8 REF |
SHOW A2 LIST |
1 very little, 2 some, or 3 a lot? 7 DK 8 REF |
|
A4.
Thinking of the people you have worked with at agencies or organizations since [RAD], is there someone to whom you can turn for advice or support with personal or family issues?
1 YES
2 NO GO TO A9
7 DON’T KNOW GO TO A9
8 REFUSED GO TO A9
CATI: IF A4= 2, 7, OR 8, GO TO A7
A5.
At which organization or program did this person work?
1 [LOCAL TJ PROGRAM ]
2 WELFARE OFFICE
3 PAROLE OFFICE
4 CHILD SUPPORT AGENCY
5 WORKFORCE CENTER (WIA)/ONE-STOP
6 UNEMPLOYMENT OFFICE OR EMPLOYMENT SERVICES PROGRAM
7 FOOD STAMPS PROGRAM
8 OTHER, SPECIFY ____________________________________________
97 DON’T KNOW
98 REFUSED
A6.
Are you still in touch with this person?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
A7.
Thinking of the people you have worked with at agencies or organizations since [RAD], is there someone who can help you guide you pesonnaly and professionally?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A7= 2, 7, OR 8, GO TO A10
A8.
At which organization or program did this person work?
1 [LOCAL TJ PROGRAM ]
2 WELFARE OFFICE
3 PAROLE OFFICE
4 CHILD SUPPORT AGENCY
5 WORKFORCE CENTER (WIA)/ONE-STOP
6 UNEMPLOYMENT OFFICE OR EMPLOYMENT SERVICES PROGRAM
7 FOOD STAMPS PROGRAM
8 OTHER, SPECIFY ____________________________________________
97 DON’T KNOW
98 REFUSED
A9.
Are you still in touch with this person?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
A10.
Thinking about the program where you got the most help since [RAD] and your relationships with other people who were also getting help from these programs, how much do you agree with the following statements?
INTERVIEWER, IF NEEDED: These questions are about the other people who were in your same or a similar position while you were getting help.
A10a.
We gave each other advice. Would you say you…
1 strongly agree,
2 agree
3 neither agree nor disagree
4 disagree, or
5 strongly disagree?
7 DON’T KNOW
8 REFUSED
A10b.
We supported each other. Would you say you…
1 strongly agree,
2 agree
3 neither agree nor disagree
4 disagree, or
5 strongly disagree?
7 DON’T KNOW
8 REFUSED
A10c.
We helped each other feel more positive about our circumstances and future goals. Would you say you…
1 strongly agree,
2 agree
3 neither agree nor disagree
4 disagree, or
5 strongly disagree?
7 DON’T KNOW
8 REFUSED
A10d.
We did not interact with each other. Would you say you…
1 strongly agree,
2 agree
3 neither agree nor disagree
4 disagree, or
5 strongly disagree?
7 DON’T KNOW
8 REFUSED
CATI: CREATE VARIABLE “WKSRAD” TO HOLD #WEEKS SINCE RAD
A11.
Have you participated in any activities since [RAD] that were about how to act when you are at work? This includes issues like being on time, managing your tasks, relating to your supervisor, and handling conflicts.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A11 = 2, 7, 8 GO TO A13
A12.
For how many weeks since [RAD] did you participate in these activities?
INTERVIEWER: ROUND UP IF LESS THAN A WHOLE WEEK.
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD. IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
.
____________________
NUMBER OF WEEKS(RANGE=1-95)
96 96 OR MORE
97 DON’T KNOW 98 REFUSED
A13.
At any time since [RAD], were you given an unpaid job by an employment or welfare program so that you could get some experience working or to learn a specific skill or trade while working? You would not have received a paycheck from anyone for doing this work.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A13 = 2, 7, 8 GO TO A16
A14.
For how many weeks or since [RAD] did you work at an unpaid job?
INTERVIEWERROUND UP IF LESS THAN A WHOLE WEEK. CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD. IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
____________________ NUMBER OF WEEKS(RANGE=1-95)
96 96 OR MORE
97 DON’T KNOW 98 REFUSED
A15.
On average, while you were working the unpaid job, how many hours per week did you work?
__________________________
HOURS PER WEEK (RANGE: 1-95)
96 96 OR MORE
97 DON’T KNOW
98 REFUSED
CATI: IF A16 = 2, 7, 8 GO TO A18
A16.
At any time since [RAD], have you taken any ESL classes, that is, English as a Second Language?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A16 = 2, 7, 8 GO TO A18
A17.
For how many weeks since [RAD] did you take ESL classes?
INTERVIEWER: ROUND UP IF LESS THAN A WHOLE WEEK. .
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD. IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
____________________
NUMBER OF WEEKS(RANGE: 1 – 95)
96 96 OR MORE
97 DON’T KNOW 98 REFUSED
CATI: IF R HAD HIGH SCHOOL DEGREE/GED OR HIGHER AT BASELINE, GO TO A23.
A18.
Since [RAD] have you taken part in any Adult Basic Education (ABE) classes?
INTERVIEWER, IF NECESSARY SAY: Adult Basic Education (ABE) classes are for improving your basic reading and math skills.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A18 = 2, 7, 8 THEN GO TO A20
A19.
How many weeks since [RAD] did you take these classes?
INTERVIEWER: ROUND UP IF LESS THAN A WHOLE WEEK.
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD.
IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
____________________
NUMBER OF WEEKS(RANGE 1-95) 96 96 OR MORE
97 DON’T KNOW 97 DON’T KNOW
98 REFUSED 98 REFUSED
A20.
Since [RAD], have you taken part in any GED classes, or classes to prepare for a regular high school diploma?
INTERVIEWER, IF NECESSARY: A GED or “General Education Development” certificate is similar to a high school diploma. GED classes help prepare for the GED test.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A20 = 2, 7, 8 THEN GO TO A22
A21.
How many weeks since [RAD] did you take these classes?
INTERVIEWER: IF R REPORTS IN WEEKSCATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD.
IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
____________________ NUMBER OF WEEKS (RANGE: 1-95)
96 96 OR MORE
97 DON’T KNOW 98 REFUSED
A22.
Since [RAD], have you earned a GED certificate or high school diploma?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
A23.
Since [RAD] have you taken any courses at a community, two-year, or four-year college?
CATI: IF A16=1, A18=1, OR A20=1, ALSO SHOW: Not including any classes you have already mentioned.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A23 = 2, 7, 8 THEN GO TO A26
A24.
Were any of these courses taken to receive credit towards an associate or bachelor’s degree, that is, college credit?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A24 = 2, 7, 8 THEN GO TO A26
A25.
For those courses that were part of your degree, how many weeks or since [RAD] did you attend college?
INTERVIEWERROUND UP IF LESS THAN A WHOLE WEEK.
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD.
IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
____________________
NUMBER OF WEEKS (RANGE:1-95)
96 96 OR MORE
97 DON’T KNOW
98 REFUSED
A26.
At any time since [RAD], did you get training for a specific job, trade, or occupation? This is sometimes called vocational training. Sometimes these classes are offered at a community college or by a private training provider, but they don’t lead to a degree. Sometimes they lead to a certificate or license.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A26 = 2, 7, 8 THEN GO TO A30
A27.
What kind of job, trade, or occupation was this training for?
INTERVIEWER RECORD VERBATIM
______________________________
JOB/TRADE/OCCUPATION
97 DON’T KNOW
98 REFUSED
A28.
For how many weeks since [RAD] did you attend vocational training?
INTERVIEWERROUND UP IF LESS THAN A WHOLE WEEK.
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD.
SHOW INTERVIEWER: “NUMBER OF WEEKS SINCE RAD IS [WKSRAD] ”
____________________
NUMBER OF WEEKS (RANGE:1-95) 96 96 OR MORE
97 DON’T KNOW
98 REFUSED
A29.
Where was this vocational training offered?
INTERVIEWER, IF NEEDED: What was the name of the place you went for training?
______________________
VERBATIM
97 DON’T KNOW
98 REFUSED
A30.
Now I’d like to ask you about professional certifications and licensures that you’ve obtained since [RAD]. Since [RAD], have you earned or received a professional certiciation or state or industry license?
INTERVIEWER, IF NECESSARY: A professional certification or license shows you are qualified to perform a specific job and includes things like Licensed Realtor, Certification Medical Assistant, Certified Construction Manager, a Project Management Profession or PMP certification, or an IT certification.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
A31.
What type of license or certification is it?
INTERVIEWER PROBE: What type of trade or work does it qualify you to do?
_________________________
VERBATIM
97 DON’T KNOW
98 REFUSED
A32.
The next few questions are about problems you may have had with substance abuse or mental health. This may be a very personal area for you and I want to reassure you that your answers to these questions will be kept private to the fullest extent allowed under the law.
Since [RAD] have your received help such as treatment or counseling related to your use of alcohol or any drug, not counting cigarettes? This includes participation in self-help groups like Alcoholics Anonymous or Narcotics Anonymous.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A32 = 2, 7, 8 THEN GO TO A34
A33.
For how many weeks since [RAD] did you receive treatment or participate in counseling for issues related to alcohol or drug use?
INTERVIEWER: ROUND UP IF LESS THAN A WHOLE WEEK. IF
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD.
SHOW INTERVIEWER: “NUMBER OF WEEKS SINCE RAD IS [WKSRAD] ”
____________________ NUMBER OF WEEKS (RANGE: 1- 95)
96 96 OR MORE
97 DON’T KNOW 98 REFUSED
A34.
Since [RAD] have you received help for problems related to your emotions, nerves, anger management or mental health? This would include help dealing with depression, anxiety, or other conditions from a mental health center, a therapist, a psychologist or psychiatrist, social worker, or counselor. Do not include any assistance related to alcohol or drug use.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF A34 = 2, 7, 8 THEN GO TO A36
A35.
For how many weeks since [RAD] did you receive treatment or participate in counseling for these issues?
INTERVIEWER: ROUND UP IF LESS THAN A WHOLE WEEK. IF
CATI: CHECK TO MAKE SURE NOT GREATER THAN WKSRAD. IF RESPONSE IS GREATER THAN WKSRAD, SHOW:
INTERVIEWER SAY: You stated that you had participated for [RESPONSE] weeks; there have only been WKSRAD weeks since [RAD]. Is [RESPONSE] correct?
____________________
NUMBER OF WEEKS (RANGE: 1-95)
96 96 OR MORE
97 DON’T KNOW 98 REFUSED
A36.
Since [RAD], have you felt like you needed or wanted help related to alcohol/drug use or mental health issues but you didn’t get it?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B1.
Are
you currently working for pay? This includes any work where you get
paid including self-employment, temporary work, work as a day
laborer, and paid work at an employment program.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B1= 2, 7, 8 THEN GO TO B27
B2.
How
many jobs do you currently have?
INTERVIEWER: SELF-EMPLOYMENT OR TEMPORARY OR “TEMP” WORK IN THE SAME FIELD COUNTS AS ONE JOB.
_________________
NUMBER OF JOBS (RANGE: 1 – 10)
97 DON’T KNOW
98 REFUSED
CATI: IF B2=1, THEN GO TO B4
B3.
For whom do you usually work the most hours?
INTERVIEWER PROBE: What is your employer’s name?
INTERVIEWER, IF HOURS ARE THE SAME: Who have you worked for the longest?
______________________
VERBATIM
96 SELF EMPLOYED
97 DON’T KNOW
98 REFUSED
B4.
CATI: IF B3 = 97, 98, SHOW THE FIRST WORDING. ELSE SHOW THE
SECOND WORDING.
I'd like to ask you some questions about your (the job you currently work at where you work the most hours or have worked the longest/ that job.)
.
When did this job start?
INTERVIEWER: IF MM/YYYY IS BEFORE [RAD], CONFIRM DATE IS CORRECT.
CATI: SHOW RAD DATE ON SCREEN FOR B4
___________
MM/YYYY
INTERVIEWER PROBE FOR SEASON IF DON’T KNOW MONTH.
02 WINTER
05 SPRING
08 SUMMER
11 FALL
97/9997 DON’T KNOW
98/9998 REFUSED
CATI: IF B3=96 (self-employed), CODE B5 AS 2 AND GO TO B8
B5.
What type of organization (are/were) you working for?
INTERVIEWER PROBE: Who did the paycheck come from?
Is it…
1 self-employment,
2 a temporary agency,
3 a for-profit company or employer,
4 a non-profit company or employer],
5 a government employer, or
6 some other work arrangement? (SPECIFY)________________
97 DON’T KNOW
98 REFUSED
CATI: if (B3 has verbatim reponse ) OR (B5 = 1) THEN GO TO B7
B6.
What is your employer's name?
______________________
EMPLOYER
97 DON’T KNOW
98 REFUSED
B7.
What kind of business or industry is that in? What do they make or what service do they provide?
_____________________
VERBATIM
97 DON’T KNOW
98 REFUSED
B8.
What (is/was) your occupation on this job?
IF NEEDED:
What kind of work do you do? That is, what are your main duties in this job?
_____________________
VERBATIM
97 DON’T KNOW
98 REFUSED
B9.
Is this job…
1 permanent regular employment,
2 seasonal work, temporary work through a temp agency, day labor, an odd job, or
3 something else? (SPECIFY _____________________)
97 DON’T KNOW
98 REFUSED
B10.
Which of the following best describes your usual weekly work
schedule at your job during the last month that you worked? Do/did
you work a…
1 daytime shift,
2 evening shift,
3 night shift,
4 rotating shift (one that changes regularly from days to evenings to nights),
5 split shift (one consisting of two distinct periods each day),
6 an irregular schedule (one that changes from day to day), or
7 something else? (SPECIFY________________________ )
97 DON’T KNOW
98 REFUSED
B11.
Including overtime, how many hours per week (do/did) you usually work in this job?
INTERVIEWER: IF SCHEDULE IS IRREGULAR OR VARIES:
How many hours did you work in the last week you worked at this job?
INTERVIEWER: CONFIRM IF MORE THAN 60 AS HOURS PER WEEK
___________________
NUMBER OF HOURS (RANGE: 1 TO 995)
996 996 OR MORE
997 DON’T KNOW
998 REFUSED
B12.
For this job, what is the easiest way to tell me your wages BEFORE taxes and other deductions: hourly, weekly, annually, or something else?
1 HOURLY
2 WEEKLY
3 BI-WEEKLY
4 TWICE MONTHLY
5 MONTHLY
6 ANNUALLY
7 PER DAY/TASK
8 OTHER (SPECIFY ______________)
97 DON’T KNOW
98 REFUSED
CATI: IF B12 = 7, 8, 97, 98 THEN GO TO B16
B13.
How much is your regular pay for that period?
CATI: SHOW ANSWER TO B12.
INTERVIEWER, IF NEEDED: Don’t include tips, commissions, bonuses, or overtime pay.
$ ___ ___ , ___ ___ ___ . ___ ___
AMOUNT (RANGE: .01 -to 50,000.00)
99999.96 MORE THAN $50,000
99999.97 DON’T KNOW
99999.98 REFUSED
CATI: IF B13 = 99999.97, 99999.98 THEN GO TO B15
B14.
Is that …
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
B15.
Do you receive tips, commissions, or overtime pay in addition to this?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B15 = 2, 7, 8 THEN GO TO B18
B16.
How much did you make the last week you worked at this job, including tips, commissions, and any overtime pay?
$___ , ___ ___ ___ AMOUNT PER WEEK (Range: 1 to 9,995)
9996 More than $9,995
9997 DON’T KNOW
9998 REFUSED
CATI: IF B16=9997 OR 9998 GO TO B18.
B17.
Was that:
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
CATI: FOR B18, IF B5=2 (self-employed), GO TO B27, ELSE ASK B18.
B18.
Some employers offer health insurance for their employees, but sometimes workers don’t participate or receive health coverage due to cost or other reasons. For this job, would you say:
1 no health insurance is available,
2 health insurance is available, but you don’t participate, or
3 you are covered by health insurance made available by your employer?
7 DON’T KNOW
8 REFUSED
B19.
Which of the following benefits are/were available to you on your job, even if you are not receiving them?
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. Sick days with full pay? |
1 |
2 |
7 |
8 |
b. Paid vacation? |
1 |
2 |
7 |
8 |
c. Paid holidays other than Christmas and New Year’s Day? |
1 |
2 |
7 |
8 |
d. Dental benefits, including any offered at a cost to you? |
1 |
2 |
7 |
8 |
e. A retirement or 401K plan? |
1 |
2 |
7 |
8 |
f. Tuition reimbursement? |
1 |
2 |
7 |
8 |
B20.
Are you a member of a labor union or an employee association like a union at this job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B
7-
Since
[RAD], have you received a promotion while working there, meaning
that you moved to a higher position or job title? This does not
include raises or changes in your wage or salary.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B22.
Do you think you are likely to move up or be promoted?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B23.
Did
staff from any agency or organization help you get this job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B23 = 2, 7, 8 THEN GO TO B25
B15.
What agency or program was it?
1 [LOCAL TJ PROGRAM ]
2 WELFARE OFFICE
3 PAROLE OFFICE
4 CHILD SUPPORT AGENCY
5 WORKFORCE CENTER (WIA)/ONE-STOP
6 UNEMPLOYMENT OFFICE OR EMPLOYMENT SERVICES PROGRAM
7 FOOD STAMPS PROGRAM/SNAP
8 OTHER, SPECIFY ____________________________________________
97 DON’T KNOW
98 REFUSED
B25.
From the following options, which was the most important resource you used to find this job?
INTERVIEWER, READ OPTIONS AND CHOOSE ONE
1 A friend, relative or acquaintance,
2 a job posting or help-wanted ad found in the newspaper, on the computer, or somewhere else,
,
3 an employment placement service at school or training provider,
a church or community center,
5 an employer that decided to retain you permanently after you were placed in a temporary, transitional, or subsidized job, or
6 some other source? (SPECIFY______________________)
97 DON’T KNOW
98 REFUSED
CATI: ASK B26 IF B25=1, ELSE GO TO B27
B26.
Is this someone you’ve known for a long time or only met within the last year?
1 KNOWN FOR A LONG TIME
2 ONLY MET WITHIN LAST YEAR
7 DON’T KNOW
8 REFUSED
CATI: FOR B27,
IF B2 > 1 and < 97 THEN ASK B27.
ELSE (B2=blank, 97,98) GO TO B47
CATI: B27 AND THE B28-B46 SERIES ASK ONLY ABOUT OTHER CURRENT JOBS HELD BY THE R.
CREATE “NUMOTHCUR” ( for number of other current jobs). NUMOTHCUR = B2-1 OR SEVEN, WHICHEVER IS LESS.
TOTAL JOBS TO ASK ABOUT IN B27 =NUMOTHCUR
B27.
Thinking now about the other jobs that you’re currently working, tell me all of the other places that you currently work.
INTERVIEWER PROBE: What are your employers’ names?
INTERVIEWER: IF R IS SELF EMPLOYED, CHECK ‘SELF EMPLOYED’ AND RECORD THE NAME OF THE COMPANY OR THE KIND OF WORK DONE
CATI: CREATE A CHECK BOX FOR EACH JOB ALLOWING INTERVIEWER TO INDICATE IF THE JOB IS SELF EMPLOYMENT
INTERVIEWER: RECORD AS MANY OTHER CURRENT JOBS AS INDICATED HERE.
CATI: SHOW : “NUMBER OF CURRENT OTHER JOBS TO REQUEST IS [NUMOTHCUR]”.
Abt/DIR: this does not need to be in table form in CATI, but this information should be collected for all (up to 7) other current jobs at this time.
OTHER JOB # |
VERBATIM |
SELF EMPLOYED |
DON’T KNOW |
REFUSED |
1 |
a. |
96 |
97 |
98 |
2 |
b. |
96 |
97 |
98 |
3 |
c. |
96 |
97 |
98 |
4 |
d. |
96 |
97 |
98 |
5 |
e. |
96 |
97 |
98 |
6 |
f. |
96 |
97 |
98 |
7 |
g. |
96 |
97 |
98 |
INTERVIEWER: IF R’S LIST OF OTHER JOBS IS DIFFERENT FROM THE COUNT EXPECTED, CONFIRM NUMBER AND NAMES WITH R AND CONFIRM ALL ARE CURRENT. IF STILL DISAGREE, ENTER NEW NUMBER HERE.
____________
NUMBER IF DISAGREE
CATI: SERIES B28-46 WILL BE ASKED FOR EACH OF UP TO 7 ADDITIONAL JOBS THAT R IS CURRENTLY WORKING AS RECORDED IN B27
DO NOT ASK ABOUT JOBS WHERE B27 = 97 OR 98.
FLAG ALL B27 JOBS WITH A VARIABLE CALLED “OTHCURJOB”. SET DEFAULT OTHCURJOB TO 1 FOR EACH JOB. IF B27=97 OR 98, SET OTHCURJOB TO 2.
THE ANSWERS GIVEN IN B27 WILL BE USED TO REFER TO EACH OF THE OTHER JOBS. AT THE END OF EACH SERIES, THE ANSWER TO B27 WILL DETERMINE WHETHER TO BEGIN THE SERIES FOR ANOTHER JOB OR CONTINUE TO B47. THE SERIES ITEMS FOR EACH JOB SHOULD USE THE SAME SUFFIX, FOR EXAMPLE, B34a, B35a, B36a ALL REFER TO THE FIRST ADDITIONAL JOB.
B28a.-B28g.
CATI: FOR EACH B27 JOB, IF OTHCURJOB=1, CONTINUE WITH B28.
IF OTHCURJOB=2, USE NEXT B27 JOB.
IF NO NEXT B27 JOB, GO TO B47.
Thinking of [B27 JOB NAME], when did this job start?
INTERVIEWER: IF MM/YYYY IS BEFORE [RAD], CONFIRM DATE IS CORRECT.
CATI: SHOW RAD DATE IN INTERVIEWER INSTRUCTION
___________
MM/YYYY
INTERVIEWER PROBE FOR SEASON IF DON’T KNOW MONTH.
02 WINTER
05 SPRING
08 SUMMER
11 FALL
97/9997 DON’T KNOW
98/9998 REFUSED
CATI: IF B27=96 (self-employed), CODE B29 AS 2 AND GO TO B31
B29a.-B29g.
What type of company or organization are you working for at [B27 JOB NAME]?
INTERVIEWER PROBE: Who does the paycheck come from?
Is it…
1 self-employment,
2 temporary agency
3 a for-profit company or employer,
4 a non-profit company or employer,
5 a government employer, or
6 someone else? (SPECIFY)________________
97 DON’T KNOW
98 REFUSED
B30a.-B30g.
What kind of business or industry is that employer? What do they make or what service do they provide?
_____________________
VERBATIM
97 DON’T KNOW
98 REFUSED
B31a.-B31g.
What is your occupation on this job?
IF NEEDED:
What kind of work do you do? That is, what are your main duties in this job?
_____________________
VERBATIM
97 DON’T KNOW
98 REFUSED
B32a.-B32g.
Is
this job…
1 permanent regular employment,
2 seasonal work, temporary work through a temp agency, day labor, an odd job, or
3 something else? (SPECIFY _____________________)
97 DON’T KNOW
98 REFUSED
B33a.-B33g.
Which of the following best describes your usual weekly work
schedule at this job during the last month? Do you work a…
1 daytime shift,
2 evening shift,
3 night shift,
4 rotating shift (one that changes regularly from days to evenings to nights),
5 split shift (one consisting of two distinct periods each day),
6 an irregular schedule (one that changes from day to day or week to week), or
7 something else? (SPECIFY________________________ )
97 DON’T KNOW
98 REFUSED
B34a.-B34g.
Including overtime, how many hours per week do you usually work on this job?
IF SCHEDULE IS IRREGULAR OR VARIES:
How many hours did you work in the last week you worked at this job?
INTERVIEWER: CONFIRM IF MORE THAN 60 AS HOURS PER WEEK
___________________
NUMBER OF HOURS (RANGE: 1 to 995)
996 996 OR MORE
997 DON’T KNOW
998 REFUSED
B35a.-B35g.
For this job, what is the easiest way to tell me your wages BEFORE taxes and other deductions: hourly, weekly, annually, or something else?
1 HOURLY
2 WEEKLY
3 BI-WEEKLY
4 TWICE MONTHLY
5 MONTHLY
6 ANNUALLY
7 PER DAY/TASK
8 OTHER (SPECIFY ______________)
97 DON’T KNOW
98 REFUSED
CATI: IF B35 = , 7, 8, 97, 98 THEN GO TO B39
B36a.-B36g.
How much is your regular pay for that period?
CATI: SHOW ANSWER TO B35.
INTERVIEWER, IF NEEDED: Don’t include tips, commissions, bonuses, or overtime pay.
$ ___ ___ , ___ ___ ___ . ___ ___
AMOUNT (RANGE: .01 -to 50,000.00)
99999.96 MORE THAN $50,000
99999.97 DON’T KNOW
99999.98 REFUSED
CATI: IF B36 = 99999.97, 99999.98 THEN GO TO B39
B37a.-B37g.
Is that …
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
B38a.-B38g.
Do you receive tips, commissions, or overtime pay in addition to this?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B38 = 2, 7, 8 THEN GO TO B41
B39a.-B39g.
How much did you make the last week you worked at this job, including tips, commissions, and any overtime pay?
$___ , ___ ___ ___ . ___ ___
AMOUNT PER WEEK (Range: 1 to 9,995)
9996.96 More than $9,995
9997.97 DON’T KNOW
9998.98 REFUSED
B40a.-B40g.
Was that:
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
CATI: FOR B41,
IF B27=96 (self-employed) AND THERE ARE ADDITIONAL CURRENT JOBS, GO TO B28 NEXT JOB.
IF B27=96 AND THERE ARE NO ADDITIONAL JOBS, GO TO B47.
IF B27 <>96, ASK B41
B41a.-B41g.
Which of the following other benefits are available to you on your job, even if you do not participate or use them?
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. Sick days with full pay? |
1 |
2 |
7 |
8 |
b. Paid vacation? |
1 |
2 |
7 |
8 |
c. Paid holidays? |
1 |
2 |
7 |
8 |
d. Health insurance, including any offered at a cost to you? |
1 |
2 |
7 |
8 |
e. Dental benefits, including any offered at a cost to you? |
1 |
2 |
7 |
8 |
f. A retirement or 401K plan? |
1 |
2 |
7 |
8 |
g. Tuition reimbursement? |
1 |
2 |
7 |
8 |
B42a-B42g.
Are you a member of a labor union or an employee association like a union at this job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B43a.-B43g.
Did
staff from any agency or organization help you get this job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B43 = 2, 7, 8 THEN GO TO B45
B44a.-B44g.
What agency or program was it?
____________________
NAME OF AGENCY/PROGRAM
97 DON’T KNOW
98 REFUSED
B45a.-B45g..
From the following options, which was the most important resource you used to find this job? Was it…
INTERVIEWER, READ OPTIONS AND CHOOSE ONE
1 a friend, relative, or acquaintance,
2 a job posting or help-wanted ad found in the newspaper, on the computer, or somewhere else,
3 an employment placement service at school or training provider,
4 a church or community center,
5 an employer that decided to retain you permanently after you were placed in a temporary, transitional, or subsidized job, or
6 something else? (SPECIFY______________________)
97 DON’T KNOW
98 REFUSED
CATI:
IF B45 > 1 AND THERE ARE ADDITIONAL CURRENT JOBS THEN GO TO B28 NEXT JOB.
IF B45>1 AND THERE ARE NO ADDITIONAL JOBS, GO TO B47.
IF B45=1, ASK B46.
B46a.-B46g.
Is this someone you’ve known for a long time or only met within the last year?
1 KNOWN FOR A LONG TIME
2 ONLY MET WITHIN LAST YEAR
7 DON’T KNOW
8 REFUSED
CATI: AFTER ASKING B46, IF THERE ARE ADDITIONAL CURRENT JOBS, GO TO B28. ELSE CONTINUE WITH B47.
B47.
[CATI: IF B2=1-96, USE THE FIRST QUESTION. IF B2=blank, 97,98 USE THE SECOND QUESTION.
CATI: USE FIRST TEXT OPTION ONLY IF B2=1.]
Besides the (job/jobs) we’ve already talked about, did you work at any other jobs since [RAD]?
Did you work at any jobs since [RAD]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B47=1, ASK B48
IF B47=2, 7, 8 AND B1=1 THEN GO TO SECTION C
IF B47=2, 7, 8 AND B1=2, 7, 8 THEN GO B62
CATI: SERIES B48-B61 WILL BE ASKED FOR EACH OF UP TO 7 ADDITIONAL JOBS THAT STOPPED SOMETIME AFTER [RAD]. AT THE END OF EACH SERIES, THE LAST QUESTION WILL DETERMINE WHETHER TO BEGIN THE SERIES FOR ANOTHER JOB OR CONTINUE TO SECTION C. THE SERIES ITEMS FOR EACH JOB SHOULD USE THE SAME SUFFIX, FOR EXAMPLE, B48a, B49a, AND B50a ALL REFER TO THE FIRST ADDITIONAL JOB.
B48a.
For the job that ended most recently, where did you work?
B48b.-B48g.
Where did you work before [PRIOR B48 JOB NAME]?
INTERVIEWER PROBE: What was your employer’s name?
_____________________
VERBATIM
97 DON’T KNOW
98 REFUSED
B49a – B49g.
When did that job end?
____/_______
MM/YYYY
INTERVIEWER PROBE FOR SEASON IF DON’T KNOW MONTH.
02 WINTER
05 SPRING
08 SUMMER
11 FALL
97/9997 DK
98/9998 REFUSED
CATI: IF B1=1 AND (B49 BEFORE [RAD] OR (MONTH OR YEAR =IS DK/REF)) , GO TO SECTION C.
IF B1=2,7,8 AND (B49a BEFORE RAD OR (MONTH OR YEAR =DK/REF)) GO TO B62.
IF B1=2,7,8 AND (B49b-g BEFORE RAD OR (MONTH OR YEAR =DK/REF)) GO TO B63.
B50a.-B50g.
When did it start?
____/_______
MM/YYYY
CATI: CHECK THAT DATE PRECEDES DATE GIVEN IN B49
INTERVIEWER PROBE FOR SEASON IF DON’T KNOW MONTH.
02 WINTER
05 SPRING
08 SUMMER
11 FALL
97/9997 DK
98/9998 REFUSED
B51a. – B51g.
What kind of employer were you working for?
INTERVIEWER PROBE: Who did the paycheck come from?
Is it…
1 self-employment,
2 a temporary agency,
3 a for-profit company or employer,
4 a non-profit company or employer,
5 a government employer, or
6 some other work arrangement? (SPECIFY)________________
97 DON’T KNOW
98 REFUSED
B52a.-B52g.
What was your occupation on this job?
IF NEEDED:
What kind of work did you do? That is, what were your main duties in this job?
_____________________
VERBATIM
97 DON’T KNOW
98 REFUSED
B53a – B453g.
Including overtime, how many hours per week (do/did) you work on this (job/job when you left)?
IF SCHEDULE IS IRREGULAR OR VARIES:
How many hours did you work the last week you had the job?
INTERVIEWER: CONFIRM IF MORE THAN 60 HOURS PER WEEK
______________________
HOURS PER WEEK (RANGE: 1 to 995)
996 996 OR MORE
997 DON’T KNOW
998 REFUSED
B54a.-B54g.
How much did you make the last week you worked at that job?
$___ , ___ ___ ___ . ___ ___
AMOUNT PER WEEK(Range: 1 to 9,995)
9996 More than $9,995
9997.97 DON’T KNOW
9998.98 REFUSED
B55a.-B55g.
Was that:
1 before taxes, or
2 after taxes?
7 DON’T KNOW
8 REFUSED
B44a – B44g.
(Do / Did) you get health or medical benefits, including any offered at a cost to you?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B56a. – B56g.
Which of the following benefits were available to you on that job, even if you did not participate or use them?
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. Sick days with full pay? |
1 |
2 |
7 |
8 |
b. Paid vacation? |
1 |
2 |
7 |
8 |
c. Paid holidays? |
1 |
2 |
7 |
8 |
d. Health insurance, including any offered at a cost to you? |
1 |
2 |
7 |
8 |
e. Dental benefits, including any offered at a cost to you? |
1 |
2 |
7 |
8 |
f. A retirement or 401K plan? |
1 |
2 |
7 |
8 |
g. Tuition reimbursement? |
1 |
2 |
7 |
8 |
B57a.-B57g.
Were you a member of a labor union or an employee association like a union at this job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
B58a – B58g.
Did staff from any agency or organization help you get this job?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF B58=2,7,8 GO TO B60
B59a – B59g.
Which agency or organization?
_____________________
NAME OF AGENCY/PROGRAM
97 DON’T KNOW
98 REFUSED
B60a – B60g.
Why did you stop working at this job?
1 GOT A NEW/DIFFERENT JOB
2 LAID OFF
3 NOT INTERESTED IN WORKING
4 UNABLE TO WORK BECAUSE OF INJURY, ILLNESS, OR DISABILITY
5 INCARCERATED
6 PREGNANCY/CHILDBIRTH
7 FAMILY RESPONSIBILITIES
8 GOING TO SCHOOL
9 OTHER. SPECIFY___________________
97 DON’T KNOW
98 REFUSED
B61a.-B61g.
Did you have any other jobs that we haven’t talked about?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: AFTER EACH B61:
IF IN JOBS a-f:
IF B61=1, GO TO B48
IF B61=2,7,8 AND B1=1 THEN GO TO SECTION C
IF B61=2,7,8 AND B1=2, 7, 8 THEN GO TO B63
IF IN JOB g:
IF B1=1 THEN GO TO SECTION C
IF B1=2, 7, 8 THEN GO TO B63
ELSE ASK B62
CATI: B62 IS ASKED ONLY
IF (B1=2,7,8 AND B47=2,7,8)
OR
IF (B1=2,7,8 AND (B49a IS BEFORE RAD OR (MONTH OR YEAR IS DK/REF)))
B62.
What is the main reason you did not work at a job since [RAD]?
1 UNABLE TO WORK BECAUSE OF INJURY, ILLNESS, OR DISABILITY
2 INCARCERATED
3 PREGNANCY/CHILDBIRTH
4 FAMILY RESPONSIBILITIES
5 GOING TO SCHOOL
6 UNABLE TO FIND WORK
7 NOT INTERESTED IN WORKING
8 OTHER. SPECIFY___________________
97 DON’T KNOW
98 REFUSED
B63.
Have you done anything to find work during the past four weeks?
1 YES
2 NO
7 DK
8 REF
CATI: IF B63 = 2, 7, 8 THEN GO TO B67
B64.
From the following list, please indicate each of these things that you have done to find work during the past four weeks:
In the past four weeks, did you: |
YES |
NO |
DON’T KNOW |
REF |
a.…contact employers? |
1 |
2 |
7 |
8 |
b.…contact a public employment agency? |
1 |
2 |
7 |
8 |
c.…attend or enroll in a program or course? |
1 |
2 |
7 |
8 |
d.…contact a private employment agency? |
1 |
2 |
7 |
8 |
e.…contact friends or relatives? |
1 |
2 |
7 |
8 |
f.…interview for a job? |
1 |
2 |
7 |
8 |
g.…contact a school or university employer center? |
1 |
2 |
7 |
8 |
h.…send out a resume or fill out application? |
1 |
2 |
7 |
8 |
i.…check union or professional registers? |
1 |
2 |
7 |
8 |
j.…look at job advertisements? |
1 |
2 |
7 |
8 |
k.…place an ad or answer an ad? |
1 |
2 |
7 |
8 |
l.…attend job training? |
1 |
2 |
7 |
8 |
m.…do something else? (SPECIFY____________) |
1 |
2 |
7 |
8 |
B65.
During the past four weeks, about how many hours in total did you spend looking for work?
INTERVIEWER: CONFIRM IF MORE THAN 40 HOURS
______________
HOURS (RANGE: 1 to 95)
96 96 OR MORE
97 DON’T KNOW
98 REFUSED
B66.
With how many different employers have you made direct contact, either by phone, mail, or in person during the past four weeks?
INTERVIEWER: CONFIRM IF MORE THAN 20
_____________
NUMBER OF EMPLOYERS
97 DON’T KNOW
98 REFUSED
B67.
Last week, could you have started a job if one had been offered?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
IF B67=1,7,8 THEN GO TO SECTION C
B68.
Why is that?
1 WAITING FOR NEW JOB TO BEGIN
2 OWN TEMPORARY ILLNESS
3 GOING TO SCHOOL
4 OTHER (SPECIFY_________________ )
97 DON’T KNOW
98 REFUSED
C1.
Which of the following best describes your housing arrangement last month? Did you:
IF R HAS MORE THAN ONE ARRANGEMENT, SAY: Tell me about the one you spent the most time at in the last month.
1 own your own home or apartment,
2 rent your home or apartment,
3 live in emergency or temporary housing, that is in a shelter or were
homeless,
4 live with friends or relatives and pay rent to them,
5 live with friends or relatives and not pay rent to them, or
6 have some other housing arrangement? (SPECIFY____________________)
7 INCARCERATED (IN JAIL/PRISON/ETC.)
97 DON’T KNOW
98 REFUSED
CATI: IF C1=2, GO TO C2
ELSE IF C1=7 THEN GO TO C9
IF C1=1,3, GO TO C3.
ELSE IF C1=7, GO TO C9.
ELSE ASK C2.
C2.
Did you live in…
1 public housing (housing owned by a federal, state or local government agency),
2 private housing that is subsidized by government aid (Section 8 or vouchers), or
3 private housing with no help from the government? (Entire rent bill paid without
any public assistance to a landlord, family member or friend.)
7 DON’T KNOW
8 REFUSED
C3.
Now, I’m going to ask you about other adults who lived in your household.
CATI: IF C1=3, use first wording, otherwise use second:
By household I mean the family members and friends that live with you in your temporary or emergency housing situation. So, including you, how many adults lived with you for at least two nights a week during [PRIOR MONTH]?
By living in your household, I mean lived with you at least two nights a week last month. Including you, how many adults lived here at least two nights a week during [PRIOR MONTH]?
INTERVIEWER WAIT FOR ANSWER THEN SAY: And that includes you, correct?
__________________
NUMBER OF ADULTS (MUST BE 1 OR MORE)
97 DON’T KNOW
98 REFUSED
CATI: IF C3=1, 97, 98, GO TO C5.
C4.
Are any of these people your spouse, boyfriend, girlfriend, or unmarried partner?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C5.
Are there any children who are under age 19 that live with you in your household? This will include biological, adoptive, foster, step, or other children or relatives currently living in your home at least half the time.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF C5=2, 7, 8, GO TO C9.
CATI: C6-C8 WILL BE ASKED FOR UP TO 15 CHILDREN LIVING IN R’S HOUSEHOLD, STARTING WITH THE OLDEST.
C6a-C6o.
[FIRST CHILD] What is the birth date of the oldest child under age 19 that lives with you?
[OTHER CHILDREN] What is the birth date of the next oldest?
INTERVIEWER: IF R ONLY KNOWS MONTH AND YEAR, CODE DAY AS 15.
CATI: CHECK THAT CHILD IS UNDER AGE 19. INFORM INTERVIEWER IF CHILD IS TOO OLD.
BIRTH DATE: ___/___/____
MM/DD/YYYY
97/97/9997 DON’T KNOW
98/98/9998 REFUSED
CATI: IF C6 IS VALID DATE (MONTH AND YEAR), GO TO C7.
C6A.a-C6A.o.
How old is she or he?
_____ ____
AGE IN YEARS AGE IN MONTHS IF LESS THAN 1 YEAR
97 DON’T KNOW
98 REFUSED
C7a-C7o.
Is that your child or a child who you’re responsible for?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C8a-C8o.
Are there any more children under age 19 who live with you in your household?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF C8=1 AND LESS THAN 15 CHILDREN HAVE BEEN RECORDED, LOOP BACK TO C6.
C9.
CATI: USE SECOND QUESTION IF C1=7; ALL OTHERS GET FIRST QUESTION WORDING.
How many children who are under 19 were you responsible for last month who do not live with you? Please include your biological and adopted children and any other children for whom you are responsible who are under 19.
Do you have any children who are under age 19?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF C9=2, 7, 8, GO TO C11. ELSE ASK C10 FOR EACH OF THE CHILDREN IN C9 UP TO 15.
C10a-C10o.
CATI: RECORD BIRTH DATE FOR EACH CHILD. ALLOW FOR 15 CHILDREN.
[FIRST CHILD] What is the birth date of the oldest child under age 19 who you are responsible for but does not live with you?
[OTHER CHILDREN] What is the birth date of the next oldest?
INTERVIEWER: IF R ONLY KNOWS MONTH AND YEAR, CODE DAY AS 15.
CATI: CHECK THAT CHILD IS UNDER AGE 19. INFORM INTERVIEWER IF CHILD IS TOO OLD.
BIRTH DATE: ___/___/____
MM/DD/YYYY
97/97/9997 DON’T KNOW
98/98/9998 REFUSED
C10A.a-C10A.o.
How old is she or he?
_____ ____
AGE IN YEARS AGE IN MONTHS IF LESS THAN 1 YEAR
97 DON’T KNOW YEARS
98 REFUSED YEARS
C10B.a – C10B.o.
Are there any more children under age 19 who you are responsible for but do not live in your household?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF C10B =1 AND LESS THAN 15 CHILDREN HAVE BEEN RECORDED,CONTINUE WITH NEXT CHILD IN C10. ELSE GO TO C11.
CATI: ALL RESPONDENTS GET C11.
C11.
Which of the following is your current marital status? Are you:
1 never married,
2 married,
3 in a civil union or domestic partnership,
4 separated,
5 divorced, or
6 widowed?
7 DON’T KNOW
8 REFUSED
C12.
Now, I am going to ask you some questions about the income that came into your household for everyone who lived together in (PRIOR MONTH). Please include all income from all the people who lived together in your household at least two nights a week last month. Again, I want to assure you that none of your answers will be discussed with anyone.
In [PRIOR MONTH], did you or anyone in your household receive any of the following sources?
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. Job earnings? |
1 |
2 |
7 |
8 |
b. SSI or Supplemental Security Income? |
1 |
2 |
7 |
8 |
c. Public assistance or welfare, not including WIC or food stamps? |
1 |
2 |
7 |
8 |
d. Retirement or social security? |
1 |
2 |
7 |
8 |
e. Unemployment insurance? |
1 |
2 |
7 |
8 |
f. Worker’s compensation, disability? |
1 |
2 |
7 |
8 |
g. Child support ? |
1 |
2 |
7 |
8 |
h. Cash from family and friends who live outside of your household? |
1 |
2 |
7 |
8 |
i. Energy assistance? |
1 |
2 |
7 |
8 |
j. Child care subsidy? |
1 |
2 |
7 |
8 |
k. Housing choice voucher, also known as Section 8? |
1 |
2 |
7 |
8 |
l. Food stamps - also known as Supplemental Nutrition Assistance Program or SNAP? |
1 |
2 |
7 |
8 |
m. WIC? |
1 |
2 |
7 |
8 |
n. Free or reduced price school lunch program? |
1 |
2 |
7 |
8 |
C14.
Was there any other source of income you received last month that we haven’t talked about?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF C14=2,7,8 THEN GO TO C16
C15.
What was that other income?
IF NEEDED: Was it from a government program we haven’t talked about, a loan, or what?
_____________________
SOURCE
97 DON’T KNOW
98 REFUSED
C16.
How about income received by other people in your household – did anyone else receive income last month that we haven’t talked about?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF C16=2,7,8 THEN GO TO C18a
C17.
What was that other income?
IF NEEDED: Was it from a government program we haven’t talked about, a loan, or what?
_____________________
SOURCE
97 DON’T KNOW
98 REFUSED
C18a.
Thinking of all of the income received by you and the people in your household last month, what was the total income for everyone living together in your household in (PRIOR MONTH)? Please don’t include tax returns in your answer.
INTERVIEWER PROBE: Your best estimate is fine.
INTERVIEWER: ROUND TO NEAREST WHOLE DOLLAR.
$ _, _ _ _
AMOUNT (RANGE 1-9995)
9996 GREATER THAN $9995
9997 DON’T KNOW
9998 REFUSED
CATI: IF C18a=9997, 9998, GO TO C19.
ELSE GO TO C20.
C19.
Would you say it was…
1 None ($0)
2 $500 or less,
3 $501-$1000,
4 $1001-$1500,
5 $1501-$2000,
6 $2000-$2500, or
7 $2500 or more?
97 DON’T KNOW
98 REFUSED
C20.
How much of that household income from (PRIOR MONTH) was your own income? Please include all sources.
INTERVIEWER: ROUND TO NEAREST WHOLE DOLLAR.
$ _, _ _ _
AMOUNT (RANGE 0-9995)
9996 GREATER THAN $9995
9997 DON’T KNOW
9998 REFUSED
CATI: IF C20 < 9997 THEN GO TO C25
C22.
Would you say it was…
1 None ($0)
2 $500 or less,
3$501-$1000,
4 $1001-$1500,
4 $1501-$2000,
5 $2000-$2500, or
6 $2500 or more?
8 DON’T KNOW
9 REFUSED
C25.
The federal government has a special rule that allows working people who make less than about $49,000 a year to take advantage of something called the Earned Income Tax Credit, or EITC. They can claim the Earned Income Tax Credit by filling out a special form called Schedule EIC when they fill out their income taxes, or they can fill out a special form with their employer.
Did you or will you claim the Earned Income Tax Credit for your earnings next?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
C26.
How much do you agree or disagree with each of the following statement? My financial situation is better than it was last year at this time. Would you say you…
1 strongly disagree,
2 disagree somewhat,
3 agree somewhat, or
4 strongly agree?
7 DON’T KNOW
8 REFUSED
C27.
Now I have some questions about your financial situation. Sometimes due to circumstances beyond your control, it can be difficult to meet all of your financial obligations. As I read each question, please let me know if you have faced any of the following situations.
Since [RAD], has there been a time when…
|
YES |
NO |
DON’T KNOW |
REF |
a. …you did not pay the full amount of the rent or mortgage because you could not afford it? |
1 |
2 |
7 |
8 |
b. …the bank or mortgage company foreclosed on your mortgage? |
1 |
2 |
7 |
8 |
c. …you were evicted from your home or apartment for not paying the rent or mortgage? |
1 |
2 |
7 |
8 |
d. …you filed in court for bankruptcy? |
1 |
2 |
7 |
8 |
e. …you did not pay the full amount of the gas, oil, or electricity bills? |
1 |
2 |
7 |
8 |
f. …you had service turned off by the gas or electric company, or oil company would not deliver oil? |
1 |
2 |
7 |
8 |
g. …you had cellular or land telephone service disconnected because payments were not made? |
1 |
2 |
7 |
8 |
h…you ever needed to go to the doctor or dentist but didn’t because you didn’t think you could afford to pay for it? |
1 |
2 |
7 |
8 |
i. ...you could not fill or postponed filling a prescription for drugs when they were needed because you could not afford it? |
1 |
2 |
7 |
8 |
C28.
In general, how do your family finances usually work out at the end of the month? Is there…
1 some money left over,
2 just enough to make ends meet, or
3 not enough money to make ends meet?
7 DON’T KNOW
8 REFUSED
C29.
When it comes to making ends meet, how much help did your household get in the past 12 months from food pantries, churches, family services or other organizations? Did you get…
1 no help at all,
2 some help, or
3 a lot of help?
7 DON’T KNOW
8 REFUSED
C30.
On a scale of 1 to 10, where 1 means “never worry” and 10 means “worry all the time”, how often do you worry about being able to meet normal monthly living expenses?
___________
SCALE SCORE
97 DON’T KNOW
98 REFUSED
C31.
Getting enough food can be a problem for some people. Which of these statements best describes the food eaten in your household in the prior month? Would you say there is…
1 enough of the kind of foods you want,
2 enough, but not always the kinds of food you want,
3 sometimes not enough to eat, or
4 often not enough to eat?
7 DON’T KNOW
8 REFUSED
The next few questions are about health coverage for you and your family.
CATI: IF B18=3 THEN GO TO D2
In [PRIOR MONTH] were you covered by any form of health insurance?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF D1=1, ASK D2. ELSE GO TO D3.
D2.
What types of health insurance were you covered by?
INTERVIEWER: MARK ALL THAT APPLY.
1 MEDICAID
2 EMPLOYER BASED
3 [INSERT NAME OF STATE’S CHILD HEALTH INSURANCE PROGRAM]
4 COBRA
5 SELF PAID PRIVATE INSURACE
6 INSURANCE PAID BY SOMEONE ELSE
7 OTHER, SPECIFY_________
97 DON’T KNOW
98 REFUSED
CATI: FOR D3, IF C4=1, ASK D3. ELSE GO TO D5
D3.
In [PRIOR MONTH] was your spouse or partner covered by any form of health insurance?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF D3=2, 7, 8 THEN GO TO D5.
D4.
What type of health insurance were they covered by?
INTERVIEWER: MARK ALL THAT APPLY.
1 MEDICAID
2 EMPLOYER BASED
3 [INSERT NAME OF STATE’S CHILD HEALTH INSURANCE PROGRAM]
4 COBRA
5 SELF PAID PRIVATE INSURACE
6 INSURANCE PAID BY SOMEONE ELSE
7 OTHER, SPECIFY_________
97 DON’T KNOW
98 REFUSED
CATI: FOR D5, IF ANY OF C7a-o=1 OR C9=1 ASK D5. ELSE GO TO SECTION E.
D5.
Regarding your children’s health insurance coverage which is the case?
1 All my children are covered,
2 some of my children are covered, or
3 none of my children are covered?
7 DON’T KNOW
8 REFUSED
CATI: IF D5=1 OR 2, ASK D6. ELSE GO TO SECTION E.
D6.
What types of health insurance were they covered by?
INTERVIEWER: MARK ALL THAT APPLY.
1 MEDICAID
2 EMPLOYER BASED
3 [INSERT NAME OF STATE’S CHILD HEALTH INSURANCE PROGRAM]
4 COBRA
5 SELF PAID PRIVATE INSURACE
6 INSURANCE PAID BY SOMEONE ELSE
7 OTHER, SPECIFY_________
97 DON’T KNOW
98 REFUSED
E1.
In general, would you say your health is…
1 excellent,
2 very good,
3 good,
4 fair, or
5 poor?
7 DON’T KNOW
8 REFUSED
E2.
Compared to one year ago, how would you rate your health in general now? Would you say it is…
1 much better than one year ago.
2 somewhat better now than one year ago,
3 about the same,
4 somewhat worse now than one year ago, or
5 much worse now than one year ago?
7 DON’T KNOW
8 REFUSED
E3.
These next questions are about feelings you may have experienced over the past month.
During the month, how often did you feel…
INTERVIEWER: READ ITEM THEN READ THE RESPONSE CATEGORIES
|
Would you say you felt this way… |
|||||
|
often, |
sometimes, |
hardly ever, or |
never? |
DK |
REF |
a. …so sad that nothing could cheer you up? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …nervous? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …restless or fidgety? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …hopeless? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …that everything was an effort? |
1 |
2 |
3 |
4 |
7 |
8 |
f. …worthless? |
1 |
2 |
3 |
4 |
7 |
8 |
E6.
Taken all together, how would you say things were these days – would you say that you are…
1 very happy,
2 pretty happy,
3 not too happy?
7 DON’T KNOW
8 REFUSED
CATI: ASK SECTION F IF SAMPLE MEMBER IS AN EX-OFFENDER (FROM SAMPLE FILE), A MEMBER OF AN EX-OFFENDER SITE, OR IS CURRENTLY INCARCERATED (C1=7). ALL OTHERS GO TO SECTION G.
F2.
At any point since [RAD], have you been arrested?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F2=1, ASK F4. ELSE GO TO F7.
CATI: F4 AND F5 RECORD DATE AND REASON FOR UP TO 15 ARRESTS. ARRESTS ARE RECORDED IN REVERSE CHRONOLOGICAL ORDER, STARTING WITH THE MOST RECENT ARREST.
F4a-F4o.
[CATI: FOR FIRST ARREST, DISPLAY:] When were you most recently arrested?
[FIRST TIME] INTERVIEWER, IF NEEDED: The most recent arrest.
[FIRST TIME]INTERVIEWER: IF DATE GIVEN IS BEFORE [RAD], CONFIRM AS MOST RECENT ARREST.
[CATI: FOR ARRESTS 2-15, DISPLAY:] What was the date of that previous arrest?
_ _/ _ _ _ _
MM/YYYY
97/9997 DON’T KNOW
98/9998 REFUSED
CATI: IF F4 ON OR AFTER [RAD], GO TO F5
IF F4 BEFORE [RAD], GO TO F7.
IF F4 NOT VALID DATE, ASK F4A.
F4Aa.-F4Ao.
Did this arrest occur after [RAD]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F4Aa = 2, 7, 8 GO TO F7.
F5a-F5o.
Why were you arrested then?
INTERVIEWER: RECORD VERBATIM RESPONSE.
______________
REASON
97 DON’T KNOW
98 REFUSED
F6a-F6o.
Did you have another arrest that occurred after [RAD DATE SHOWING DAY]?
1 YES
2 NO
97 DON’T KNOW
98 REFUSED
CATI: IF F6=1 AND FEWER THAN 15 ARRESTS HAVE BEEN RECORDED, LOOP BACK TO F4.
F7.
At any time since [RAD], have you been on parole or probation?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F7 = 2, 7, 8 THEN GO TO F15
F8.
Since [RAD], have you been sanctioned or have you violated the conditions of your supervision? By sanction or violation, we mean that your parole or probation officer determined that you broke the rules of your parole/probation.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F8=1, ASK F9. ELSE GO TO F14.
CATI: SERIS F9-F13 WILL BE ASKED FOR EACH OF UP TO 15 VIOLATIONS, RECORDED IN REVERSE CHRONOLOGICAL ORDER, STARTING WITH THE MOST RECENT.
F9a – F9o.
[CATI: FOR FIRST VIOLATION, DISPLAY:] When was the last time your parole/probation officer issued a technical violation?
[FIRST VIOLATION] INTERVIEWER: IF DATE GIVEN IS BEFORE [RAD], CONFIRM AS MOST RECENT ARREST.
[CATI: FOR VIOLATIONS 2-15, DISPLAY:] What was the date of your previous violation?
_ _/ _ _ _ _
MM/YYYY
97/9997 DON’T KNOW
98/9998 REFUSED
CATI: IF F9 ON OR AFTER [RAD], GO TO F10
IF F9 BEFORE [RAD], GO TO F14.
IF F9 NOT VALID DATE, ASK F9A.
F9Aa.-F9Ao.
Was this technical violation issued after [RAD]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F9A = 2, 7, 8, GO TO F14.
F10a – F10o.
What was the reason you received the technical violation?
1 MISSED CURFEW
2 FAILURE TO REPORT FOR SCHEDULED APPOINTMENT WITH
PAROLE/PROBATION OFFICER
3 DRUG USE
4 FAILURE TO SEEK OR MAINTAIN EMPLOYMENT
5 ASSOCIATED WITH RESTRICTED PEOPLE
6 HOUSING
7 FAILURE TO PAY PAROLE/PROBATION FEES
8 DID NOT NOTIFY PAROLE/PROBATION OFFICER OF ADDRESS
CHANGE
9 CONTACT WITH VICTIM
10 ARRESTED FOR A NEW CRIME
11 FAILED TO ATTEND TREATMENT OR A PROGRAM AS DIRECTED
12 OTHER (SPECIFY______________________)
97 DON’T KNOW
98 REFUSED
F11a – F11o.
Were you sanctioned for the technical violation?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F11=2, 7, 8 GO TO F13
F12a – F12o.
What type of sanction did your parole/probation officer impose for that violation?
INTERVIEWER: DO NOT READ LIST. CODE RESPONSE GIVEN. ONLY ONE RESPONSE ALLOWED.
1 TREATMENT
2 CURFEW
3 REPRIMAND
4 ELECTRONIC MONITORING
5 HOUSE ARREST
6 DAY REPORTING
7 INCARCERATION
8 OTHER (SPECIFY __________________)
97 DON’T KNOW
98 REFUSED
F13a-F13o.
Were you sanctioned or did you violate the conditions of your supervision another time since [RAD DATE SHOWING DAY]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F13=1, AND FEWER THAN 15 VIOLATIONS ARE REPORTED, GO TO F9. ELSE GO TO F14.
F14.
Was your parole or probation ever revoked since [RAD]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: FOR F15, IF CURRENTLY INCARCERATED (F1=1), GO TO F16.
F15.
At any point since [RAD], have you spent time in jail or prison?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF F15=1, ASK F16. ELSE GO TO SECTION G.
F16.
What was the total amount of time that you spent in jail or prison since [RAD]?
INTERVIEWER, CONFIRM UNIT OF TIME: Was that days, week, months, or years?
INTERVIEWER, IF NEEDED: In total for all sentences.
RECORD BOTH TIME AND UNIT
__________________
AMOUNT OF TIME
1 DAYS,
2 WEEKS
3 MONTHS
4 YEARS
7 DON’T KNOW
8 REFUSED
F17.
Please rate your agreement with the following statements.
INTERVIEWER: READ ITEM THEN READ RESPONSE SET
CATI: IN THE FOLLOWING TABLE, IF F1=2, USE FIRST (PAST) WORD OPTION. IF F1=1, USE SECOND (CURRENT) WORD OPTION.
|
Would you say you… |
||||||
|
strongly disagree, |
disagree, |
neither agree nor disagree, |
agree, or |
strongly agree? |
DON’T KNOW |
REF |
a. You (were/are) locked up because you had a run of bad luck. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
b. The real reason you (were/are) locked up is because of your race. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
c. Nothing you do is going to make a difference in the way you are treated. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
d. You are not to blame for everything you have done. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
e. Laws are just a way to keep poor people down. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
f. You may have committed crimes, but your environment is to blame. |
1 |
2 |
3 |
4 |
5 |
7 |
8 |
ASK SECTION G ONLY IF SAMPLE MEMBER IS A MEMBER OF A TANF SITE AND ALSO HAS AT LEAST ONE CHILD OF THEIR OWN LIVING IN THEIR HOUSEHOLD UNDER AGE 13 (AGE CALCULATED FROM C6<13 AND C7=1).
G1.
Now I’m going to ask you about child care. Child care includes day care centers or nursery schools, Head Start, before- or after-school care centers, a babysitter, including brothers or sisters, the child’s other parent if that parent does not live with you, or other relatives, and summer camps. Please don’t count kindergarten, first grade, or higher. Were any of your children under age 13 that live with you cared for in a child care arrangement last month?
INTERVIEWER: REGULAR CUSTODY ARRANGEMENTS (VISITATION) DO NOT COUNT AS CHILD CARE
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF G1=1, ASK G2. ELSE GO TO G11.
G2.
How many of your children under age 13 were in a regular child care arrangement? By ‘regular’ I mean at least 10 hours per week last month.
INTERVIEWER: REGULAR CUSTODY ARRANGEMENTS (VISITATION) DO NOT COUNT AS CHILD CARE.
______________________
NUMBER OF CHILDREN (RANGE = 0 -15)
97 DON’T KNOW
98 REFUSED
CATI: IF G2=0, 97, OR 98, GO TO G11.
G3.
Did you or anyone in your household pay anything for any of this child care? Include payments that were later paid back or reimbursed.
INTERVIEWER: THIS IS FOR CASH PAYMENTS ONLY; DO NOT INCLUDE VOUCHER OR IN-KIND PAYMENTS.
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF G3=1, ASK G4. ELSE GO TO G5.
G4.
Last month, about how much money did you or anyone in your household spend on child care for your children under age 13. Include costs which were paid back or will be reimbursed by the government or by someone else and only count payments made by you and others in your household, whether or not it equals the total cost of the child care.
INTERVIEWER: ROUND TO THE NEAREST WHOLE DOLLAR.
$ ___ ___ ___
AMOUNT
(RANGE = 1 – 995)
996 MORE THAN $995
997 DON’T KNOW
998 REFUSED
G5.
Did anyone else pay or reimburse part or all of the costs of the child care for your children last month? By this I mean a government agency, an employer, or someone else outside your household?
INTERVIEWER: IF R IS AWAITING REIMBURSEMENT FOR CHILDCARE EXPENSE, CODE AS 1 (YES).
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF G5=1 ASK G6. ELSE GO TO G10.
G6.
Did or will the government or someone else pay any money directly to the provider for the the child care used by your children last month?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF G6=1 ASK G7. ELSE GO TO G8.
G7.
How much did they or will they pay directly to the child care provider for this child care?
INTERVIEWER: ROUND TO THE NEAREST WHOLE DOLLAR.
$ ___ ___ ___
AMOUNT
(RANGE = 1 – 995)
996 MORE THAN $995
997 DON’T KNOW
998 REFUSED
G8.
Did or will the government or someone else pay you back for the child care you used last month?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF G8=1 ASK G9. ELSE GO TO G10.
G9.
How much did they or will they pay you back for the child care you used last month?
INTERVIEWER: ROUND TO THE NEAREST WHOLE DOLLAR.
$ ___ ___ ___
AMOUNT
(RANGE = 1 – 995)
996 MORE THAN $995
997 DON’T KNOW
998 REFUSED
G10.
During the past month, have you had a child care arrangement where the amount you paid depended on how much your income was?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
G11.
Since [RAD], did you have to quit a job or quit school or a training activity because you had problems arranging child care or keeping a child care arrangement?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
G12.
Since [RAD], did you refuse a job offer or decide not to enroll in school or a training activity because you had problems arranging child care or keeping a child care arrangement?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: ASK SECTION H IF
SAMPLE MEMBER IS A MEMBER OF A NON-CUSTODIAL SITE OR
SAMPLE MEMBER IS A MEMBER OF AN EX-OFFENDER SITE WHO IS ALSO A NONCUSTODIAL PARENT (FROM SAMPLE FILE) OR SAMPLE MEMBER IS NON-CUSTODIAL PARENT FROM C9.
NOTE ON GENERAL PLAN FOR VARIABLES HSCREEN1 THRU HSCREEN4.
The task is to identify a focal child (FC) of any age under 19 and about whom much of Section H will be asked. The sample file provided by MDRC will identify a focal child for Rs that had a focal child identified at baseline. There may also be some Rs who qualify for this section who do not have an identified FC in the sample file.
For Rs with focal child information in the sample file, HSCREEN1A/B confirms that the sample file information corresponds to a child that R knows. If this is the case, several system variables about that child are created that are used in later parts of H. Then proceed with HSCREEN4 and the remaining questions in H.
If FC is not identified in HSCREEN1, we search for an FC in HSCREEN2A/B from among any children the R identified as living away from the R in C9. The youngest child identified by the R in that category will be the FC. If identified, the system variables are created about the child. Then proceed with HSCREEN4 and the remaining questions in H.
If FC is not identified in HSCREEN2, we move to HSCREEN3A/B. Here we search for an FC from among any children R identified as living in the R’s household (C5) who are R’s own children (C7). The youngest child identified by the R in this group will be the FC. If identified, the system variables are created about the child. Then proceed with HSCREEN4 and the remaining questions in H.
If no FC is identified after the three HSCREENs, those items in Section H referring to an FC will be skipped.
Vendors will create only one set of the system variables; the value for a variable may change as we work through the three HSCREENs. The system variables are noted below. Both Abt and DIR should use the same variable name and values in programming and data file production. The variables will be needed in the data file delivered to MDRC. All sample members should show these variables. These variables should be blank for sample members who are not included in Section H or who are skipped out before HSCREEN1.
FCLOCATE. To identify whether child DOB was matched with DOB from C6 or C10.
FCNAME. Record the name of the child identified as FC.
FCDOB. To capture the DOB of the FC eventually identified.
FCFOUND. To clearly identify whether an FC was found or not.
FCAGE. To store the age of the child in months.
BEGIN SELECTION OF FOCAL CHILD
HSCREEN1.
CATI: ASK HSCREEN1A IF FOCAL CHILD INFORMATION IS IN SAMPLE FILE.
ELSE GO TO HSCREEN2A.
I have a few questions about one of your children, with a date of birth of [FOCAL CHILD DOB FROM SAMPLE FILE].
Do you know the child who I am referring to?
INTERVIEWER: DOES R RECOGNIZE THE CHILD?
1 YES
2 NO
7 DK
8 REF
CATI: IF HSCREEN1A=1, ASK HSCREEN1Aa. ELSE GO TO HSCREEN2A.
HSCREEN1Aa.
What is that child’s name?
INTERVIEWER: IF NEEDED SAY: We can use an initial if you don’t want to name the child. I just need to have something to call him or her as I ask questions.
INTERVIEWER: IF NO NAME OR INITIAL OFFERED SAY: I’ll call the child “Bobby” for this interview.
__________________
FOCAL CHILD NAME
HSCREEN1B.
Does [FOCAL CHILD NAME FROM SAMPLE FILE] currently live with you?
1 YES
2 NO
7 DK
8 REF
CATI: IF HSCREEN1A=1:
1) CREATE “FCLOCATE”,
IF HSCREEN1B=1, SET FCLOCATE VALUE TO 1
IF HSCREEN1B= 2,7,8, SET VALUE TO 2.
2) CREATE “FCNAME” TO INDICATE FOCAL CHILD NAME FROM HSCREEN1Aa
3) CREATE “FCDOB” (MMDDYYYY) TO INDICATE FOCAL CHILD DOB (use sample file DOB)
4) CREATE “FCFOUND” TO INDICATE (Y/N) A FOCAL CHILD WAS IDENTIFIED (1=Yes, 2=No)
5) CREATE “FCAGE” TO STORE FOCAL CHILD AGE IN MONTHS (a child less than 30 days old will be age 0 months) TRUNCATE AGE TO WHOLE MONTHS
6) GO TO HSCREEN4.
ELSE CONTINUE WITH HSCREEN2A.
HSCREEN2a.
CATI: IF NO CHILDREN REPORTED IN C9 (C9=2,7,8), GO TO HSCREEN3A.
CATI: USE FIRST WORDING IF MULTIPLE CHILDREN INDICATED IN C10. USE SECOND WORDING OTHERWISE.
I would like to ask you some questions about (your youngest/your) child that does not live with you. What is that child’s name?
INTERVIEWER: IF NEEDED SAY: We can use an initial if you don’t want to name the child. I just need to have something to call him or her as I ask questions.
INTERVIEWER: IF NO NAME OR INITIAL OFFERED SAY: I’ll call the child “Bobby” for this interview.
CATI: PROVIDE INTERVIEWER A CHECK BOX FOR NO FOCAL CHILD ACKNOWLEDGED BY R.
__________________
FOCAL CHILD NAME
Checkbox NO FOCAL CHILD ACKNOWLEDGED BY R
7 DON’T KNOW
8 REFUSED
CATI: IF NO CHILD ACKNOWLEDGED BY R, GO TO HSCREEN3A. ELSE CONTINUE.
HSCREEN2B.
What is his or her date of birth?
INTERVIEWER: IF R CAN’T PROVIDE BOTH MONTH AND YEAR OF BIRTH, ALSO ASK FOR CHILD’S AGE.
IF R KNOWS MONTH AND YEAR BUT NOT DAY, INSERT 15 FOR DAY.
IF R ISN’T CERTAIN OF AGE SAY: Your best guess is fine.
____/___/___________ _________________
(MM/DD/YYYY) (AGE IN YEARS)
DOB AGE
NONRESPONSE CODES FOR DOB
97979997 DON’T KNOW
98989998 REFUSED
NONRESPONSE CODES FOR AGE
97 DON’T KNOW
98 REFUSED
BLANK DOB GIVEN OR R NOT ASKED HSCREEN2B
CATI:
1) CREATE “FCLOCATE” AND CODE FCLOCATE=2, CHILD DOES NOT LIVE WITH R
2) CREATE “FCNAME” TO INDICATE FOCAL CHILD NAME
3) CREATE “FCDOB” TO INDICATE FOCAL CHILD DOB
IF DOB IS KNOWN (at least YYYY is known), STORE DOB.
IF DOB IS UNKNOWN, CALCULATE PROBABLE YEAR BASED ON AGE (current year minus age) AND APPLY 97 FOR MONTH AND DAY.
IF BOTH DOB AND AGE NOT KNOWN, ENTER 97979997 FOR DOB
4) CREATE “FCFOUND” =1 TO INDICATE A FOCAL CHILD WAS
IDENTIFIED
5) CREATE “FCAGE” TO STORE FOCAL CHILD AGE IN MONTHS
IF DOB IS KNOWN, CALCULATE AGE IN MONTHS, TRUNCATE MONTHS. LESS THAN 1 MONTH IS ZERO MONTHS.
IF DOB IS UNKNOWN, CALCULATE AGE IN MONTHS BASED ON AGE PROVIDED HERE (current year minus age times 12).
IF BOTH DOB AND AGE NOT KNOWN, MARK FCAGE=997
6) GO TO HSCREEN4.
HSCREEN3a.
CATI: IF CHILDREN REPORTED IN C5 (C5=1) AND ANY OF C7=1, CONTINUE WITH HSCREEN3A.
ELSE, MARK FCFOUND=2 AND GO TO H16.
Earlier, you told me that you had children that you were responsible for who lived with you.
CATI: USE FIRST WORDING IF MULTIPLE CHILDREN INDICATED IN C6 WHERE C7=1. USE SECOND WORDING OTHERWISE.
I would like to ask you some questions about (your youngest/your) child that lives with you. What is that child’s name?
INTERVIEWER: IF NEEDED SAY: We can use an initial if you don’t want to name the child. I just need to have something to call him or her as I ask questions.
INTERVIEWER: IF NO NAME OR INITIAL OFFERED SAY: I’ll call the child “Bobby” in this interview.
CATI: PROVIDE INTERVIEWER A CHECK BOX FOR NO FOCAL CHILD ACKNOWLEDGED BY R.
__________________
FOCAL CHILD NAME
Checkbox NO FOCAL CHILD ACKNOWLEDGED BY R
7 DON’T KNOW
8 REFUSED
CATI: IF NO CHILD ACKNOWLEDGED BY R, MARK FCLOCATE=2 AND GO TO H16.
HSCREEN3B.
What is his or her date of birth?
INTERVIEWER: IF R CAN’T PROVIDE BOTH MONTH AND YEAR OF BIRTH, ALSO ASK FOR CHILD’S AGE.
IF R KNOWS MONTH AND YEAR BUT NOT DAY, INSERT 15 FOR DAY.
IF R ISN’T CERTAIN OF AGE SAY: Your best guess is fine.
____/___/___________ _________________
(MM/DD/YYYY) (AGE IN YEARS)
DOB AGE
NONRESPONSE CODES FOR DOB
97979997 DON’T KNOW
98989998 REFUSED
NONRESPONSE CODES FOR AGE
97 DON’T KNOW
98 REFUSED
BLANK DOB GIVEN OR R NOT ASKED HSCREEN2B
CATI:
1) CREATE “FCLOCATE” AND CODE FCLOCATE=1, CHILD LIVES WITH R
2) CREATE “FCNAME” TO INDICATE FOCAL CHILD NAME
3) CREATE “FCDOB” TO INDICATE FOCAL CHILD DOB
IF DOB IS KNOWN (at least YYYY is known), STORE DOB.
IF DOB IS UNKNOWN, CALCULATE PROBABLE YEAR BASED ON AGE (current year minus age) AND APPLY 97 FOR MONTH AND DAY.
IF BOTH DOB AND AGE NOT KNOWN, ENTER 97979997 FOR DOB
4) CREATE “FCFOUND” =1 TO INDICATE A FOCAL CHILD WAS
IDENTIFIED
5) CREATE “FCAGE” TO STORE FOCAL CHILD AGE IN MONTHS
IF DOB IS KNOWN, CALCULATE AGE IN MONTHS, TRUNCATE MONTHS. LESS THAN 1 MONTH IS ZERO MONTHS.
IF DOB IS UNKNOWN, CALCULATE AGE IN MONTHS BASED ON AGE PROVIDED HERE (current year minus age times 12).
IF BOTH DOB AND AGE NOT KNOWN, MARK FCAGE=997
6) GO TO HSCREEN4.
HSCREEN4:
How many months have you lived with [FOCAL CHILD] during the last 12 months?
INTERVIEWER: ROUND TO WHOLE NUMBER.
________
MONTHS
(RANGE 1-12)
95 NONE
96 LESS THAN ONE MONTH
97 DON’T KNOW
98 REFUSED
H1.
Some people have an agreement about how much time a parent can spend with children they don’t live with. Do you currently have a legal agreement about your visits with [FCNAME]?
1 YES
2 NO
7 DON’T KNOW
8 REF
H2.
In what month and year did you last see [FCNAME]?
_ _/ _ _ _ _
MM/YYYY
97/9997 DON’T KNOW
98/9998 REFUSED
CATI: IF H2 MORE THAN THREE MONTHS PRIOR (current mmyyyy minus H2 mmyyyy >3 months)OR H2=DK/REF; GO TO H9.
H3.
During the past three months, about how often did you spend one or more hours a day with [FCNAME]? Would you say it was…
1 everyday or nearly every day,
2 a few times a week,
3 a few times per month,
4 only once or twice, or
5 not at all?
7 DK
8 REFUSED
CATI: USE FCAGE. IF FOCAL CHILD IS < 12 MONTHS OLD, ASK H4. ELSE GO TO H5.
H4.
In the past 3 months, how often did you help with caring for the baby by feeding, bathing, providing transportation, helping with chores, or other things to help care for the baby? Would you say…
1 every day or almost every day,
2 a few times a week,
3 a few times a month,
4 less often than that, or
5 never?
7 DON’T KNOW
8 REFUSED
CATI: USE FCAGE. IF FOCAL CHILD IS BETWEEN 12 AND 59 MONTHS (1 YEAR TO 4 YEARS, 11 MONTHS) OLD ASK H5. ELSE GO TO H6.
H5.
About how often in the past three months have you…
INTERVIEWER: READ ITEM THEN READ RESPONSE SET
CATI: RANDOMIZE PRESENTATION OF ITEMS.
|
Would you say it was |
|||||
|
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
a. …played inside with games or toys with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …taken [FCNAME] for a walk or to play outside? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …sung songs or nursery rhymes with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …read books or told stories to [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …dealt with [FCNAME] when he/she did something wrong? |
1 |
2 |
3 |
4 |
7 |
8 |
CATI: USE FCAGE. IF FOCAL CHILD IS 60 to 107 MONTHS (5 YEARS – 8 YEARS, 11 MONTHS) OLD, ASK H6. ELSE GO TO H7.
H6.
About how often in the past three months have you…
INTERVIEWER: READ ITEM THEN READ RESPONSE SET
CATI: RANDOMIZE PRESENTATION OF ITEMS.
|
Would you say it was… |
|||||
|
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
a. …talked with [FCNAME] about school, grades, homework, or other things that he/she does at school? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …spent time with [FCNAME] doing one of his/her favorite activities like shopping, playing a sport, going to a movie, watching TV, or playing video games? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …talked with [FCNAME] about his/her friends? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …read a book with [FCNAME] or talked about a book he/she was reading? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …dealt with [FCNAME] when he/she did something wrong? |
1 |
2 |
3 |
4 |
7 |
8 |
CATI: USE FCAGE. IF FOCAL CHILD IS 108 TO 227 MONTHS (9 YEARS TO 18 YEARS, 11 MONTHS), ASK H7. ELSE GO TO H8.
H7.
About how often in the past three months have you…
INTERVIEWER: READ ITEM THEN READ RESPONSE SET
CATI: RANDOMIZE PRESENTATION OF ITEMS.
|
Would you say it was… |
|||||
|
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
a. …talked with [FCNAME] about school grades, homework, or other things that he/she does at school? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …spent time with [FCNAME] doing one of his/her favorite activities like shopping, playing a sport, going to a movie, watching TV, or playing video games? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …talked with [FCNAME] about his/her friends or dating relationships? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …talked about a book [FCNAME] was reading? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …dealt with child when [FCNAME] did something wrong? |
1 |
2 |
3 |
4 |
7 |
8 |
H8.
About how often in the past three months have you…
INTERVIEWER: READ ITEM THEN READ RESPONSE SET
CATI: RANDOMIZE PRESENTATION OF ITEMS.
|
Would you say it was… |
|||||
|
every day or almost every day, |
a few times a week, |
a few times per month, or |
never? |
DON’T KNOW |
REF |
a. …told [FCNAME] that you love him/her? |
1 |
2 |
3 |
4 |
7 |
8 |
b. …hugged or kissed [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
c. …praised [FCNAME] or told him/her that you appreciated something that he/she did? |
1 |
2 |
3 |
4 |
7 |
8 |
d. …laughed with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
e. …argued with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
f. …lost your temper with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
g. …yelled or shouted at [FCNAME] because you were angry at him/her? |
1 |
2 |
3 |
4 |
7 |
8 |
h. …hit, spanked, grabbed or used physical punishment with [FCNAME]? |
1 |
2 |
3 |
4 |
7 |
8 |
H9.
How close do you feel to [FCNAME]? Would you say…
1 very close,
2 quite close,
3 fairly close,
4 not very close?
7 DON’T KNOW
8 REFUSED
H10.
INTERVIEWER: SELECT WORDING ACCORDING TO R’S GENDER.
What is your relation to [FCNAME]’s (mother/father)? Are you married, divorced, never married, or what?
1 MARRIED
2 DIVORCED
3 SEPARATED
4 NEVER MARRIED TO EACH OTHER
5 MARRIAGE ANNULED
6 WIDOWED (OTHER PARENT IS DECEASED)
7 OTHER (SPECIFY______________ )
97 DON’T KNOW
98 REFUSED
CATI: IF H10= 1 or 6 GO TO H12.
H11.
Which of the following statements best describes your current relationship with that person?
1 We are romantically involved on a steady basis, or
2 we are involved in an on again and off again relationship, or
3 we are not in a romantic relationship?
7 DON’T KNOW
8 REFUSED
CATI: FOR H12, IF FCLOCATE=1 (child lives with R), GO TO H16.
H12.
Overall, would you describe your current relationship with [FCNAME]’s caregiver as…
INTERVIEWER: CAREGIVER IS THE PERSON FOCAL CHILD LIVES WITH WHO IS RESPONSIBLE FOR FOCAL CHILD, NOT NECESSARILY THE OTHER PARENT.
1 very friendly,
2 somewhat friendly,
3 neither friendly nor unfriendly,
4 somewhat unfriendly,
5 very unfriendly, or
6 no relationship at all?
7 DON’T KNOW
8 REFUSED
H13.
In the last month, how often did you talk with [FCNAME]’s caregiver about him or her, such as how things are going in school or day care, how the child spends their time, problems with the child, or anything to do with child? Would you say it was…
INTERVIEWER: CAREGIVER IS THE PERSON FOCAL CHILD LIVES WITH WHO IS RESPONSIBLE FOR FOCAL CHILD, NOT NECESSARILY THE OTHER PARENT.
1 often,
2 sometimes,
3 hardly ever, or
4 never?
7 DK
8 REFUSED
H14.
How much involvement do you currently have in making major decisions about such things as [FCNAME]’s education, religion, and health care? Would you say…
INTERVIEWER: CAREGIVER IS THE PERSON FOCAL CHILD LIVES WITH WHO IS RESPONSIBLE FOR FOCAL CHILD, NOT NECESSARILY THE OTHER PARENT.
1 none,
3 some,
5 a great deal?
7 DK
8 REFUSED
H15.
Now I would like to read you a list of issues that people raising a child may have disagreements about. For each one, please tell me how often you and the [FCNAME]’s caregiver disagree.
INTERVIEWER: CAREGIVER IS THE PERSON FOCAL CHILD LIVES WITH WHO IS RESPONSIBLE FOR FOCAL CHILD, NOT NECESSARILY THE OTHER PARENT.
INTERVIEWER: READ ITEM THEN READ RESPONSE SET
|
Would you say you disagree… |
|||||
|
often, |
sometimes, |
hardly ever, or |
never? |
DON’T KNOW |
REF |
a. Setting rules for disciplining child. |
1 |
2 |
3 |
4 |
7 |
8 |
b. The activities that the child participates in. |
1 |
2 |
3 |
4 |
7 |
8 |
c. How money is spent on the child. |
1 |
2 |
3 |
4 |
7 |
8 |
d. Who does childcare tasks. |
1 |
2 |
3 |
4 |
7 |
8 |
e. The amount of time you spend with child. |
1 |
2 |
3 |
4 |
7 |
8 |
H16.
Are you required by a court or state agency to pay child support for any children?
CATI: IF FCFOUND=1 (Yes), ALSO SHOW:
This would be for any of your children, not only [FCNAME]?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF H16=1, ASK H17. ELSE GO TO H23.
H17.
Now I want to ask you a few questions about that child support.
CATI: IF FCFOUND=1 (Yes), ALSO SHOW:
These questions are about [FCNAME] and any other children you may have.
For how many children are you required to pay child support? Include any children for which you are required to pay arrears or make back payments.
_______________________
NUMBER OF CHILDREN (RANGE = 0-30)
97 DON’T KNOW
98 REFUSED
H18.
What is the total amount are you required to pay?
INTERVIEWER, IF NEEDED: This is the total for all of your children.
INTERVIEWER: ROUND TO NEAREST DOLLAR
$_ ,_ _ _
(1 to 9995)
9996 $9,996 or more
9997 DON’T KNOW
9998 REFUSED
H19.
Is that…
1 per week,
2 every other week,
3 per month, or
4 some other time period?
7 DON’T KNOW
8 REFUSED
H20.
Last month, did you pay the full amount of the payment ordered by the court or state agency?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF H20 = 1 THEN GO TO H22
H21.
How much child support did you actually pay last month?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$_ ,_ _ _
(1 to 9995)
9996 $9.996 or more
9997 DON’T KNOW
9998 REFUSED
H22.
How many children did this cover?
_______________________
NUMBER OF CHILDREN (RANGE 1-30)
97 DON’T KNOW
98 REFUSED
CATI: FOR H23, IF C9=1 ASK H23. ELSE GO TO H27.
H23.
CATI: IF ONLY ONE CHILD IS REPORTED IN C10/C10A, USE SINGULAR TEXT FILL, ELSE USE PLURAL.
CATI:
IF H16=1, THEN DISPLAY: Not counting child support you already told me about, in the past 30 days did you provide cash for (your child that does/any of your children that do) not live with you?
IF H16=2,7,8, THEN DISPLAY: In the past 30 days did you provide cash for (your child that does/any of your children that do) not live with you?
1 YES
2 NO
7 DON’T KNOW
8 REFUSED
CATI: IF H23=2,7,8 THEN GO TO H26.
H24.
In the past 30 days, approximately how much cash did you provide [CATI: IF H16=1, ALSO DISPLAY: not counting child support required by a court]?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$ ___ , ___ ___ ___
AMOUNT (1 to 9995)
9996 $9,9996 or more
9997 DON’T KNOW
9998 REFUSED
CATI: IF ONLY ONE CHILD REPORTED IN C10/C10A, GO TO H26.
H25.
How many children did this cover?
______________________
NUMBER OF CHILDREN (RANGE =1-30)
97 DON’T KNOW
98 REFUSED
H26.
CATI: IF ONLY ONE CHILD REPORTED IN C10/C10A, USE SINGULAR TEXT FILL, ELSE USE PLURAL.
During the past month did you provide help with any of the following for (the child that does/your children that do) not live with you?
|
YES |
NO |
DON’T KNOW |
REFUSED |
a. Food? |
1 |
2 |
7 |
8 |
b. Clothing or diapers? |
1 |
2 |
7 |
8 |
c. Child care or babysitting? |
1 |
2 |
7 |
8 |
d. Medicine/health care? |
1 |
2 |
7 |
8 |
e. Bbills or payments? |
1 |
2 |
7 |
8 |
f. Ttoys, books, school supplies? |
1 |
2 |
7 |
8 |
g. Ttransportation to school, appointments, or other activities? |
1 |
2 |
7 |
8 |
CATI: IF H20=1 OR (H21>0 AND H21<9997.97) OR H23=1 OR (ANY)H26A-H26G=1 THEN GO TO H28.
H27.
There are many reasons why someone may not provide financial support for their children. I’m going to read a list of reasons, please tell me whether the reason applied to you for any of your children.
|
YES |
NO |
DON’T KNOW |
REF |
a. You don’t have the money. |
1 |
2 |
7 |
8 |
b. [CATI: IF H16=1:]Your child support order is set too high. |
1 |
2 |
7 |
8 |
c. You have another family to support. |
1 |
2 |
7 |
8 |
d. You have some disagreements about visitation. |
1 |
2 |
7 |
8 |
e. [CATI: IF H16=1:]The child support money goes to the state, not the children. |
1 |
2 |
7 |
8 |
f. Custodial parent doesn’t need the money or help. |
1 |
2 |
7 |
8 |
g. Custodial parent has a new partner. |
1 |
2 |
7 |
8 |
h. Custodial parent does not want you involved. |
1 |
2 |
7 |
8 |
i. You don’t believe that child is really yours. |
1 |
2 |
7 |
8 |
j. Child is not your responsibility. |
1 |
2 |
7 |
8 |
k.
Some other reason.
|
1 |
2 |
7 |
8 |
CATI: ASK H28 IF H16=1, ELSE GO TO H29.
H28.
Does owing child support affect your willingness to accept jobs that are offered to you?
1 YES
2 NO
7 DON’TKNOW
8 REFUSED
H29.
Since [RAD], have you been arrested for not paying child support?
1 YES
2 NO
7 DON’TKNOW
8 REFUSED
CATI: IF H29=1, ASK H30. ELSE GO TO CLOSE.
H30.
Since [RAD], how many times have you been arrested for not paying child support?
_______________________
TIMES ARRESTED (Range: 1 to 95)
96 96 or more
97 DON’T KNOW
98 REFUSED
CATI: IF H30 >= 1 AND < 97, ASK H31. ELSE GO TO CLOSE.
H31.
How much time have you been incarcerated for not paying child support since [RAD]?
_________
NUMBER (Range: 1 to 995)
996 996 or more
997 DON’T KNOW
998 REFUSED
H32.
Is that…
1 days,
2 weeks, or
3 months?
7 DON’T KNOW
8 REFUSED
CLOSE
That was the last question I have for you today/tonight. I want to thank you again for your time.
P-
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Appendix A |
| Author | Joseph Broadus |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |