Download:
pdf |
pdfCTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
INTRO
In this section of the interview we are interested in ^YOURHISHER income and other
circumstances, since ^MONTH1 1st ^CALENDAR_YRFIL. Sometimes, it's easier for people to
remember dates from the past if they think about other events in their lives.
INFO
(For example, any births or deaths in your family? Divorces or marriages? A vacation? An accident or
an illness? Changes in your employment? A residence change? Or anything else that was unusual or
memorable?)
If necessary, probe especially for events that happened early in the year.
SCREENER2
Are there there two or three events in your life that stand out in your mind from last year,
^YR_FIL?
1. Yes
2. No
BMONTH
1. January ^CALENDAR_YRFIL
Page 1 of 163
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
Page 2 of 163
18. June ^INTYEARFIL
LANDMARK
? [F1]
Please provide a short description of the event so that we can use it throughout the interview to
help recall when other events occurred.
NOMORESPELLS
The landmark topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
Were there any other events that stand out in your mind from last year, ^YR_FIL?
1. Yes
2. No
HOWMANY
You've told me about six significant events. How many additional significant events have you
had since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
Page 3 of 163
RES_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
RESIDENCEID
**NON-DISPLAYED ITEM**
RESIDENCECODE
**NON-DISPLAYED ITEM**
INTRO
^RESINTROTEXT
INFO
All months of the reference period must be accounted for; this includes both ^YR_FIL PLUS any
months to date in ^INTYEARFIL.
A maximum of 5 addresses is collected per household member for the reference period.
When recording changes in residences, FROM and TO months should be selected for the residence
where the respondent lived for the majority of the month.
SCREENER
^RESSCREENERTEXT
1. Yes
2. No
BMONTH
^RESFROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 4 of 163
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
^RESTOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 5 of 163
PICK_ADDRESS
? [F1]
What was the address where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH?
Select from below list of previously entered addresses OR select 'Add new address' to enter a new
address.
EHC_CNTRY
? [F1]
In what country did ^TEMPNAME live ^BETWEEN_BMONTH_EMONTH?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
Page 6 of 163
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
Page 7 of 163
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
Page 8 of 163
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other
EHC_COUNTRY
EHC_HNO
What was the house number where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH?
EHC_STRNAME
What was the street name (where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH)?
EHC_HNOSUF
What was the house number suffix (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
(For example, did this address have an apartment/unit number?)
EHC_PO
What was the city (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
EHC_NONCITYADD
? [F1]
What was the non-city address (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
(For example, any description you can add to the address to make it more specific.)
EHC_ST
What was the state (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
1. Alabama
2. Alaska
Page 9 of 163
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
Page 10 of 163
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming
EHC_STATE
EHC_CNTY
What was the county (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
EHC_ZIP
What was the zip code (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
EHC_LIVEWITH
? [F1]
Ask or verify
During this period, (^BETWEEN_BMONTH_ALTEMONTH,) did ^TEMPNAME live with any of the
following people?
Read answer list
Page 11 of 163
1. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
2. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
3. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
4. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
5. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
6. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
7. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
8. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
9. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
10. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
11. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
12. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
13. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
14. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
15. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
16. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
17. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
18. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
19. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
20. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
21. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
22. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
23. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
24. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
25. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
26. Did not live with any of these people/Lived alone
PRVLVQRT
^ASKORVERIFY
What type of living quarters ISWAS
Read address?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. House, apartment, flat
2. Unit in rooming house, hotel, motel, etc.
Page 12 of 163
3. Mobile home or trailer
4. Other housing unit
5. Correctional institution
6. Medical institution/nursing home
7. Military quarters (barracks, ship at sea)
8. Student quarters
9. Other group quarters unit
10. Emergency or transitional shelter
11. Unoccupied tent or trailer site
12. Car, van, or other non-permanent accommodations
EHC_TEN
^ASKORVERIFY
C_ISWAS
Read address: Read answer categories?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Owned or being bought by someone in the household
2. Rented
3. Occupied without payment of rent
EHC_RENTSUB
^ASKORVERIFY
^EHCRENTSUBQTEXT
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Yes
2. No
EHC_VOUCHER
^ASKORVERIFY
Page 13 of 163
C_DOESDID ^PTEMPNAME household receive a housing voucher for Read address?
(A housing voucher gives a renter the right to choose where he/she lives AND it helps pay the rent.)
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Yes
2. No
EHC_WHY
W
What was the main reason ^TEMPNAME moved to
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Change in marital/relationship status
2. To move into own apartment or house
3. Other family-related reason
4. New job or job transfer
5. To look for work or lost job
6. To be closer to work or school
7. Other job-related reason
8. Wanted to own home, not rent
9. Wanted a better quality apartment or house
10. Wanted a better neighborhood
11. Cheaper housing
12. Other housing-/neighborhood-related reason
13. Disaster loss (fire, flood, hurricane, etc.)
14. Eviction/foreclosure
15. Always lived here (never moved)
16. Other reason (specify)
EHC_WHYOT
What was the other reason ^TEMPNAME moved?
Page 14 of 163
Read address?
EHC_MVYR
What year did ^TEMPNAME move to
Read address?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
EHC_MVMO
What month did ^TEMPNAME move to
Read address?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
EHC_PVCNTRY
? [F1]
Before ^TEMPNAME moved to
Read address, in what country did ^YOUHESHE live?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. United States (US, USA)
2. Afghanistan
Page 15 of 163
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
Page 16 of 163
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
Page 17 of 163
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other
EHC_PVCOUNTRY
Page 18 of 163
EHC_PVCTY
? [F1]
(Before ^TEMPNAME moved to
Read address ,) in what city did ^YOUHESHE live?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
EHC_PVST
? [F1]
(Before ^TEMPNAME moved to
Read address,) in what state did ^YOUHESHE live?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
Page 19 of 163
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming
EHC_PVSTATE
Page 20 of 163
EHC_PVCNTY
? [F1]
(Before ^TEMPNAME moved to
Read address,) in what county did ^YOUHESHE live?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
EHC_PVTEN
? [F1]
Was the address ^TEMPNAME lived in before
Read address: Read answer categories?
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Owned or being bought by someone in the household
2. Rented
3. Occupied without payment of rent
RESIDENCYCONTINUE
Enter '1' to continue.
1. Continue
NOMORESPELLS
The residences topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
Now let's talk about the other places ^TEMPNAME lived since ^MONTH1 1st
^CALENDAR_YRFIL.
Enter 1 to return to calendar and enter a new residence spell.
1. Continue
Page 21 of 163
HOWMANY
We've talked about five residences. In how many more residences did ^TEMPNAME live since
^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
MARITAL_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
Let's talk about ^YOURHISHER marital history since ^MONTH1 1st ^CALENDAR_YRFIL.
INFO
All people age 15 and over should complete the marital status section since it also asks about
cohabitation during the reference period.
SCREENER
^MHXSCREEN_QTEXT
Enter 1 to continue
Page 22 of 163
1. Continue
3. Refused
BMONTH
When did that start?
If prior to ^MONTH1 ^CALENDAR_YRFIL, select ^MONTH1 ^CALENDAR_YRFIL
EMONTH
^MARITALTOTEXT
MS_EHC
? [F1]
What ISWAS ^PTEMPNAME marital status ^BETWEEN_BMONTH_EMONTH?
Read answer categories
1. Married
2. Married, spouse absent -- DO NOT READ
3. Widowed
4. Divorced
5. Separated
6. Never Married
WHO_SPOUSE_EHC
Who ISWAS ^PTEMPNAME spouse (^BETWEEN_BMONTH_EMONTH)?
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
Page 23 of 163
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
26. Someone not listed
GOT_PARTNER
? [F1]
During this period, (^BETWEEN_B_EMONTH,) did ^TEMPNAME have a boyfriend, girlfriend, or
partner who lived in the household?
1. Yes
2. No
WHO_PARTNER_EHC
Who ISWAS ^PTEMPNAME ^PARTNER?
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
Page 24 of 163
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
26. Someone not listed
REGDOMPARTNER
IS/WAS for partnership question ^PTEMPNAME relationship with ^PARTNMFIL a registered
domestic partnership or civil union?
If it is necessary to clarify this question, please be aware that we are intending to capture couples who
registered with a government (city, state) rather than those who are allowed to list their partner on their
health insurance through their employer, but have not registered with the state.
1. Yes
2. No
NOMORESPELLS
The marital history topic is complete. Enter '1' to continue.
1. Continue
ANYMORESPELLS
Now let's talk about the rest of ^PTEMPNAME marital history since ^MONTH1 1st
^CALENDAR_YRFIL.
Enter '1' to return to the calendar and enter a new marital history spell.
Page 25 of 163
1. Continue
HOWMANY
We've talked about three different marital statuses. How many other marital statuses ^HAVEHAS
^TEMPNAME had since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
ED_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
^ENROLLINTROTEXT
INFO
(Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that
leads to a high school diploma, a college or graduate degree, or an educational certificate.)
SCREENER
Page 26 of 163
C_AREIS ^YOUHESHE currently attending ^ENROLLSCREENERTEXT?
1. Yes
2. No
SCREENER2
^ENROLLSCREENER2TEXT
1. Yes
2. No
BMONTH
^FROMTEXT
EMONTH
^TOTEXT
GRADE
? [F1]
What level of school ISAREWASWERE ^TEMPNAME enrolled in
^BETWEEN_BMONTH_EMONTH?
1. 1st
2. 2nd
3. 3rd
4. 4th
5. 5th
6. 6th
7. 7th
8. 8th
9. 9th
10. 10th
11. 11th
12. 12th
Page 27 of 163
13. College year 1 (Freshman)
14. College year 2 (Sophomore)
15. College year 3 (Junior)
16. College year 4 (Senior)
17. College year 5 (First year graduate or professional school)
18. College year 6+ (Second year or higher in graduate or professional school)
19. Enrolled in college, but not working towards degree
20. Vocational, technical, or business school beyond high school level
21. Nursery school or preschool
22. Kindergarten
EDTYPE
What type of school ISAREWASWERE ^TEMPNAME enrolled in
Read answer categories?
If the respondent is enrolled in more than one type of school, select the type of school in which he/she
was enrolled for the most time.
1. Public
2. Private
3. Charter school
4. Home school
CRED
What degree or certificate ISAREWASWERE ^TEMPNAME working on?
1. Associate's Degree
2. Bachelor's Degree
3. Master's Degree
4. Doctoral or Professional Degree (Including JD)
5. Undergraduate certificate or diploma leading to a license (for example: nursing, mechanics, cosmetology)
6. Undergraduate certificate or diploma, NOT including those leading to a license
7. Post-baccalaureate certificate
8. Post-master's certificate
9. Not enrolled for a degree or certificate
EDHEADST
Some preschool programs are federally sponsored and are primarily for children from
low-income families. Some examples of these are Head Start, Even Start and Fair Start.
Page 28 of 163
C_ISWAS ^TEMPNAME enrolled in a federally-sponsored program like this?
1. Yes
2. No
EDGRADE1
**NON-DISPLAYED ITEM**
EDGRADE2
**NON-DISPLAYED ITEM**
GRADEREP
You said that ^TEMPNAME WASWERE enrolled in the same grade at the beginning and end
^CALENDAR_YRFIL. Was this because ^YOUHESHE had to repeat a grade or WASWERE held
back for any reason?
1. Yes-repeated grade or was held back
2. No-enrolled in same grade
3. No-grade entered for ^BMONTH to ^EMONTH is incorrect
4. No-grade entered in previously recorded spell is incorrect
PREV_GRADE
What is the correct grade?
This refers to the grade of the previous spell.
1. 1st
2. 2nd
3. 3rd
4. 4th
5. 5th
6. 6th
7. 7th
8. 8th
9. 9th
Page 29 of 163
10. 10th
11. 11th
12. 12th
13. College year 1 (Freshman)
14. College year 2 (Sophomore)
15. College year 3 (Junior)
16. College year 4 (Senior)
17. College year 5 (First year graduate or professional school)
18. College year 6+ (Second year or higher in graduate or professional school)
19. Enrolled in college, but not working towards degree
20. Vocational, technical, or business school beyond high school level
21. Nursery school or preschool
22. Kindergarten
FTPT
C_ISAREWASWERE ^TEMPNAME enrolled full-time or part-time?
1. Full-time
2. Part-time
NOMORESPELLS
The enrollment topic is complete. Enter '1' to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME attend school or college at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about three periods of school enrollment. How many other times WASWERE
^TEMPNAME enrolled in school since ^MONTH1 1st ^CALENDAR_YRFIL?
Page 30 of 163
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
JOBNUM
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
JOB_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
JOBID
**NON-DISPLAYED ITEM**
INTRO
^JOBINTROTEXT
INFO
If necessary probe with additional question: Did ^YOUHESHE have a paid job, or do any work at
all, no matter how small, that earned some money?
SCREENER
^JOBSCREENER
Page 31 of 163
1. Yes
2. No
SCREENER2
^JOBSCREENER2
1. Yes
2. No
BMONTH
^FROMTEXT
EMONTH
^TOTEXT
COPYJOB
Enter 1 to continue
JBORSE
? [F1]
C_DIDDODOES ^TEMPNAME work for an employer, or ISAREWASWERE ^YOUHESHE
self-employed, or DIDDODOES ^YOUHESHE have some other work arrangement?
1. employer
2. self-employed (owns a business)
3. other work arrangement
CONCHK1
?[F1]
C_DIDDODOES ^TEMPNAME have a definite arrangement with one or more employers to work on
an ongoing basis?
1. Yes
2. No
Page 32 of 163
STARTJAN
Did ^TEMPNAME begin this JOBBUS in ^MONTH1 ^CALENDAR_YRFIL?
1. Yes
2. No
STARTYEAR
In what year did ^TEMPNAME begin this JOBBUS?
STARTMONTH
In what month did ^TEMPNAME begin this JOBBUS?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
STARTWEEK
T
During which week did ^TEMPNAME begin this JOBBUS?
^ASKORVERIFY
ENDWEEK
T
During which week did ^TEMPNAME end this JOBBUS?
Page 33 of 163
RSEND
G
What is the main reason ^YOUHESHE stopped working for ^YOURHISHER employer?
1. On layoff
2. Retirement
3. Childcare problems
4. Other family/personal obligations
5. Own illness
6. Own injury
7. School or training
8. Discharged or fired
9. Employer bankrupt
10. Employer sold business
11. Job was temporary and ended
12. Quit to take another job
13. Slack work or business conditions
14. Unsatisfactory work arrangements
15. Quit for some other reason
RENDB
G
What is the main reason ^TEMPNAME gave up or ended this business?
1. Retirement
2. Childcare problems
3. Other family/personal oroblems
4. Own illness
5. Own injury
6. School or training
7. Went bankrupt or business failed
8. Sold business or transferred ownership
9. To start other business or take a job
10. Season ended for a seasonal business
11. Quit for some other reason
EMPBSNAME
Page 34 of 163
? [F1]
What ISWAS the name of ^PTEMPNAME Fill for Employer/Business?
^EBSNAMEFILL
JBADDSTRNUM
? [F1]
What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?
Street Number
JBADDSTRNAME
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Street Name
JBADDNUMSUF
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Suite or Office Number
JBADDCITY
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
City
JBADDST
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
State
AL. Alabama
AK. Alaska
AZ. Arizona
AR. Arkansas
Page 35 of 163
CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
NE. Nebraska
NV. Nevada
NH. New Hampshire
NJ. New Jersey
NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
SD. South Dakota
TN. Tennessee
Page 36 of 163
TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming
JBADDZIP5
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Zip code
CLWRK
? [F1]
^CUREMONTH ISWAS ^EMPNAME:
Read answer list
1. a government organization (includes Armed Forces)
2. a private, for profit company
3. a non-profit organization, including tax exempt and charitable organizations
KINDG
? [F1]
What type of government DIDDODOES ^TEMPNAME work for ^INEMONTHFILL?
Read answer list
1. Federal Military Departments (CIVILIAN ONLY) (ex. Dept. of Defense, Dept. of Army, and other military departme
2. All other Federal Departments (CIVILIAN ONLY)
3. State Government
4. Local Government
5. U.S. Armed Forces (ACTIVE DUTY ONLY)
Page 37 of 163
KINDG2
What type of government DIDDODOES ^TEMPNAME work for ^INEMONTHFILL?
Read answer list
1. Federal Military Departments (CIVILIAN ONLY) (ex. Dept. of Defense, Dept. of Army, and other military departme
2. U.S. Armed Forces (ACTIVE DUTY ONLY)
KNDIN
? [F1]
^CUREMONTH what kind of business or industry or organization ISWAS this?
Read if necessary: What do they make or do where ^TEMPNAME WORKSWORKED?
TYPIN
? [F1]
C_ISWAS this kind of business or industry or organization mainly --Read answer list
Read if necessary: "^C_BETWEEN_BMONTH_EMONTH, when this JOBBUS was held, at the location
where ^TEMPNAME WORKSWORKED, what ISWAS this ^EMPBUSPOS primary activity?
1. Manufacturing
2. Wholesale trade
3. Retail trade
4. Service
5. Or something else (agriculture, construction, government, etc.)
KNDWK
? [F1]
What kind of work DIDDODOES ^TEMPNAME do ^INEMONTHFILL, that is, what ISWAS
^YOURHISHER occupation?
(For example: bookkeeper, plumber, registered nurse)
Page 38 of 163
ACTVT
? [F1]
What ^AREWERE ^YOURHISHER usual activities at ^EMPNAME ^INEMONTHFILL?
(For example: keeping account books, repairing pipes, patient care)
UNION
? [F1]
At ^EMPNAME, ISAREWASWERE ^TEMPNAME a member of either a labor union or an employee
association like a union?
1. Yes
2. No
CNTRC
? [F1]
C_ISAREWASWERE ^TEMPNAME covered by either a union contract or something like a union
contract?
1. Yes
2. No
EMPLOC
Does ^EMPNAME operate in more than one location?
1. Yes
2. No
EMPALL
About how many people are employed by ^EMPNAME at ALL LOCATIONS together?
1. Less than 10
Page 39 of 163
2. 10 to 25
3. 26 to 50
4. 51 to 100
5. 101 to 200
6. 201 to 500
7. 501 to 1000
8. Greater than 1000
EMPSIZE
? [F1]
About how many people are employed by ^EMPNAME at the location where ^TEMPNAME
WORKSWORKED?
1. Less than 10
2. 10 to 25
3. 26 to 50
4. 51 to 100
5. 101 to 200
6. 201 to 500
7. 501 to 1000
8. Greater than 1000
EMPB
^C_BETWEEN_BMONTH_EMONTH, what is the maximum number of employees,
including ^TEMPNAME, working for ^EMPNAME at any one time?
1. 1 (Only self)
2. 2 to 9
3. 10 to 25
4. 26 to 50
5. 51 to 100
6. 101 to 200
7. 201 to 500
8. 501 to 1000
9. Greater than 1000
Page 40 of 163
INCPB
? [F1]
Is ^EMPNAME incorporated?
1. Yes
2. No
PROPB
? [F1]
DIDDODOES ^TEMPNAME own ^EMPNAME Fill for SELF or ISWAS it a partnership?
1. alone
2. partnership
HPRTB
C_ISWAS any other member of this household an owner or partner in ^EMPNAME?
1. Yes
2. No
PARTB
Who ISWAS that?
Mark all that apply.
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
Page 41 of 163
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_
26. Someone not listed
BSLRYB
DIDDODOES ^YOUHESHE draw a regular salary from ^EMPNAME - that is, take a regular
paycheck, as opposed to just treating the profits as ^YOURHISHER income?
1. Yes
2. No
TYPPAY
Which of the following types of pay DIDDODOES ^TEMPNAME receive ^INEMONTHFILL?
Read answer list
Mark all that apply
If payment is given per service or per unit of production, enter commission and collect monthly total
amounts.
1. Salary/hourly rate
2. Commission
3. Tips
4. Overtime
5. Bonus pay
Page 42 of 163
PAYHR1
H, ? [F1]
Ask or verify
The next questions are about ^PTEMPNAME gross income from ^EMPNAME before taxes and
other deductions. What is the easiest way for you to report ^YOURHISHER pay rate or salary
information?
Read answer list
1. Annual salary (pay rate for the year)
2. Actual gross amount earned in the year
3. pay per hour
4. pay per week
5. pay every two weeks
6. pay per month
7. pay twice a month
8. some other way (report monthly average)
PYRAT1
? [F1]
What ISWAS the gross dollar amount of ^PTEMPNAME PHRFILL1 before any taxes and other
deductions?
TAKEHOME1
? [F1]
C_ISWAS this take-home pay or ISWAS it gross pay before any taxes and other deductions
^AREWERE taken out?
Page 43 of 163
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)
JOBHRS1
? [F1]
How many hours per week DIDDODOES ^TEMPNAME usually work at ^EMPNAME
^INEMONTHFILL?
^JOBHRSFILL
PTYN1
? [F1]
C_DIDDODOES ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME?
1. Yes
2. No
PTRESN1
I, ? [F1]
What ISWAS the main reason ^TEMPNAME WORKSWORKED less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other
Page 44 of 163
CHEARN1
You said ^TEMPNAME ISAREWASWERE paid ^PYRAT1FIL ^PAYHR1FIL ^INEMONTHFILL. Did
^YOURHISHER pay rate change ^BETWEEN_BMONTH_ALTEMONTH?
1. Yes
2. No
CHERMNTH1
In what month was ^PTEMPNAME most recent pay rate change?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
CHERWEEK1
T
In which week did ^PTEMPNAME pay rate change?
PAYHR2
H, ? [F1]
What type of pay rate or salary did ^TEMPNAME have at ^EMPNAME ^CHERMNTH1?
Page 45 of 163
Read answer list
1. Paid an annual salary
2. Paid by the hour
3. Paid by the week
4. Paid once every 2 weeks
5. Paid once a month
6. Paid twice a month
7. Paid some other way (report monthly average)
PYRAT2
? [F1]
What was the gross dollar amount of ^PTEMPNAME PHRFILL2 before any taxes and other
deductions at ^EMPNAME ^CHERMNTH1?
TAKEHOME2
? [F1]
Was this take-home pay or was it gross pay before any taxes and other deductions were taken
out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)
CHHOUR1
^CHHOUR1FILL
1. Yes
Page 46 of 163
2. No
CHHOMON1
In what month did ^PTEMPNAME hours change?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
CHHOWEEK1
T
In which week did ^PTEMPNAME hours change?
JOBHRS2
? [F1]
How many hours per week did ^TEMPNAME usually work at ^EMPNAME before ^CHHOMON1?
^JOBHRSFILL
PTYN2
Page 47 of 163
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME before this change?
1. Yes
2. No
PTRESN2
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other
CHEARN2
You said ^TEMPNAME WASWERE paid ^PYRAT2FIL ^PAYHR2FIL ^CHERMNTH1. Did
^PTEMPNAME pay rate change ^BTWN_BMONTH_CHERMNTH1?
1. Yes
2. No
CHERMNTH2
When did ^PTEMPNAME pay rate change ^BTWN_BMONTH_CHERMNTH1?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 48 of 163
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
CHERWEEK2
T
In which week did ^PTEMPNAME pay rate change?
PAYHR3
H, ? [F1]
What type of pay rate or salary did ^TEMPNAME have at ^EMPNAME ^CHERMNTH2?
Read answer list
1. Paid an annual salary
2. Paid by the hour
3. Paid by the week
4. Paid once every 2 weeks
5. Paid once a month
6. Paid twice a month
7. Paid some other way (report monthly average)
PYRAT3
? [F1]
What was the gross dollar amount of ^PTEMPNAME PHRFILL3 before any taxes and other
Page 49 of 163
deductions ^CHERMNTH2?
TAKEHOME3
? [F1]
Was this take-home pay or was it gross pay before any taxes and other deductions were taken
out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)
CHHOUR2
^CHHOUR2FILL
1. Yes
2. No
CHHOMON2
When did ^PTEMPNAME hours change CHHOMONFILL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
Page 50 of 163
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
CHHOWEEK2
T
In which week did ^PTEMPNAME hours change?
JOBHRS3
? [F1]
How many hours per week did ^TEMPNAME usually work ^CHHOMON2?
^JOBHRSFILL
PTYN3
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME ^CHHOMON2?
1. Yes
2. No
PTRESN3
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
Page 51 of 163
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other
CHHOUR3
^CHHOUR3FILL
1. Yes
2. No
CHHOMON3
When did ^PTEMPNAME hours change CHHOMON3FILL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
CHHOWEEK3
Page 52 of 163
T
In which week did ^PTEMPNAME hours change?
JOBHRS4
? [F1]
How many hours per week did ^TEMPNAME usually work ^CHHOMON3?
^JOBHRSFILL
PTYN4
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME before ^CHHOMON3?
1. Yes
2. No
PTRESN4
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of injury
4. Temporarily unable to work full-time because of illness
5. Unable to work full-time because of chronic health condition/disability
6. Taking care of children/other persons
7. Full-time work week is less than 35 hours
8. Slack work or material shortage
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other
CTRLNUM
Page 53 of 163
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
JOBNUM
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
BMONTH
**NON-DISPLAYED ITEM**
EMONTH
**NON-DISPLAYED ITEM**
TYPPAYCODE
**NON-DISPLAYED ITEM**
TYPEXPAY
Earlier you said ^TEMPNAME received ^TYPEXPAY_FILL while working at ^EMPNAME. Did
these ^TYPEXPAY_FILL ^PAYMENTS occur every month?
1. Yes
2. No
EXEARNAMT1
^EXEARNFILL much did ^TEMPNAME usually earn per month in ^TYPEXPAY_FILL?
Page 54 of 163
EXEARNMNTH
During which months did ^TEMPNAME earn ^TYPEXPAY_FILL while working for ^EMPNAME?
Mark all that apply
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EXEARNAMT2
How much ^SPELL_AREWERE these ^TYPEXPAY_FILL ^PAYMENTS ^EXEARNMNTH_FILL?
OINCB
? [F1]
Besides what has already been reported, did ^TEMPNAME receive any other income for Fill for
SELF out of the money that ^EMPNAME brought in?
1. Yes
2. No
OINCAMT
What was the average monthly amount of other income ^YOUHESHE usually received from
^EMPNAME?
Page 55 of 163
PRFTLOSS
? [F1]
Did ^EMPNAME make a net profit, net loss, or break even for the year ^CALENDAR_YRFIL?
1. profit (positive)
2. loss (negative)
3. no profit/break even
PRFTB
? [F1]
For ^EMPNAME, what was the dollar amount of ^PTEMPNAME share of the ^PRFTLOSSFIL for
the year ^CALENDAR_YRFIL?
PRFTBCHK
C_ISWAS ^HISHER own income from ^EMPNAME (that we talked about earlier) reported in this
^PRFTLOSSFIL? Or do we need to subtract ^HISHER income to get a total ^PRFTLOSSFIL?
1. salary/draw is included in the net profit/loss amount
2. subtract salary/draw to get total ^PRFTLOSSFIL
FPAWOPYN1
? [F1]
^C_FPAWOPYN1FILL, did ^TEMPNAME have any time away without pay from ^EMPNAME for a
period of at least two weeks?
1. Yes
2. No
FPAWOPSM1
^C_BEMIN which month did the most recent period of leave without pay begin?
FR Note for FPAWOPSM
1. January ^CALENDAR_YRFIL
Page 56 of 163
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FPAWOPSW1
T
In which week did this period of leave without pay begin?
FR notes for FPAWOPSW
FPAWOPEM1
Between ^FPAWOPSM1 and ^EMONTHFILL, in which month did the most recent period of leave
without pay end?
FR note for FPAWOPEM
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
Page 57 of 163
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FPAWOPEW1
T
In which week did this period of leave without pay end?
FR note for FPAWOPEW
FPAWOPRE1
J
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff (temporary or indefinite)
2. Slack work/business conditions
3. Vacation/scheduled time off/personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own injury/own illness/medical problems
6. Taking care of children/childcare problems
7. Caring for an elderly/disabled family member
8. Pregnancy/childbirth/maternity or paternity leave
9. Labor dispute
10. Bad weather
11. Civic/Jury/Military duty
12. Other
FPAWOPCH1
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
Page 58 of 163
1. Yes
2. No
FPAWOPYN2
? [F1]
^C_FPAWOPYN2FILL ^TEMPNAME have a second period of time away without pay from
^EMPNAME for at least two weeks?
1. Yes
2. No
FPAWOPSM2
^C_FPAWOPSM2FILL what month did the second period of leave without pay begin?
FR Note for FPAWOPSM
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FPAWOPSW2
Page 59 of 163
T
In which week did the second period of leave without pay begin?
FR notes for FPAWOPSW
FPAWOPEM2
^C_FPAWOPEM2FILL, in which month did the second period of leave without pay end?
FR note for FPAWOPEM
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FPAWOPEW2
T
In which week did the second period of leave without pay end?
FR note for FPAWOPEW
FPAWOPRE2
Page 60 of 163
J
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff (temporary or indefinite)
2. Slack work/business conditions
3. Vacation/scheduled time off/personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own injury/own illness/medical problems
6. Taking care of children/childcare problems
7. Caring for an elderly/disabled family member
8. Pregnancy/childbirth/maternity or paternity leave
9. Labor dispute
10. Bad weather
11. Civic/Jury/Military duty
12. Other
FPAWOPCH2
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No
FPAWOPYN3
? [F1]
^C_FPAWOPYN3FILL ^TEMPNAME have a third period of time away without pay from
^EMPNAME for at least two weeks?
1. Yes
2. No
FPAWOPSM3
^C_FPAWOPSM3FILL which month did the third period of leave without pay begin?
FR Note for FPAWOPSM
Page 61 of 163
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FPAWOPSW3
T
In which week did the third period of leave without pay begin?
FR notes for FPAWOPSW
FPAWOPEM3
^C_FPAWOPEM3FILL, in which month did the third period of leave without pay end?
FR note for FPAWOPEM
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
Page 62 of 163
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FPAWOPEW3
T
In which week did the third period of leave without pay end?
FR note for FPAWOPEW
FPAWOPRE3
J
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff (temporary or indefinite)
2. Slack work/business conditions
3. Vacation/scheduled time off/personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own injury/own illness/medical problems
6. Taking care of children/childcare problems
7. Caring for an elderly/disabled family member
8. Pregnancy/childbirth/maternity or paternity leave
9. Labor dispute
10. Bad weather
11. Civic/Jury/Military duty
12. Other
FPAWOPCH3
Page 63 of 163
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
JOBNUMBER
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
BMONTH
**NON-DISPLAYED ITEM**
EMONTH
**NON-DISPLAYED ITEM**
PVWORKTRAN
U, ? [F1]
Let's talk about ^PTEMPNAME commuting expenses, job-related expenses and work schedule
with ^EMPNAME.
During a typical week, how DIDDODOES ^TEMPNAME get to work?
Page 64 of 163
Mark all that apply.
Include all work-related travel.
1. Drove own vehicle
2. Rider in someone else's vehicle/van pool
3. Bus
4. Rail
5. Other public transportation
6. Walked
7. Bicycled
8. Drove company vehicle
9. Worked at home
10. Other
PVTRANPRIM
? [F1]
Which of these methods accounts for the greatest distance travelled as part of ^PTEMPNAME
work commute?
1. Drove own vehicle
2. Rider in someone else's vehicle/van pool
3. Bus
4. Rail
5. Other public transportation
6. Walked
7. Bicycled
8. Drove company vehicle
9. Worked at home
10. Other
PVTIME
? [F1]
How many minutes ^DIDDOES it usually take ^TEMPNAME to get from home to work as part of
^YOURHISHER work commute?
Page 65 of 163
PVMILE
? [F1]
How many miles DIDDODOES ^TEMPNAME drive from home to work as part of ^YOURHISHER
work commute?
PVREIMBMI
? [F1]
^DIDDOES ^EMPNAME reimburse ^TEMPNAME for the miles driven to work?
1. Yes
2. No
PVREIMBMIC
? [F1]
How many of those PVMILES miles ^AREWERE reimbursed by ^EMPNAME?
PVPARK
? [F1]
DIDDODOES ^TEMPNAME have to pay for parking or tolls as a part of ^YOURHISHER
work-commuting expenses?
Enter 1 for "yes" if ANY parking costs or tolls are out of pocket; enter 2 for "no" if ALL such costs are
reimbursed.
1. Yes
2. No
PVPARKC
? [F1]
Typically, how much DIDDODOES^TEMPNAME spend per day for parking or tolls?
Include only costs that were NOT reimbursed.
Page 66 of 163
PVOTHRC
? [F1]
In a typical day,PVOTHRCFILL about how much ^AREWERE ^PTEMPNAME PVOTHRCFILL2 work
commuting expensesPVOTHRCFILL3?
Enter 0 for "none." Include only work-commuting expenses that were NOT reimbursed.
PVOEXPNS
? [F1]
^BETWEEN_BMONTH_EMONTH, not counting expenses ^PTEMPNAME employer ^PAYSPAID,
DIDDODOES ^TEMPNAME have any work-related expenses such as licenses, permits, union
dues, special tools, or uniforms for ^YOURHISHER work at ^EMPNAME?
1. Yes
2. No
PVOEXPNSC
? [F1]
Altogether, between ^BETWEEN_BMONTH_EMONTH, how much ^AREWERE ^PTEMPNAME
expenses for such items?
Include only work-related expenses that were required for employment and were NOT reimbursed.
WSWHDY
? [F1]
During a typical week at ^EMPNAME, which days DIDDODOES ^TEMPNAME work?
Mark all that apply.
If the days that the respondent ^WRKD varies, enter the days that ^HESHE most recently worked for
this job.
1. Monday through Friday
2. Sunday
Page 67 of 163
3. Monday
4. Tuesday
5. Wednesday
6. Thursday
7. Friday
8. Saturday
9. All seven days (every day in a typical week)
WSBEG
? [F1]
During a typical week, what time DIDDODOES ^TEMPNAME usually begin work at ^EMPNAME?
Enter the time followed by a.m. or p.m.
12:00 a.m. is midnight and 12:00 p.m. is noon.
If the start time varies, enter the most common start time for this job.
WSEND
? [F1]
During a typical week, what time DIDDODOES ^TEMPNAME usually end work at ^EMPNAME?
Enter the time as well as a.m. or p.m.
12:00 a.m. is midnight and 12:00 p.m. is noon.
If the end time varies, enter the most common end time for this job.
WSHMWRK
? [F1]
As part of ^PTEMPNAME typical work schedule for ^EMPNAME, ^AREWERE there any days
when ^TEMPNAME WORKSWORKED only at home?
1. Yes
2. No
Page 68 of 163
WSHOMDY
? [F1]
Which days DIDDODOES ^TEMPNAME work only from home?
Mark all that apply.
1. Monday through Friday
2. Sunday
3. Monday
4. Tuesday
5. Wednesday
6. Thursday
7. Friday
8. Saturday
9. All seven days (every day in a typical week)
WSJOB
M, ? [F1]
Which of the following best describes ^PTEMPNAME work schedule at ^EMPNAME?
Mark variable work schedules as 6 ("Irregular").
1. Regular daytime schedule
2. Regular evening shift
3. Regular night shift
4. Rotating shift (one that changes regularly from days to evenings to nights)
5. Split shift (one that consists of two distinct periods each day)
6. Irregular schedule (one that changes from day to day)
7. Other - specify
WSOTH
Please describe the 'other' type of work schedule.
WSMNR
Page 69 of 163
What is the MAIN reason ^TEMPNAME WORKSWORKED this type of schedule?
DO NOT read answer categories.
1. Requirement of the job
2. Could not get any other job
3. Other involuntary reasons
4. Better pay
5. Better child care arrangements
6. Better arrangements for care of other family members
7. Allows time for school
8. Other voluntary reasons
ANYMORESPELLS
Did ^TEMPNAME work for ^EMPNAME2 at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about two periods working for ^EMPNAME2. How many other times did
^TEMPNAME work for ^EMPNAME2 since ^MONTH1 1st ^CALENDAR_YRFIL?
ANYOTHERWORK
^OTHERWORK
1. Yes
2. No
NOMORESPELLS
The jobs and no job topics are complete. Enter '1' to continue.
NJSCREEN
I'm showing ^TEMPNAME WASWERE not working for pay during the following ^TIME_S since
Page 70 of 163
^MONTH1 1st ^CALENDAR_YRFIL:
^LFGAPS_TEXTFIL
Have we talked about all times, since ^MONTH1 1st ^CALENDAR_YRFIL, when ^YOUHESHE
worked for pay?
1. Yes
2. No
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
INTRO
^OJINTRO_QTEXT
INFO
This job line collects summary information about all remaining jobs and businesses beyond the 7 jobs
reported on lines 1-7. Ask respondent to think about and report all of ^HISHER work as a WHOLE rather
than separately.
Record separate spells when ^HESHE reports disconnected time periods of employment for these
additional employers.
SCREENER2
Did ^YOUHESHE have any more time working for pay since ^MONTH1 1st ^CALENDAR_YRFIL
Page 71 of 163
that you have not yet told me about?
1. Yes
2. No
BMONTH
EMONTH
STARTJAN
Did ^TEMPNAME begin this work in ^MONTH1 ^CALENDAR_YRFIL?
1. Yes
2. No
STARTWEEK
T
During which week did ^TEMPNAME begin this other work?
ENDWEEK
T
During which week did ^TEMPNAME end this other work?
NUMBER_OF_JOBS
How many additional jobs, businesses, or other arrangements DIDDODOES ^TEMPNAME have
^BETWEEN_BMONTH_EMONTH?
JBORSEOTH
? [F1]
^OTHJBFIL you reported ^BETWEEN_BMONTH_EMONTH for ^EMPLOYER, or was it
self-employment, or a combination of ^EMPLOYER and self-employment, or was it some other
kind of arrangement?
Mark all that apply
Page 72 of 163
1. employer
2. self-employed (owns a business)
3. other work arrangement
EARN
Including all wages, salaries, tips, commissions, bonuses, and profits, what ISWAS the total
amount of ^YOURHISHER gross earnings from ^NOTHJOB ^BETWEEN_BMONTH_EMONTH?
Gross earnings are earnings before any taxes or other deductions.
TAKEHOME
C_ISWAS this a take-home amount or ISWAS it a gross amount before any taxes and deductions
^AREWERE taken out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)
HOURS
^C_BETWEEN_BMONTH_EMONTH, DIDDODOES ^YOUHESHE usually work 35 hours or more per
week at ^NOTHJOB?
1. Yes
2. No
PTRESN
What ISWAS the main reason ^TEMPNAME WORKSWORKED fewer than 35 hours per week at
^NOTHJOB?
1. Worked at one or more other jobs or businesses
2. Could not find full-time job
3. Wanted to work part-time
4. Temporarily unable to work full-time because of injury
5. Temporarily unable to work full-time because of illness
Page 73 of 163
6. Unable to work full-time because of chronic health condition/disability
7. Taking care of children/other persons
8. Full-time work week is less than 35 hours
9. Slack work or material shortage
10. Participated in a job-sharing arrangement
11. On vacation
12. In school
13. Other
NOMORESPELLS
The job and no job topics are complete. Enter '1' to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME work at ^NOTHJOB at any other times since ^MONTH1 1st ^CALENDAR_YRFIL
that you have not yet told me about?
1. Yes
2. No
HOWMANY
We've talked about three periods of employment at ^NOTHJOB. How many other times, since
^MONTH1 1st ^CALENDAR_YRFIL, WASWERE ^YOUHESHE employed at ^NOTHJOB?
NJSCREEN
I'm showing ^TEMPNAME WASWERE not working for pay during the following ^TIME_S since
^MONTH1 1st ^CALENDAR_YRFIL:
^LFGAPS_TEXTFIL
Have we talked about all times, since ^MONTH1 1st, when ^YOUHESHE worked for pay?
1. Yes
2. No
CTRLNUM
Page 74 of 163
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
INTRO
Now I'm going to talk to you about time when ^YOUHESHE WASWERE not working for pay.
SCREENER
Read if necessary:
C_AREIS ^YOUHESHE currently not working for pay?
1. Yes
2. No
SCREENER2
Did ^YOUHESHE not work for pay at any time since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No
BMONTH
When did this period of not working for pay start?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 75 of 163
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
When did the period ^YOUHESHE did not work for pay end?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
NOWRK_1
K
Page 76 of 163
Why This is the fill for DIDDODONT ^TEMPNAME work for pay
^NWBETWEEN_BMONTH_EMONTH?
Read or show the respondent the answer list. After each response, ask: "Any other reason?"
1. Temporarily unable to work because of an injury
2. Temporarily unable to work because of an illness
3. Unable to work because of chronic health condition or disability
4. Retired
5. Pregnancy/childbirth
6. Taking care of children/other persons
7. Going to school
8. Unable to find work
9. On layoff (temporary or indefinite)
10. Not interested in working at a job
11. Usually worked 15 or more hours per week without pay in a family business or farm
12. Other
UNPDWRKYN
? [F1]
C_DIDDODOES ^TEMPNAME work 15 or more hours per week without pay in a related household
member's family business or farm ^BETWEEN_BMONTH_ALTEMONTH?
1. Yes
2. No
FAM_BUS_KNDIN_1
? [F1]
What kind of business or enterprise is the family business?
(What do they make or do?)
FAM_BUS_TYPIN_1
Is it mainly ---
Read answer list
1. Manufacturing
2. Wholesale trade
Page 77 of 163
3. Retail trade
4. Service
5. Or something else (agriculture, construction, government, etc.)
FAM_BUS_KNDWK_1
What kind of work DIDDODOES ^TEMPNAME do? That is, what ISWAS ^YOURHISHER
occupation?
(For example: bookkeeper, plumber, registered nurse)
FAM_BUS_ACTVT_1
What ^AREWERE ^YOURHISHER usual work activities?
(For example: Keeping account books, repairing pipes, patient care)
LAYOFF_1
? [F1]
^LAYOFFFILL ^TEMPNAME spend any time on layoff from a job?
1. Yes
2. No
LAYOFF_TYPE_1
When ^TEMPNAME WASWERE laid off, WASWERE ^YOUHESHE either informed that
^YOUHESHE would be recalled to work within 6 months, or given a date to return to work?
1. Yes
2. No
LAYOFF_DURATION
C_WASWERE ^TEMPNAME on layoff for the entire period?
1. Yes
2. No
Page 78 of 163
LAYOFF_ENDMNTH
In which month did the layoff end?
FR note for ENDMONTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
LAYOFF_ENDWEEK
T
In which week did the layoff end?
FR note for ENDWEEK
LKWRK_1
? [F1]
^LKWRKFILL ^TEMPNAME ACTIVELY look for work in one or more weeks?
1. Yes
2. No
FROM_LKMNTH_11
Page 79 of 163
^C_BEMIN what month did ^TEMPNAME FIRST begin looking for work?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FROM_LKWEEK_11
T
In which week did ^TEMPNAME first begin looking for work?
FR note for FROM_LKWEEK
TO_LKMNTH_11
From ^FROM11FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 80 of 163
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TO_LKWEEK_11
T
In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK
MORE_STRETCH_12
^C_BTWN_TO11_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No
FROM_LKMNTH_12
^C_LKMNTH12 what month did ^TEMPNAME begin looking for work for the second time?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 81 of 163
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FROM_LKWEEK_12
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK
TO_LKMNTH_12
From ^FROM12FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 82 of 163
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TO_LKWEEK_12
T
In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK
MORE_STRETCH_13
^C_BTWN_TO12_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No
FROM_LKMNTH_13
^C_LKMNTH13 what month did ^TEMPNAME begin looking for work for the third time?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
Page 83 of 163
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FROM_LKWEEK_13
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK
TO_LKMNTH_13
From ^FROM13FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
Page 84 of 163
18. June ^INTYEARFIL
TO_LKWEEK_13
T
In which week did ^TEMPNAME stop looking for work?
FR note for TO_LKWEEK
MORE_STRETCH_14
^C_BTWN_TO13_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No
FROM_LKMNTH_14
^C_LKMNTH14 what month did ^TEMPNAME begin looking for work for the fourth time?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 85 of 163
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FROM_LKWEEK_14
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK
TO_LKMNTH_14
From ^FROM14FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TO_LKWEEK_14
T
In which week did ^TEMPNAME stop looking for work?
Page 86 of 163
FR note for TO_LKWEEK
NOMORESPELLS
The no jobs topic is complete. Enter '1' to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME have any other times not working for pay since ^MONTH1 1st
^CALENDAR_YRFIL?
HOWMANY
We've talked about six periods of time not working for pay. How many other times, since
^MONTH1 1st ^CALENDAR_YRFIL, did ^YOUHESHE spend not working for pay?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
SSI_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
Page 87 of 163
INTRO
(Next are some questions about assistance programs for people in need.) ^SSIINTROTEXT
INFO
(Only collect SSI spells that cover the person being interviewed. SSI collected on behalf of someone
else - such as a child - will be collected in that person's interview. SSI provides assistance to blind and
disabled children and adults, and, in some instances, people over age 65 who have low income. It is not
the same as income from Social Security.)
SCREENER
AREIS ^YOUHESHE currently receiving SSI?
1. Yes
2. No
SCREENER2
Did ^YOUHESHE receive SSI ^SCREENER2TEXT?
BMONTH
^FROMTEXT
EMONTH
^TOTEXT
SSI_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving SSI
continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.
SSI_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving SSI
continuously?
Page 88 of 163
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
SSI_WHY
Why did ^TEMPNAME begin receiving SSI in ^SSI_BMONTHFIL?
1. Disabled
2. Blind
3. Other
SSI_STOP
What were the reasons ^TEMPNAME stopped receiving SSI in ^EMONTHFILL?
1. Became ineligible because of increased income
2. Because of family changes
3. Still eligible but could not/chose not to collect
4. The money is not worth it
5. Other
SSI_STOP_OTHER
Ask if necessary.
What was that other reason?
SSI_PAYMENT
C_DIDDODOES ^TEMPNAME receive ^PTEMPNAME monthly SSI benefit in one or two
payments?
Page 89 of 163
1. One
2. Two
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
SSI1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
SSI1_GUESS
What would you estimate the monthly amount to be?
SSI1_AMT1_START
When did ^TEMPNAME start receiving ^SSIAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
Page 90 of 163
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI1_AMT2
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?
SSI1_AMT2_START
When did ^TEMPNAME start receiving ^SSIAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI1_AMT3
How much did ^TEMPNAME receive before ^SSI_AMT2_STARTFIL?
Page 91 of 163
SSI1_AMT3_START
When did ^TEMPNAME start receiving ^SSIAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI1_AMT4
How much did ^TEMPNAME receive before ^SSI_AMT3_STARTFIL?
SSI1_AMT4_START
When did ^TEMPNAME start receiving ^SSIAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
Page 92 of 163
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI1_STARTAMT
How much did ^TEMPNAME receive in ^BMONTHFILL?
SSI1_SRC
^C_AREWERE the SSI payments from
Read answer categories?
1. Federal Government
2. State Government
3. Both
SSI1_AMT(copy)
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
Page 93 of 163
SSI2_AMT
Let's talk about the second payment you reported earlier.
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
SSI2_GUESS
What would you estimate the monthly amount to be?
SSI2_AMT1_START
When did ^TEMPNAME start receiving ^SSIAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI2_AMT2
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?
SSI2_AMT2_START
When did ^TEMPNAME start receiving ^SSIAMT2_FIL?
1. January ^CALENDAR_YRFIL
Page 94 of 163
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI2_AMT3
How much did ^TEMPNAME receive before ^SSI_AMT2_STARTFIL?
SSI2_AMT3_START
When did ^TEMPNAME start receiving ^SSIAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
Page 95 of 163
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI2_AMT4
How much did ^TEMPNAME receive before ^SSI_AMT3_STARTFIL?
SSI2_AMT4_START
When did ^TEMPNAME start receiving ^SSIAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
SSI2_STARTAMT
How much did ^TEMPNAME receive in ^BMONTHFILL?
SSI2_SRC
Page 96 of 163
^C_AREWERE the SSI payments from
Read answer categories?
1. Federal Government
2. State Government
3. Both
NOMORESPELLS
The SSI topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME receive SSI at any other times since the ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about three periods of SSI receipt. How many other times did ^YOUHESHE receive
SSI since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
Page 97 of 163
FS_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
(Next are some questions about assistance programs for people in need.) ^FSINTROTEXT
INFO
(The Food Stamp Program, or Supplemental Nutrition Assistance Program - SNAP, was created to
assist low-income households in buying the food they need for good health and nutrition. The benefit
amount allowed to a household varies by the household's size and monthly cash income. Benefits are
generally provided through plastic electronic card called an Electronic Benefit Transfer (EBT).)
SCREENER
C_AREIS ^YOUHESHEFAM currently receiving Food Stamp/SNAP benefits?
1. Yes
2. No
SCREENER2
Did ^YOUHESHEFAM receive Food Stamps/SNAP benefits ^SCREENER2TEXT?
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 98 of 163
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 99 of 163
FS_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving Food
Stamps/SNAP continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.
FS_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving Food
Stamps/SNAP continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
FS_BEGIN
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to receive Food Stamps/SNAP in
^BMONTHFILL?
1. New Child (or other dependent) or pregnancy
2. Separation, divorced or widowed
3. Job loss / layoff or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other
FS_WHY_OTHER
Page 100 of 163
Ask if necessary
What was the other reason?
FS_STOP
What were the reasons ^TEMPNAME stopped receiving Food Stamps/SNAP ^SPELLEND?
1. Became ineligible because of an increase in income
2. Became ineligible because of family changes (family member left, over age limit, etc)
3. Still eligible but could not / chose not to collect
4. Became ineligible because program requirements were not met (did not attend school, job training, etc)
5. Eligibility ran out because of time limits
6. The money/benefits were not worth the trouble to continue enrollment
7. Other
FS_STOP_OTHER
Ask if necessary
What was the other reason?
FS1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
FS1_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
FS_AMT1_START
When did ^TEMPNAME start receiving ^FSAMT1_FIL?
Page 101 of 163
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FS2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?
FS2_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
FS_AMT2_START
When did ^TEMPNAME start receiving ^FSAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
Page 102 of 163
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FS3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?
FS3_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
FS_AMT3_START
When did ^TEMPNAME start receiving ^FSAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 103 of 163
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FS4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?
FS4_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
FS_AMT4_START
When did ^TEMPNAME start receiving ^FSAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
Page 104 of 163
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
FS_COV
Please list everyone (including yourself) who ^AREWERE_COV covered by ^YOURHISHER benefits
at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
Page 105 of 163
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
26. Someone not listed
FS_OWNER
Whose name ^AREWERE the benefits under?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 106 of 163
NOMORESPELLS
The Food Stamps/SNAP topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME receive Food Stamps/SNAP benefits at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about three periods of Food Stamps/SNAP benefit receipt. How many other times
did ^YOUHESHE receive Food Stamps/SNAP benefits since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
TANF_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
Page 107 of 163
INTRO
(Next are some questions about assistance programs for people in need.) ^TANFINTROTEXT.
INFO
(In this area you may know this as TANF FIL1 or TANF FILL or TANF FILL (PACASH1, PATANF).
Pass-through child support is also called called bonus child support and disregard payments).
SCREENER
C_AREIS ^YOUHESHEFAM currently receiving TANF benefits, or any other cash assistance from
a state or local welfare program^TANFLE18FIL?
1. Yes
2. No
SCREENER2
Did ^YOUHESHEFAM receive TANF benefitsclosing text for the second TANF screener?
1. Yes
2. No
BMONTH
^FROMTEXT
EMONTH
^TOTEXT
TANF_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving
payments continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.
TANF_LC_MONTH
Page 108 of 163
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start
receiving payments continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
TANF_BEG
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need assistance in
^BMONTHFILL?
1. New child (or other dependent) or pregnancy
2. Separation, divorce, or widowed
3. Job loss or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other
TANF_BEG_OTHER
Ask if necessary
What was the other reason?
TANF_STOP
What were the reasons ^TEMPNAME stopped receiving payments ^SPELLEND?
Page 109 of 163
1. Got a job or earnings increased
2. Family situation changed
3. Others in the household earned enough money
4. Penalized or sanctioned for non-cooperation
5. Time limit expired
6. Didn't want to use up time limit
7. Chose not to participate
8. The money is not worth it
9. Other
TANF_STOP_OTHER
Ask if necessary
What was the other reason?
TANF1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
TANF1_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
TANF_AMT1_START
When did ^TEMPNAME start receiving ^TANFAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 110 of 163
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TANF2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?
TANF2_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
TANF_AMT2_START
When did ^TEMPNAME start receiving ^TANFAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
Page 111 of 163
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TANF3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?
TANF3_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
TANF_AMT3_START
When did ^TEMPNAME start receiving ^TANFAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
Page 112 of 163
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TANF4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?
TANF4_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
TANF_AMT4_START
When did ^TEMPNAME start receiving ^TANFAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 113 of 163
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
TANF_ADULT_KID
Do these benefits cover children only, both children and adults, or only a pregnant woman?
1. Only children
2. Only a pregnant or nursing woman
3. Both a woman and children
TANF_COV
Please list coverage roster fill for TANF_COV question who ^AREWERE_COV covered by
^YOURHISHER benefits at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
Page 114 of 163
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
26. Someone not listed
TANF_OWNER
Whose name ^AREWERE the payments in?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 115 of 163
PASSTHRU_YN
? [F1]
Now I am going to ask you questions about receipt of pass-through child support
^BETWEEN_BMONTH_EMONTH.
At any time during this period, DIDDODOES ^TEMPNAME receive any child support as a bonus
or pass-through from a state or county welfare program, or any disregard payment?
(Pass-through child support may also be known as "bonus child support" or "disregard payments.")
1. Yes
2. No
PASSTHRU_KID_COV
Which person or people under the age of 22 are or were covered by pass-through child support
payments ^BETWEEN_BMONTH_EMONTH?
1. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
2. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
3. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
4. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
5. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
6. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
7. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
8. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
9. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
10. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
11. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
12. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
13. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
14. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
15. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
16. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
17. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
18. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
19. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
20. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
21. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
Page 116 of 163
22. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
23. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
24. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
25. ^LNO ^FNAME ^LNAME of all people where age <= 22on (the final HH roster, excluding the respondent, where P
26. Someone not listed
PASSTHRU_TYPE
Do the TANF FIL1 amounts you just reported include ^PTEMPNAME pass-through child support
payments?
1. Yes, bonus/pass through amounts are included
2. No, amounts do not include bonus/pass through
3. Did not receive any bonus/pass through income
PASSTHRU1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
PASSTHRU1_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PASSTHRU_AMT1_START
When did ^TEMPNAME start receiving ^PTAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
Page 117 of 163
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PASSTHRU2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?
PASSTHRU2_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PASSTHRU_AMT2_START
When did ^TEMPNAME start receiving ^PTAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
Page 118 of 163
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PASSTHRU3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?
PASSTHRU3_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PASSTHRU_AMT3_START
When did ^TEMPNAME start receiving ^PTAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
Page 119 of 163
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PASSTHRU4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?
PASSTHRU4_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PASSTHRU_AMT4_START
When did ^TEMPNAME start receiving ^PTAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
Page 120 of 163
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PTAGENCY1_AMT
Now I am going to ask you about the child support that the welfare agency
COLLECTSCOLLECTED on ^PTEMPNAME behalf. How much child support ISWAS collected by
the agency on ^PTEMPNAME behalf ^IN_EMONTHFIL?
PTAGENCY1_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PTAGENCY_AMT1_START
When did the agency start receiving ^PTAAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
Page 121 of 163
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PTAGENCY2_AMT
How much did the agency receive on ^PTEMPNAME behalf before ^AMT1_STARTFIL?
PTAGENCY2_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PTAGENCY_AMT2_START
When did the agency start receiving ^PTAAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
Page 122 of 163
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PTAGENCY3_AMT
How much did the agency receive on ^PTEMPNAME behalf before ^AMT2_STARTFIL?
PTAGENCY3_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PTAGENCY_AMT3_START
When did the agency start receiving ^PTAAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 123 of 163
17. May ^INTYEARFIL
18. June ^INTYEARFIL
PTAGENCY4_AMT
How much did the agency receive on ^PTEMPNAME behalf before ^AMT3_STARTFIL?
PTAGENCY4_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
PTAGENCY_AMT4_START
When did the agency start receiving ^PTAAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 124 of 163
NOMORESPELLS
The TANF topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME receive TANF at any other times since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about three periods of TANF receipt. How many other times did ^TEMPNAME
receive TANF since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
GA_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
Page 125 of 163
(Next are some questions about assistance programs for people in need.) ^GAINTROTEXT.
INFO
(General Assistance or General Relief - which can be called something different depending on where
you live - is a program for people who do not qualify for federal assistance. It may help the disabled,
elderly, and unemployed, as well as families with children. Assistance may be cash or non-cash and
may be a one-time emergency payment or regular monthly payments.)
SCREENER
C_AREIS ^YOUHESHEFAM currently receiving General Assistance (either for ^YOURHIMHERSELF
or on behalf of a child)?
1. Yes
2. No
SCREENER2
Did ^YOUHESHEFAM receive General Assistance ^GASCREENER2TEXT?
1. Yes
2. No
BMONTH
^FROMTEXT
EMONTH
^TOTEXT
GA_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving General
Assistance continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.
Page 126 of 163
GA_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving
General Assistance continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December
GA_BEG
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need assistance in
^BMONTHFILL?
1. New child (or other dependent) or pregnancy
2. Separation, divorce, or widowed
3. Job loss or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other
GA_BEG_OTHER
Ask if necessary
What was the other reason?
GA_STOP
What were the reasons ^TEMPNAME stopped receiving General Assistance ^SPELLEND?
Page 127 of 163
1. Got a job or earnings increased
2. Family situation changed
3. Others in the household earned enough money
4. Penalized or sanctioned for non-cooperation
5. Time limit expired
6. Didn't want to use up time limit
7. Chose not to participate
8. The money is not worth it
9. Other
GA_STOP_OTHER
Ask if necessary
What was the other reason?
GA1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?
GA1_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
GA_AMT1_START
When did ^TEMPNAME start receiving ^GAAMT1_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 128 of 163
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
GA2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?
GA2_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
GA_AMT2_START
When did ^TEMPNAME start receiving ^GAAMT2_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
Page 129 of 163
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
GA3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?
GA3_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
GA_AMT3_START
When did ^TEMPNAME start receiving ^GAAMT3_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
Page 130 of 163
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
GA4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?
GA4_GUESS
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
GA_AMT4_START
When did ^TEMPNAME start receiving ^GAAMT4_FIL?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 131 of 163
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
GA_COV
Please list everyone (including yourself) who ^AREWERE_COV covered by ^YOURHISHER benefits
at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply
1. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
2. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
3. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
4. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
5. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
6. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
7. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
8. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
9. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
10. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
11. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
12. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
13. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
14. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
15. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
16. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
17. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
18. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
19. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
20. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
21. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
22. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
23. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
24. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
25. ^LNO ^ROST_FNAME ^ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_T
Page 132 of 163
26. Someone not listed
GA_OWNER
Whose name ^AREWERE the benefits under?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
NOMORESPELLS
The General Assistance topic is complete. Enter 1 to continue.
1. Continue
Page 133 of 163
ANYMORESPELLS
Did ^TEMPNAME receive General Assistance benefits at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about three periods of General Assistance benefit receipt. How many other times
did ^TEMPNAME receive General Assistance benefits since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
WIC_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
(Next are some questions about assistance programs for people in need.) ^WICINTROTEXT.
INFO
(The WIC program serves low-income pregnant or nursing women, and infants and children up to age 5,
Page 134 of 163
by providing nutritious foods to supplement diets.)
SCREENER
C_AREIS ^YOUHESHE currently receiving WIC benefits^WICLT5FIL?
1. Yes
2. No
SCREENER2
Did ^YOUHESHE receive WIC benefits closing text for the second WIC screener?
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 135 of 163
EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
WIC_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving WIC
continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.
WIC_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving WIC
continously?
1. January
2. February
3. March
4. April
5. May
6. June
Page 136 of 163
7. July
8. August
9. September
10. October
11. November
12. December
WIC_BEGIN
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need assistance in
^BMONTHFILL?
1. New Child (or other dependent) or pregnancy
2. Separation, divorced or widowed
3. Job loss / layoff or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other
WIC_BEGIN_OTHER
Ask if necessary
What was the other reason?
WIC_STOP
What were the reasons ^TEMPNAME stopped receiving WIC ^SPELLEND?
1. Became ineligible because of an increase in income
2. Became ineligible because of family changes (family member left, over age limit, etc)
3. Still eligible but could not / chose not to collect
4. Became ineligible because program requirements were not met (did not attend school, job training, etc)
5. Eligibility ran out because of time limits
6. The money/benefits were not worth the trouble to continue enrollment
7. Other
Page 137 of 163
WIC_STOP_OTHER
Ask if necessary
What was the other reason?
WIC_COV
Do these benefits cover only children, only pregnant or nursing women aged 15 or older, or
both?
WIC_ADULT_COV
Ask or verify
Which woman ^DIDDOES ^PTEMPNAME benefits cover?
1. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
2. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
3. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
4. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
5. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
6. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
7. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
8. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
9. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
10. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
11. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
12. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
13. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
14. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
15. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
16. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
17. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
18. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
19. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
20. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
21. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
22. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
23. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
24. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
25. ^LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
26. Someone not listed
Page 138 of 163
WIC_KID_COV
Which child or children DODID ^PTEMPNAME benefits cover?
1. ^LNO ^FNAME ^LNAME of all childen AGE < 5 on (the final HH roster, excluding the respondent, where PEOPLE
2. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
3. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
4. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
5. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
6. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
7. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
8. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
9. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
10. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
11. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
12. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
13. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
14. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
15. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
16. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
17. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
18. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
19. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
20. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
21. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
22. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
23. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
24. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
25. ^LNO ^FNAME ^LNAME of all children AGE < 5 on (the final HH roster, excluding the respondent, where PEOPL
26. Other child not listed
NOMORESPELLS
The WIC topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
Did ^TEMPNAME receive WIC at any other times since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
Page 139 of 163
2. No
HOWMANY
We've talked about three periods of WIC receipt. How many other times did ^TEMPNAME receive
WIC since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
PRIVNUMBER
**NON-DISPLAYED ITEM**
PRIV_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
^PRIVATE_INTROQTEXT
INFO
(Private health insurance includes comprehensive medical insurance plans provided through an
Page 140 of 163
employer or union, as well as plans purchased directly from an insurance company individually or as part
of a group.)
DO NOT include plans that contain only one type of coverage, like dental-only or vision-only plans.
SCREENER
C_AREIS ^YOUHESHE currently covered by a private health insurance plan?
Do NOT include Military/VA coverage, or coverage through a Medicare Advantage (Part C) plan.
1. Yes
2. No
SCREENER2
^PRIVATE_SCREENER2QTEXT
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
Page 141 of 163
18. June ^INTYEARFIL
EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
OWNINS
? [F1]
(Health insurance plans are usually obtained in one person's name even if other family members are
covered. That person is called the policyholder.) Who ISWAS the policyholder for this plan?
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
Page 142 of 163
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
26. Someone outside of the household
PRIVTYPE
? [F1]
What ISWAS the source of ^PTEMPNAME coverage ^BETWEEN_BMONTH_EMONTH? ISWAS it
through:
Read answer list
1. an Employer or Work ^DURINGTHISTIME
2. a Former Employer
3. a Union or Association
4. Bought it directly
5. School
6. or Something else
PRIVOTH
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.
Page 143 of 163
HICOST
? [F1]
C_DOESDID ^YOURHISHER ^EMPUNION pay all, part, or none of the premium of the plan?
1. All
2. Part
3. None
PRIVUNIT
? [F1]
Other than ^TEMPNAME, who else ISWAS covered by this plan
^BETWEEN_BMONTH_EMONTH?
HIOTHR
C_DOESDID this plan also cover anyone else who ^DIDDOES NOT live in this household?
1. Yes
2. No
HIWHO
Who outside of this household ^DIDDOES the plan cover?
1. Child under 18
2. Child 18-25
3. Child 26 or over
4. Spouse/partner
5. Other
PRIVPLAN
? [F1]
C_ISWAS this plan:
Read answer list
Page 144 of 163
1. an HMO (Health Maintenance Organization)/IPA (Individual Practice Association)
2. a PPO (Preferred Provider Organization)
3. a POS (Point-of-service)
4. a Fee-for-service/Indemnity
5. some other kind of plan
HDEDPLN
Is the ^HDEDFILL1 annual deductible for medical care for this plan ^HDEDFILL2 or more?
1. Yes (^HDEDFILL2 or more)
2. No (Less than ^HDEDFILL2)
HLTHSAV
? [F1]
As part of this plan, ISWAS there a special account or fund used to pay for medical expenses?
(These accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement
Accounts (HRAs), Personal Care Accounts, Personal Medical Funds, or Choice Funds and are different
from Flexible Spending Accounts.)
1. Yes
2. No
PRIVEND
What was the reason this insurance plan coverage ended?
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with Plan
5. ^WAITING
6. Other
NOMORESPELLS
^PRIVATE_NOMOREFRNOTE
Page 145 of 163
1. Continue
ANYMORESPELLS
C_WASWERE ^TEMPNAME covered by another private health insurance plan since ^MONTH1 1st
^CALENDAR_YRFIL?
^PRIVATE_ANYMOREFIL
1. Yes
2. No
HOWMANY
^PRIVATE_HOWMANYQTEXT
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
MEDICARE_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
Page 146 of 163
^MEDICAREINTROTEXT
INFO
Respondents may confuse MediCAID, the health insurance program for low-income people, with
MediCARE. Medicare is mostly for the elderly, and it is NOT based on income. Respondents may have
both Medicare and Medicaid. Please report Medicare here, and Medicaid on the Medical Assistance
line.
SCREENER
C_AREIS ^YOUHESHE currently covered by Medicare?
Include coverage through Part C Medicare Advantage, or any other kind of Medicare plan.
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 147 of 163
EMONTH
^MEDICARE_TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
MCPART
AA
The Medicare Program contains a number of different kinds of plans. Please tell me which of
these plan types you are covered by:
Read answer list
Mark all that apply
1. Part A (Hospital Insurance)
2. Part B (Medical Insurance)
3. Medigap (Supplemental Insurance)
4. Part C (Advantage Plan)
5. Part D (Prescription Drug Coverage)
NOMORESPELLS
Page 148 of 163
The medicare topic is complete. Enter 1 to continue.
1. Continue
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
MEDICAID_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
^MEDICAIDINTROTEXT
INFO
(In this area you might be more familiar with the names ^MCAIDFIL or ^CHIPFIL.)
Respondents may have both Medicare and Medicaid. Please report Medicaid here, and Medicare
plans on the Medicare line above.
SCREENER
C_AREIS ^YOUHESHE currently covered by Medicaid, or S-CHIP, or any other government
program that helps pay health care costs for low-income people?
Page 149 of 163
1. Yes
2. No
SCREENER2
Were ^YOUHESHE covered by Medicaid, or S-CHIP, or any other government program that helps
pay health care costs for low-income people ^SCREENER2TEXT?
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
Page 150 of 163
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
MDUNIT
Other than ^TEMPNAME, who else ISWAS covered by this plan ^BETWEEN_BMONTH_EMONTH?
0. None
1. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
2. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
3. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
4. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
5. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
6. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
7. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
8. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
9. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
10. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
11. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
12. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
13. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
14. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
15. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
16. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
17. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
18. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
19. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
Page 151 of 163
20. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
21. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
22. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
23. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
24. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
25. ^LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=
26. Someone outside of the household
27. All household members
MDPLAN
? [F1]
C_ISWAS this plan:
Read answer list
1. an HMO (Health Maintenance Organization)
2. a Fee-for-service Plan
3. another Managed-care Type Program
4. some other kind of plan
MDEND
What was the reason this coverage ended?
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with Plan
5. ^WAITING
6. Other
NOMORESPELLS
The Medicaid topic is complete. Enter 1 to continue
1. Continue
ANYMORESPELLS
Page 152 of 163
WASWERE ^TEMPNAME covered by Medicaid, or S-CHIP, or any other government program that
helps pay health care costs for low-income people at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about six periods of Medicaid coverage. How many other times WASWERE
^TEMPNAME covered by Medicaid since ^MONTH1 1st ^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
MILI_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
^MILIINTROTEXT
INFO
Page 153 of 163
("CHAMPVA" is the civilian health and medical program of the Department of Veterans Affairs.)
SCREENER
C_AREIS ^YOUHESHE currently covered by any health insurance through one of those sources?
1. Yes
2. No
SCREENER2
Were ^YOUHESHE covered by health insurance provided by the military or Department of
Veterans Affairs ^SCREENER2TEXT?
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 154 of 163
EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
MILITYPE
What type of health coverage DIDDODOES ^YOUHESHE have ^BETWEEN_BMONTH_EMONTH?
Read answer list
1. TRICARE or CHAMPUS
2. CHAMPVA
3. VA
4. Other
MILIOTH
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.
MOWNINS
? [F1]
Who ISWAS the policyholder or sponsor for this plan?
Page 155 of 163
1. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
2. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
3. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
4. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
5. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
6. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
7. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
8. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
9. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
10. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
11. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
12. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
13. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
14. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
15. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
16. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
17. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
18. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
19. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
20. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
21. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
22. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
23. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
24. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
25. ^LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER
26. Someone outside of the household
MILIUNIT
Other than ^TEMPNAME, who else ISWAS covered by this plan
^BETWEEN_BMONTH_EMONTH?
MHIOTH
C_DOESDID this plan also cover anyone else who ^DIDDOES NOT live in this household?
1. Yes
2. No
Page 156 of 163
MILIEND
What was the reason this Military-based health coverage ended?
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with Plan
5. ^WAITING
6. Other
NOMORESPELLS
The military insurance topic is complete. Enter 1 to continue
1. Continue
ANYMORESPELLS
WASWERE ^TEMPNAME covered by any of these sources (such as TRICARE, CHAMPUS,
CHAMPVA, VA, or military health care) at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No
HOWMANY
We've talked about four periods of military health care coverage. How many other times
WASWERE ^TEMPNAME covered by military health care coverage Medicaid since ^MONTH1 1st
^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
SPELLNUMBER
**NON-DISPLAYED ITEM**
Page 157 of 163
PERIODNUM
**NON-DISPLAYED ITEM**
INFO
(Perhaps a government program, Indian Health Services, ^MEDASSISTFIL, or a policy through a parent,
a foreign government, or any other source.)
DO NOT include plans that contain only one type of coverage, like dental-only or vision-only plans.
SCREENER
(Other than what we've already talked about,) AREIS ^YOUHESHE currently covered by any other
type of health insurance plan?
1. Yes
2. No
SCREENER2
C_WASWERE ^YOUHESHE covered by any other type of health insurance plan at any time since
^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No
BMONTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
Page 158 of 163
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
OTHCOVTYPE
? [F1]
What type of health coverage is this?
Read answer list
1. Government/public assistance
2. Through someone else (parent, relative)
3. Foreign government/country
4. Indian Health Services
5. Other
Page 159 of 163
OTHCOVOTH
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.
OTHEND
What was the reason this insurance plan coverage ended?
1. ^EXPENSIVE
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with Plan
5. ^WAITING
6. Other
NOMORESPELLS
The other health insurance topic is complete. Enter 1 to continue.
1. Continue
ANYMORESPELLS
WASWERE ^TEMPNAME covered by another health insurance plan at any other times since
^MONTH1 1st ^CALENDAR_YRFIL? (Perhaps a government program such as ^MEDASSISTFIL, or a
policy through a parent, a foreign government, or any other source?)
1. Yes
2. No
HOWMANY
We've talked about four periods of other health care coverage. How many other times
WASWERE ^TEMPNAME covered by other health insurance since ^MONTH1 1st
^CALENDAR_YRFIL?
CTRLNUM
**NON-DISPLAYED ITEM**
LNO
**NON-DISPLAYED ITEM**
Page 160 of 163
SPELLNUMBER
**NON-DISPLAYED ITEM**
PERIODNUM
**NON-DISPLAYED ITEM**
NOCOV_RETURNING
**NON-DISPLAYED ITEM**
PWAVE_COMPLETE
**NON-DISPLAYED ITEM**
INTRO
^HIGAPS_TEXTFIL
INFO
If it looks like the respondent had one or more months without any coverage of any type, confirm this.
Then enter no coverage spells for each confirmed month/spell.
SCREENER2
^NOCOV_SCREENER2TEXT
1. Yes
2. No
BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
Page 161 of 163
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
EMONTH
^NOCOV_TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
NOMORESPELLS
The no coverage topic is complete. Enter 1 to continue.
1. Continue
Page 162 of 163
ANYMORESPELLS
I'm showing ^TEMPNAME HADHASHAVE ^OTHERTIME when ^YOUHESHE WASWERE not
covered by health insurance.
LIST REMAINING GAPS
Month Year to Month Year
OR
Month Year
Let's talk about ^THISTHOSE ^TIME_S.
Enter 1 to return to calendar and enter a new No Coverage spell.
1. Continue
HOWMANY
We've talked about six periods during which ^TEMPNAME did not have health care coverage.
How many other times WASWERE ^YOUHESHE not covered by health insurance since ^MONTH1
1st ^CALENDAR_YRFIL?
RETURNING
^RETURN_TEXT
Press '1' to continue.
1. Continue
EHC_EMONTH
**NON-DISPLAYED FIELD**
Page 163 of 163
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2012-07-24 |