Follow-Up Surveys, 18 and 36 months

Follow-Up Survey Information for Green Jobs and Health Care Impact Evaluation, American Recovery Reinvestment Act Grants

GJ-HC_EVALUATION_FOLLOW-UP_SURVEY fpr 18 and 36 months

Follow-Up Surveys, 18 and 36 months

OMB: 1205-0506

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1205-0506 can be found here:

2013-08-29 - No material or nonsubstantive change to a currently approved collection

Document [docx]

Download: docx | pdf

Ame rican Recovery and Reinvestment Act (ARRA) “Pathways Out of Poverty” and “Health Care Sector and other High Growth and Emerging Industries” Grants

Draft 18-month and 36-month Follow-Up Survey Instrument

CONTENTS

Section Page

A. INTRODUCTION AND SCREENING 1

B. employment 3

C. barriers to employment & opinions about work 18

D. service receipt & educational outcomes 22

E. financial hardship 61

F. current family status & demographics 64

G. income and receipt of public benefits 66

H. contact information 72

A. INTRODUCTION

ALL

A1 Hello, my name is [NAME]. I am calling from Mathematica Policy Research on behalf of the U.S. Department of Labor’s Employment and Training Administration. May I please speak to [SAMPLE PERSON]?

1. SPEAKING WITH SAMPLE PERSON

2. SAMPLE PERSON COMES TO PHONE

3. SPEAKING WITH SAMPLE PERSON BUT NEED TO RESCHEDULE INTERVIEW

3. SAMPLE PERSON IS UNAVAILABLE

4. SAMPLE PERSON IS NOT AT THIS PHONE NUMBER

IF A1 = 3 SCHEDULE A TIME AND CALL BACK LATER.

IF A1 = 3 CALL BACK LATER

IF A1 = 4, ASK FOR PHONE NUMBER WHERE SAMPLE CAN BE

REACHED

IF A1 = 1, DO NOT READ FILL. IF A1 = 2, READ FILL

A2. [Hello, my name is [NAME] and I am calling from Mathematica Policy Research.] As you may recall from the letter we recently mailed you, we are conducting a survey on behalf of the U.S. Department of Labor’s Employment and Training Administration, which provides funding for training programs held around the United States. We are conducting this survey to learn more about people’s training needs and experiences. Our OMB approval number for this information collection is _______ and permission to collect this data expires on ________. Responding to this questionnaire is completely voluntary. This survey will take about 40 minutes for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. All answers you give will be kept private to the extent allowed by the law, your name will never be associated with your answers, and no individual results will be calculated or presented. As a token of appreciation, we will be sending you a (check/gift card) for $25 after the interview is complete.

INTERVIEWER READ AS NEEDED: This is a follow-up to a survey you filled out about 18 months ago at [NAME OF ARRA GRANT FUNDED PROGRAM]. Your responses will be private and will not be shared with the U.S. Department of Labor, the Employment and Training Administration, or any other government agency.

BEGIN INTERVIEW

A3. To get started, I need to verify that I am speaking with the correct person. Could you please tell me your date of birth?

| | | / | | | / | | | | | GO TO A5

MONTH DAY YEAR

(01-12) (01-31) (1937-1996)

DON’T KNOW d

REFUSED r

IF A3 = DON’T KNOW OR REFUSED

A4. What are the last four digits of your Social Security Number?

DON’T KNOW d

REFUSED r

A5. PROGRAMMER: DISPLAY ON SCREEN SAMPLE PERSON’S DOB AND LAST 4 DIGITS OF SSN FROM BASELINE INFORMATION FORM

INTERVIEWER: DOES THE DOB OR LAST FOUR SSN DIGITS MATCH A3/A4?

YES 1 GO TO B1

NO 0

IF A5 = NO

A6. I will need to check our records before this interview can continue. I am sorry for the inconvenience and I thank you for your time.

END CALL

B. EMPLOYMENT

ALL

IF 18 MONTH INTERVIEW, REFER TO RANDOM ASSIGNMENT (RA) DATE.

IF 36 MONTH INTERVIEW AND RESPONDENT HAS COMPLETED 18 MONTH INTERVIEW, REFER TO 18 MONTH INTERVIEW DATE

IF 36 MONTH INTERVIEW AND RESPONDENT HAS NOT COMPLETED 18 MONTH INTERVIEW, REFER TO RA DATE

B1. Most of the questions in this interview refer back to the time that you [applied to the [NAME OF ARRA GRANT FUNDED PROGRAM]/completed an 18 month interview with us about one and one-half years ago]. That would be on [RA DATE/DATE OF THE 18-MONTH INTERVIEW]. If I say that date, can you recall things that have happened since then or would you prefer that I refer to another event around that time, such as a birthday or other special event?

OKAY TO REFER TO RA/18 MO DATE

REFER TO ANOTHER DATE NEAR THEN AND CLARIFY THAT ALTERNATIVE DATE SHOULD BE CLOSE TO 18 MONTHS AGO (SPECIFY)

REFER TO ANOTHER DATE NEAR THEN AND CLARIFY THAT ALTERNATIVE DATE SHOULD BE CLOSE TO 36 MONTHS AGO (SPECIFY)

B2. The first questions are about jobs that you have had since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW].

Are you currently working at a job for pay? Please include any full- or part-time jobs, self employment, temporary positions, odd jobs, side jobs such as babysitting, gardening, or housekeeping, under-the-table jobs, business ventures, or other types of paid jobs that you have had.

PROBE: Please remember to include any type of job that you have had for pay.

YES 1

NO 0 GO TO B3b

DON’T KNOW d GO TO B3b

REFUSED r GO TO B3b

IF B2 = 1

B3a. Do you have more than one job, including part time, evening, or weekend work?

PROBE: Please include any full- or part-time jobs, self employment, temporary positions, odd jobs, side jobs such as babysitting, gardening, or housekeeping, under-the-table jobs, business ventures, or other types of paid jobs that you have had.

YES 1

NO 0 GO TO B5

DON’T KNOW d GO TO B5

REFUSED r GO TO B5

IF B2 = 0, d, r

B3b. Which of the following best describes your work-related activities last week?

Were you…

CODE ONLY ONE

retired, ........................................................................... 01

unable to work because of a disability, .......................... 02

attending school or long-term training program, ............03

on active military duty,……...………………………,……….04

on temporary layoff (waiting for callback) .......................05

without a job, looking for work ........................................ 06

without a job, not looking for work, or .............................07

doing something else? (SPECIFY) ...................................99

DON’T KNOW ............................................................... d

REFUSED ..................................................................... r

IF B3a =1

B4. Altogether, how many jobs do you currently have?

PROBE: Again, please include any full- or part-time jobs, self employment, temporary positions, odd jobs, side jobs such as babysitting, gardening, or housekeeping, under-the-table jobs, business ventures, or other types of paid jobs that you have had.

| | | NUMBER OF CURRENT JOBS

DON’T KNOW d

REFUSED r

if b2 = 1, FILL “Including your current jobs, HOW”.

if b3A = 0, D OR R, FILL “how”

B5. [Including your current job(s)] how / How) many different jobs have you had since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW]?

PROBE: Please include any full- or part-time jobs, self employment, temporary positions, odd jobs, side jobs such as babysitting, gardening, or housekeeping, under-the-table jobs, business ventures, or other types of paid jobs that you have had.

| | | NUMBER OF JOBS

NONE 0

DON’T KNOW d

REFUSED r

FOR THOSE CURRENTLY WORKING b2 = 1

IF B3A = 0, D, R (CURRENTLY WORKS 1 JOB): FILL “Where are you currently working?”

IF B3A =1 (CURRENTLY WORKING AT MORE THAN ONE JOB): FILL “At which of your current jobs do you work the most hours?”

IF B2 ≠1 AND B5 GE 1 (NOT CURRENTLY WORKING, BUT HAD A JOB): FILL “Where did you work most recently since [RA DATE/DATE OF 18 MONTH INTERVIEW]?”

B6. [Where are you currently working? / At which of your current jobs do you work the most hours? / Where did you work most recently since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW]?]

COMPANY/EMPLOYER: (STRING 255) (JOB #1)

for those who had more than one job since ra date/18 month interview

B7. Where else have you worked since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW]?

COMPANY/EMPLOYER (STRING 255) (JOB #2)

COMPANY/EMPLOYER (STRING 255) (JOB #3)

COMPANY/EMPLOYER (STRING 255) (JOB #4)

COMPANY/EMPLOYER (STRING 255) (JOB #5)

COMPANY/EMPLOYER (STRING 255) (JOB #6)

COMPANY/EMPLOYER (STRING 255) (JOB #7)

COMPANY/EMPLOYER (STRING 255) (JOB #8)

COMPANY/EMPLOYER (STRING 255) (JOB #9)

COMPANY/EMPLOYER (STRING 255) (JOB #10)

COMPANY/EMPLOYER (STRING 255) (JOB #11)

COMPANY/EMPLOYER (STRING 255) (JOB #12)

PROGRAMMER BOX 1

BEGIN JOB LOOP: ASK B8 to B15 FOR EACH JOB LISTED AT B6 and b7

B8. What month, day, and year did you start working at [JOB NAME]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

IF RESPONDENT CAN REMEMBER WHEN IN THE MONTH THAT HE OR SHE STARTED BUT NOT THE EXACT DAY, THEN CODE RESPONSE AS B=BEGINNING, M=MIDDLE, AND E=END OF THE MONTH IN THE DAY BOX. IF RESPONDENT DOES NOT KNOW WHEN IN THE MONTH THEY STARTED, THEN ACCEPT MONTH AND YEAR ONLY.

| | | / I_ I _I / | | | | | GO TO BOX 2

MONTH DAY YEAR

DON’T KNOW d

REFUSED r

IF B8 = D, R (DON’T KNOW OR REFUSED)

B9. Do you recall what year you started working at [JOB NAME]?

| | | | |

YEAR

DON’T KNOW d

REFUSED r

PROGRAMMER BOX 2

ASK B10-B15 FOR non current JOBS #2 – #12

IF B2 = 1 (CURRENTLY EMPLOYED), SKIP B10 & B11 FOR JOB #1;

if b3a = 1 (more than 1 current job), skip b10 & b11 for all current jobs (job #2+);

IF B2 (NOT CURRENTLY EMPLOYED): at b10 FILL [JOB NAME] WITH JOB #1

IF B2 Ne 1 (NOT CURRENTLY WORKING); start B10 with job #1 and ask for ALL OTHER JOBS.

programmers: CATI check to make sure that stop date of the job (month, day, and year or year only) is after the RA date. Or, in the case of the 36-month survey, after the RA date/18-month interview date.

also be sure that end date is after start date.

B10. What month, day, and year did you stop working for [JOB NAME]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | GO TO B12

MONTH DAY YEAR

DON’T KNOW d

REFUSED r

B11. Do you recall what year you stopped working for [JOB NAME]?

| | | | |

YEAR

DON’T KNOW d

REFUSED r

For EACH JOB

B12. How many hours did you work in a typical week when you first started at [JOB NAME]? Please include any regular overtime hours.

| | | HOURS PER WEEK

DON’T KNOW d

REFUSED r

For EACH JOB

IF CURRENT JOB: fill “do” and “now”

if PREVIOUS JOB: FILL “DId” and “JUST BEFORE YOU LEFT”

B13. And, how many hours (do/did) you work in a typical week at [JOB NAME] (now/just before you left)? Again, please include any regular overtime hours.

| | | HOURS PER WEEK

DON’T KNOW d

REFUSED r

B13a. (Do/Did) you usually work a regular daytime schedule or some other schedule at [JOB NAME]?

A REGULAR DAYTIME SCHEDULE (ANYTIME BETWEEN 6AM TO 6PM) 1 GO TO B13C

SOME OTHER SCHEDULE 2 ASK B13B

DON’T KNOW d

REFUSED r

B13b. Which of the following best describes the hours you usually (work/worked) at [JOB NAME]?

A regular evening shift (Anytime between 2 pm to Midnight), 1

A regular night shift (Anytime around 9pm to 8am), 2

A rotating shift - one that changes periodically from day to evenings or night, 3

A split shift - one consisting of two distinct periods each day, 4

An irregular schedule arranged by employer, or 5

Some other schedule? (SPECIFY) 99

(STRING (NUM))

DON’T KNOW d

REFUSED r

B13c. (Is/Was) this job part of a defined career path at the company, with opportunities for promotion? A “defined career path” is the specific path for an occupation in which there are opportunities for promotions or job advancement based on work experience or performance, or on the attainment of additional occupational certificates, licenses, or credentials. These opportunities might be available either at the company you worked for or through switching jobs to work for a different company. Please note that receiving pay raises or cost-of-living increases on an occasional basis is not the same as having a defined career path, since a defined career path is based on work experience or the receipt of additional certificates, licenses, or credentials.

YES 1

NO 0

DON’T KNOW d

REFUSED r

For each job

B14. How much did you earn, before taxes and other deductions, when you started at [JOB NAME]? Please include tips, commissions, bonuses, and regular overtime.

INTERVIEWER: ACCEPT MOST CONVENIENT PAY PERIOD. IF NECESSARY, CONFIRM PAY PERIOD.

WHEN ENTERING AN AMOUNT IN DOLLARS AND CENTS, BE SURE TO INCLUDE THE DECIMAL POINT.

AMOUNT $ |__| | |, | | | |.| | |

INSERT DROPDOWN:

INCLUDE RANGE CHECK

PER HOUR 01

PER WEEK 02

PER YEAR 03

ONCE EVERY TWO WEEKS 04

TWICE A MONTH 05

PER MONTH 06

IN-KIND ONLY 07

NOT YET PAID 08

PER DAY 09

PER JOB 10

COMMISSION 11

COMMISSION PLUS (PER HOUR) 12

COMMISSION PLUS (PER WEEK) 13

COMMISSION PLUS (PER MONTH) 14

COMMISSION PLUS (PER YEAR) 15

SOME OTHER PAY PERIOD 16

DON’T KNOW d

REFUSED r

IF CURRENT JOB: fill “do” and “NOW”

if PREVIOUS JOB: FILL “DId” and “just before you left”

B15. And how much (do/did) you earn, before taxes and other deductions, at [JOB NAME] (now/just before you left)? Again please include tips, commissions, bonuses, and regular overtime.

INTERVIEWER: ACCEPT MOST CONVENIENT PAY PERIOD. IF NECESSARY, CONFIRM PAY PERIOD.

WHEN ENTERING AN AMOUNT IN DOLLARS AND CENTS, BE SURE TO INCLUDE THE DECIMAL POINT.

AMOUNT $ |__| | |, | | | |.| | |

INSERT DROPDOWN:

include range check

PER HOUR 01

PER WEEK 02

PER YEAR 03

ONCE EVERY TWO WEEKS 04

TWICE A MONTH 05

PER MONTH 06

IN-KIND ONLY 07

NOT YET PAID 08

PER DAY 09

PER JOB 10

COMMISSION 11

COMMISSION PLUS (PER HOUR) 12

COMMISSION PLUS (PER WEEK) 13

COMMISSION PLUS (PER MONTH) 14

COMMISSION PLUS (PER YEAR) 15

SOME OTHER PAY PERIOD 16

DON’T KNOW d

REFUSED r

PROGRAMMER BOX 3

ASK B16-B21 FOR JOBS UNDER THE FOLLOWING CONDITIONS:

IN 18 MONTH IW:

ALWAYS ASK ABOUT FIRST JOB SINCE RA

AND, IF WORKING AT 18 MONTH, ASK ABOUT CURRENT PRIMARY JOB

OR, IF NOT WORKING AT 18 MONTH, ASK ABOUT MOST RECENT PRIOR JOB

IF NOT WORKING AT 18 MONTH AND HAD PREVIOUS MULTIPLE JOBS, PRIORITIZE MOST RECENT PRIOR JOB AS ONE IN WHICH THE RESPONDENT WORKED THE MOST HOURS

IN 36 MONTH IW (IF 18 MONTH IS COMPLETED):

ALWAYS ASK ABOUT CURRENT PRIMARY JOB

AND, IF NOT WORKING AT 36 MONTH, ASK ABOUT MOST RECENT PRIOR JOB

IF NOT WORKING AT 18 MONTH AND HAD PREVIOUS MULTIPLE JOBS, PRIORITIZE MOST RECENT PRIOR JOB AS ONE IN WHICH THE RESPONDENT WORKED THE MOST HOURS

IF NO JOBS REPORTED IN 18-MONTH INTERVIEW, ALSO ASK ABOUT 1^ST JOB AFTER RA

IN 36 MONTH IW (IF 18 MONTH IS NOT COMPLETED): SAME AS IN 18 MONTH

FOR first job since [RA DATE/date of 18 month interview] AND CURRENT PRIMARY JOB;

if no current primary job, ask about most recent prior job

B16. In what city and state (is/was) [JOB NAME] located?

PROBE: In what city and state did you perform the majority of your work?

[explore use of blaise Trigram search capability FOR CITY; if not feasible, LIST THE NAME OF THE CITY WHERE GRANTEE PROGRAM IS LOCATED and neighboring cities. ALLOW “SPECIFy OTHER” OPTION. (e.g., gRAND rAPIDS, mi; Bakersfield, ca; mINNEAPOLIS, mn; St. Paul, MN, Gainesville, TX; Corinth, TX; Flower Mound, TX; Bowie, TX and Graham, TX, etc)

DON’T KNOW d

REFUSED r

FOR first job since [RA DATE/date of 18 month interview] AND CURRENT PRIMARY JOB;

if no current primary job, ask about most recent prior job

B17. What kind of company is [JOB NAME]? What do they make, do, or sell?

PROBE, IF NECESSARY: What was the major product or service of [JOB NAME].

(STRING 255)

DON’T KNOW d

REFUSED r

FOR first job since [RA DATE/date of 18 month interview] AND CURRENT PRIMARY JOB;

if no current primary job, ask about most recent prior job

B18. Please briefly describe what you [do / did] at [JOB NAME]? What [are / were] your most important duties?

(STRING 255)

DON’T KNOW d

REFUSED r

FOR first job since [RA DATE/date of 18 month interview] AND CURRENT PRIMARY JOB;

if no current primary job, ask about most recent prior job

B19. [Are/Were] you covered or represented by a union at your job with [JOB NAME]?

PROBE: On some jobs you might be represented by a union, even if you are not a union member.

YES 1

NO 0

DON’T KNOW d

REFUSED r

FOR first job since [RA DATE/date of 18 month interview] AND most recent prior job if noT A current JOB. ask b20-b20d about all jobs selected through programmer box 3 that are not current jobs, regardless of whether or not the respondent has any current job.

B20. What was the main reason your job at [JOB NAME] ended? Was it because you were laid off, you retired, you were discharged or fired, you quit, or was there some other reason?

CODE ONE ONLY

laid off 01 GO TO B20a

(INCLUDE / REORGANIZATION/ DOWNSIZING/ COMPANY SOLD/ COMPANY MOVED/ COMPANY WENT OUT OF BUSINESS / PLANT OR FACILITY MOVED OR CLOSED/ END OF TERM IN SERVICE/ ENLISTMENT UP/ REDUCTION IN FORCE OR RIF’ED/ JOB/POSITION ELIMINATED)

RETIRED 02 GO TO B21

DISCHARGED OR FIRED 03 GO TO B21

QUIT 04 GO TO B21

SOME OTHER REASON (SPECIFY) 05 GO TO B21

(STRING 80)

COMMON PRECODES:

GOT A BETTER JOB 06 GO TO B21

MOVED 07 GO TO B21

HAD HEALTH PROBLEMS 08 GO TO B21

RETURNED TO SCHOOL 09 GO TO B21

NEEDED TO TAKE CARE OF A FAMILY MEMBER 10 GO TO B21

JOB COMPLETED/TEMP WORK/SEASONAL WORK/WORK PERIOD ENDED 11 GO TO B21

DON’T KNOW d GO TO B21

REFUSED r GO TO B21

IFB20 = 1 (LAID OFF)

B20a. Which of the following best describes the reason that you were laid off?

READ ALL CATEGORIES BEFORE ACCEPTING ANSWER.

CODE ONE ONLY

The company moved or closed, 1

The plant or facility moved or closed, 2

Your job or shift was eliminated, 3

There was a lack of work, 4

There was a strike, or 5

Was there some other reason? (SPECIFY) [specify] 99

COMMON PRECODES:

EMPLOYER SAID RESPONDENT COULDN’T DO JOB ANYMORE 6 GO TO B21

TEMPORARILY CLOSED/CLOSED FOR INVENTORY 7

TEMPORARY WORKER 8

DISPUTE WITH MANAGEMENT 9

POOR WORK PERFORMANCE 10

WEATHER 11

COMPANY DOWNSIZING 12

COMPANY BOUGHT/SOLD/MERGED OR REORGANIZED/ RESTRUCTURED 13

OUTSOURCED/JOB SENT OVERSEAS 14

COMPANY FINANCES/BUDGET CUTS/BANKRUPT 15

DON’T KNOW d

REFUSED r

B20b. At the time that you were laid off, did you expect to go back to that job?

PROBE: Did you think it would be a temporary layoff?

YES 1

NO 0 GO TO B20d

DON’T KNOW d GO TO B20d

REFUSED r GO TO B20d

B20c. When you were laid off, were you given a specific date to return to work?

YES 1

NO 0

DON’T KNOW d

REFUSED r

B20d. Did you actually go back to that job?

YES 3

NO, Still waiting for the recall…………………………………………….. 2

NO, Did not go back and do not expect to 1

DON’T KNOW d

REFUSED r

FOR first job since [RA DATE/date of 18 month interview] AND CURRENT PRIMARY JOB;

if no current primary job, ask about most recent prior job

B21. (Are/Were) any of the following benefits available to you at [FILL JOB NAME]? If you (had) wanted it, (could you receive/could you have received)


	YES	NO	DON’T KNOW	REFUSED
a. Health insurance?	1	0	d	r
IF B21a = 1 (YES) a.1 Did you take this health insurance coverage?	1	0	d	r
IF B21a.1 = 1 AND CURRENT JOB a.2 Are you currently covered by this health insurance?	1	0	d	r
b. Paid vacation?	1	0	d	r
c. Paid holidays?	1	0	d	r
d. Paid sick days?	1	0	d	r
e. Retirement or pension benefits?	1	0	d	r

IF B21A.2 ≠ 1

B22. Have you been covered by health insurance at any time since [RA DATE / DATE OF 18-MONTH INTERVIEW]?

YES 1

NO 0 GO TO C1

DON’T KNOW d GO TO C1

REFUSED r GO TO C1

B23. Have you been covered by health insurance for the entire period since [RA DATE / DATE OF 18-MONTH INTERVIEW)]?

YES 1 GO TO B25

NO 0

DON’T KNOW d

REFUSED r

If B23 = 0, d, r

B24. For approximately how many months since [RA DATE / DATE OF 18-MONTH INTERVIEW) were you covered by health insurance?

| | | NUMBER OF MONTHS

CATI: CHECK THAT NUMBER OF MONTHS IS 18 FOR 18-MONTH INTERVIEW AND 36 FOR 36-MONTH INTERVIEW

DON’T KNOW d

REFUSED r

B25. I am going to read you a list of sources of insurance. Please tell me which one describes the main source of health insurance or health coverage that you have had since [RA DATE/DATE OF 18-MONTH INTERVIEW] Is it ..

IF SAMPLE MEMBER GIVES MORE THAN ONE, PROBE:”WHICH OF THOSE WAS THE PRIMARY COVERAGE?” ”

IF SAMPLE MEMBER TELLS YOU THE NAME OF THEIR HEALTH INSURANCE PLAN, READ ANSWER CHOICES AGAIN AND STRESS THAT THE QUESTION IS ASKING WHAT TYPE OF HEALTH INSURANCE THEY HAD, NOT THE NAME OF THEIR INSURANCE CARRIER.

PLEASE TELL ME WHICH ONE OF THESE SOURCES OF INSURANCE DESCRIBES YOUR [PLAN NAME] PLAN

CODE ONLY ONE

from your current or former employer, union, or school? 1

from your spouse’s current or former employer, union, or school? 2

bought on your own,

from a professional association. 3

provided by your parent or guardian 4

Medicare, the health insurance plan for people 65 years old and older, or persons with certain disabilities? 5

Medicaid, a government assistance program that pays for health care, 6

another state specific plan, 7

VA, CHAMPUS, CHAMP-VA, TRICARE, or some other military care, or 8

Indian health service? 9

HEALTH COVERAGE TAX CREDIT (HCTC) 10

OTHER (SPECIFY) 99

STRING (100)

DON’T KNOW d

REFUSED r

C. BARRIERS TO EMPLOYMENT AND
OPINIONS ABOUT WORK

In this next set of questions, we are interested in learning more about your household and issues that may affect your ability to work.

C1. How many people, including yourself, currently make up your household? By household, we mean people who live together and share finances.

| | | # PEOPLE IN HOUSEHOLD

DON’T KNOW d

REFUSED r

IF C1 > 1

C2. How many members of your household are children under 12?

| | | # CHILDREN UNDER 12

NONE 0

DON’T KNOW d

REFUSED r

IF C2 >= 1

If C2 = 0, d, r then skip to C5

C3. Would you say finding quality child care you can afford has limited your ability to work during the past month…

Very much, 1

A little, or 2

Not at all? 3

DON’T KNOW d

REFUSED r

IF C2 >= 1

C4. Would you say finding quality child care you can afford has limited your ability to work between [RA DATE] and [BEFORE THE PAST MONTH] …

Very much, 1

A little, or 2

Not at all? 3

DON’T KNOW d

REFUSED r

C5. Would you say problems with transportation have limited your ability to work during the past month…

IF NECESSARY: Transportation may be by car, bus, subway, bike, or other modes. This includes availability and cost.

Very much, 1

A little, or 2

Not at all? 3

DON’T KNOW d

REFUSED r

C6. Would you say problems with transportation have limited your ability to work between [RA DATE] and [BEFORE THE PAST MONTH] …

IF NECESSARY: Transportation may be by car, bus, subway, bike, or other modes. This includes availability and cost.

Very much, 1

A little, or 2

Not at all? 3

DON’T KNOW d

REFUSED r

C7. Do you have a physical, emotional, or other health condition that has limited the kind or amount of work you could do during the past month?

YES 1

NO 0

DON’T KNOW d

REFUSED r

C8. Do you have a physical, emotional, or other health condition that has limited the kind or amount of work you could do between [RA DATE] and [BEFORE THE PAST MONTH]?

YES 1

NO 0

DON’T KNOW d

REFUSED r

C9. Are there any other personal barriers you face that have limited the kind or amount of work you could do since [RA DATE] ?

LACK OF EDUCATION 1

LACK OF WORK HISTORY 2

DISABILITY 3

LANGUAGE BARRIERS 4

CARING FOR AN ELDERLY FAMILY MEMBER 5

HOMELESSNESS 6

SUBSTANCE ABUSE 7

CRIMINAL HISTORY 8

RACIAL/ETHNIC/GENDER DISCRIMINATION 9

OTHER (SPECIFY) 99

______________________________________________(STRING 65)

NONE 0

DON’T KNOW d

REFUSED r

C10. How much must a job pay per hour for it to make sense for you to take it?

IF NECESSARY: What is the lowest hourly wage you are willing to accept? Think about the costs of taking a job, which might include child care and transportation.

Allow respondent to indicate a weekly, monthly, or yearly salary if they prefer.

$| | | | , | | | |.| | |

PER HOUR 1

PER WEEK 2

PER MONTH 3

PER YEAR 4

DON’T KNOW d

REFUSED r

ASK C11-C14 FOR MI PARTICIPANTS ONLY

In this section, we are interested in learning about other issues that may affect employment, such as past arrests or criminal convictions. Please be assured that all responses to these questions will be kept private and will never be associated with your name.

MI ONLY

C11. How many times have you been convicted of a felony since [RA DATE / DATE OF 18-MONTH INTERVIEW], if any?

| | | TIMES

NONE 0

DON’T KNOW d

REFUSED r

MI ONLY

C12. How many parole or probation violations have you had since [RA DATE / DATE OF 18-MONTH INTERVIEW], if any?

| | | TIMES

NONE 0

DON’T KNOW d

REFUSED r

MI ONLY

C13. How many new arrests have you had since [RA DATE / DATE OF 18-MONTH INTERVIEW)], if any?

| | | TIMES

NONE 0

DON’T KNOW d

REFUSED r

MI ONLY

C14. How long have you been incarcerated since [RA DATE / DATE OF 18-MONTH INTERVIEW)], if at all?

| | | NUMBER OF DAYS/MONTHS

NONE 0

DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

DON’T KNOW d

REFUSED r

D. SERVICE RECEIPT AND EDUCATIONAL OUTCOMES

ALL

IF 18 MONTH INTERVIEW, REFER TO RANDOM ASSIGNMENT (RA) DATE.

IF 36 MONTH INTERVIEW AND RESPONDENT HAS COMPLETED 18 MONTH INTERVIEW, REFER TO 18 MONTH INTERVIEW DATE

IF 36 MONTH INTERVIEW AND RESPONDENT HAS NOT COMPLETED 18 MONTH INTERVIEW, REFER TO RA DATE

D1. In this next set of questions we are interested in the types of classes, courses or trainings you have participated in over the past [18 months / 3 years]. To begin, since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW], have you attended any. . .

D1a. ...adult basic education classes, English language learning classes, or GED classes? Adult basic education classes are for improving fundamental reading and math skills and GED classes help you prepare for the GED test.

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF R REPORTED AT LEAST A HIGH SCHOOL DIPLOMA DURING RANDOM ASSIGNMENT (IN THE BASELINE INFORMATION FORM), SKIP D1B AND ASK D1C

D1b. What about classes to prepare for a regular high school diploma - - have you attended any of these since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW]?

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF R REPORTED COLLEGE DEGREE IN BASELINE INFORMATION FORM, FILL “ANOTHER”

D1c. And what about courses for credit towards (a / another) college degree? Please do not include recreational courses, classes preparing for the GED, or other kinds of courses that don’t provide credit towards a college degree. Have you attended any “for credit” college courses since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW]?

YES 1

NO 0

DON’T KNOW d

REFUSED r

D1d. What about vocational courses or training programs for a specific job, trade, or occupation? By vocational training, we mean courses or programs where you are trained for a specific occupation. This training usually leads to a certificate, license, or credential in a specified field. Please do not include on-the-job training or unpaid work experience because we’ll ask about that later in the survey. Please only include training that was not for college credit. Since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW] have you attended any vocational or job-specific training programs?

YES 1

NO 0

DON’T KNOW d

REFUSED r

D1e. And what about courses focusing on study skills, workplace skills, or general life skills? Here we mean courses on how to be a successful student, how to take tests, how to manage your time, how to work well within a team, how to manage your finances, how to be a good employee, and other skills of that nature. We’re only talking about courses we have not yet discussed.

YES 1

NO 0

DON’T KNOW d

REFUSED r

ASK D2 IF RESPONDENT WAS RANDOMLY ASSIGNED INTO THE TREATMENT CONDITION AND D1A and D1B and D1C and D1D and D1E ALL = NO OR SOME WERE SKIPPED AND REMAINING ITEMS ALL = NO

D2. Our records indicate that approximately [18 months/3 years] ago, you participated in the [NAME OF ARRA GRANT FUNDED PROGRAM] offered by [NAME OF ARRA GRANT FUNDED PROGRAM PROVIDER]. Do you remember participating in that training program?

YES 1

NO 0 GO TO D4

DIDN’T PARTICIPATE IN TREATMENT CONDITION 2 GO TO D4

STARTED BUT DIDN’T COMPLETE 3

DON’T KNOW d

REFUSED r

IF D2 = 1 or 3

D3. What type of classes did you take at [INSERT SITE NAME]? Were they adult basic education classes (such as foundational reading and math, English language learning, or preparation for the GED), and/or were they classes toward a regular high school diploma, or courses for credit towards a college degree, or were they vocational courses or training for a specific job, trade, or occupation, and/or were they courses focusing on study skills, workplace skills, or general life skills?

ADULT BASIC EDUCATION 1

TOWARD A REGULAR HIGH SCHOOL DIPLOMA 2

COURSE FOR COLLEGE CREDIT 3

VOCATIONAL COURSE / JOB-SPECIFIC TRAINING PROGRAM 4

COURSES FOCUSING ON STUDY SKILLS, WORKPLACE SKILLS, OR GENERAL LIFE SKILLS 5

DON’T KNOW d

REFUSED r

IF D1A = 1 OR D3 = 1

D4. How many adult basic education courses have you participated in since [RA DATE / DATE OF 18 MONTH INTERVIEW]? If the classes were held over multiple sessions, please count that as one course.

| | | COURSES

DON’T KNOW d

REFUSED r

IF D1B = 1 or D3 =2

D5. How many different high school diploma preparation courses have you participated in since [RA DATE / DATE OF 18 MONTH INTERVIEW]? If this course involved multiple classes/sessions, please count that as one course.

| | | COURSES

DON’T KNOW d

REFUSED r

IF D1C = 1 or D3 = 3

D6. How many “for credit” college courses have you participated since [RA DATE / DATE OF 18 MONTH INTERVIEW]?

INTERVIEWER, IF ASKED: Recall, this can include courses offered by a community college, a 2-year or a 4-year college on the campus or offered on-line.

| | | COURSES

DON’T KNOW d

REFUSED r

IF D1D = 1 or D3 = 4

D7. How many vocational courses or job-specific training courses have you participated in since [RA DATE / DATE OF 18 MONTH INTERVIEW]? By vocational training, we mean courses or programs where you are trained for a specific occupation. This training usually leads to a certificate, license, or credential in a specified field. Recall, these training courses or programs are for a specific job, trade or occupation but do NOT include on-the-job training or unpaid work experience. Only include training that was not for college credit. If you have taken multiple courses for one certification/program, please count each one as a separate course.

| | | COURSES

DON’T KNOW d

REFUSED r

If D1E = 1 or D3 = 5

D8. And how many courses focusing on study, workplace, or general life skills have you participated in since [RA DATE / DATE OF 18 MONTH INTERVIEW]?

| | | COURSES

DON’T KNOW d

REFUSED r

IF “YES” IN D1A -D1E or D3 ≠ d, r

D9. I am now going to ask you a few questions about the training (program/programs) or (course/courses) you mentioned above. If you don’t know the exact information, your best guess is fine.

IF D1A = 1 or D3 = 1

IF D4>1, FILL “these courses.”

D9a. Starting with the adult basic education classes, please tell me who offered [this course/these courses]?

IF PROVIDER UNKNOWN, PROBE: Where did you attend this training?

ONE: ___________________________________________ (STRING 100)

TWO: ___________________________________________ (STRING 100)

THREE: _________________________________________ (STRING 100)

FOUR: __________________________________________ (STRING 100)

FIVE: ___________________________________________ (STRING 100)

IF NOT OBVIOUS ASK FOR EACH:

D9b. And what type of place is [FILL NAME OF PROVIDER IN (ONE / TWO / THREE / FOUR / FIVE)]?

SELECT ONE FOR EACH (ONE / TWO / THREE / FOUR / FIVE)

COMPANY WHERE RESPONDENT WORKS 1

COMMUNITY COLLEGE/2 YR COLLEGE 2

4 YR COLLEGE OR UNIVERSITY 3

STATE UNEMPLOYMENT OR EMPLOYMENT OFFICE 4

ONE-STOP CENTER 5

ADULT EDUC / ADULT HS / COMMUNITY SCHOOL / NIGHT SCHOOL 7

PRIVATE COMPANY THAT PROVIDES TRAINING 8

COMMUNITY BASED ORG / NON-PROFIT ORG 9

SOME PLACE ELSE (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D1B = 1 or D3 = 2

IF D5>1, FILL ”courses”

D9c. (Who / And who) offered the high school diploma preparation [course/courses]?

IF PROVIDER UNKNOWN, PROBE: Where did you attend [this course/ courses]?

ONE: ___________________________________________ (STRING 100)

TWO: ___________________________________________ (STRING 100)

THREE: _________________________________________ (STRING 100)

FOUR: __________________________________________ (STRING 100)

FIVE: ___________________________________________ (STRING 100)

IF NOT OBVIOUS ASK FOR EACH:

D9d. And what type of place is [FILL NAME OF PROVIDER IN (ONE / TWO / THREE / FOUR / FIVE)]?

SELECT ONE FOR EACH (ONE / TWO / THREE / FOUR / FIVE)

COMPANY WHERE RESPONDENT WORKS 1

COMMUNITY COLLEGE/2 YR COLLEGE 2

4 YR COLLEGE OR UNIVERSITY 3

STATE UNEMPLOYMENT OR EMPLOYMENT OFFICE 4

ONE-STOP CENTER 5

ADULT EDUC / ADULT HS / COMMUNITY SCHOOL / NIGHT SCHOOL 7

PRIVATE COMPANY THAT PROVIDES TRAINING 8

COMMUNITY BASED ORG / NON-PROFIT ORG 9

SOME PLACE ELSE (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D1C = 1 or D3 =3

D9e. Who offered the college credit courses?

IF PROVIDER UNKNOWN, PROBE: Where did you take these classes?

ONE: ___________________________________________ (STRING 100)

TWO: ___________________________________________ (STRING 100)

THREE: _________________________________________ (STRING 100)

FOUR: __________________________________________ (STRING 100)

FIVE: ___________________________________________ (STRING 100)

IF NOT OBVIOUS ASK FOR EACH:

D9f. And what type of place is [FILL NAME OF PROVIDER IN (ONE / TWO / THREE/FOUR/FIVE)]?

SELECT ONE FOR EACH (ONE / TWO / THREE / FOUR / FIVE)

COMPANY WHERE RESPONDENT WORKS 1

COMMUNITY COLLEGE/2 YR COLLEGE 2

4 YR COLLEGE OR UNIVERSITY 3

STATE UNEMPLOYMENT OR EMPLOYMENT OFFICE 4

ONE-STOP CENTER 5

ADULT EDUC / ADULT HS / COMMUNITY SCHOOL / NIGHT SCHOOL 7

PRIVATE COMPANY THAT PROVIDES TRAINING 8

COMMUNITY BASED ORG / NON-PROFIT ORG 9

SOME PLACE ELSE (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

ASK FOR EACH:

D9g. What type of job, trade or occupation does the course or program qualify you to perform?

__________________________(STRING 65)

DON’T KNOW d

REFUSED r

IF D1D = 1 or D3 = 4

D9h. Who offered the vocational courses or the training programs for a specific job, trade, or occupation?

IF PROVIDER UNKNOWN, PROBE: Where did you take these classes?

ONE: ___________________________________________ (STRING 100)

TWO: ___________________________________________ (STRING 100)

THREE: _________________________________________ (STRING 100)

FOUR: __________________________________________ (STRING 100)

FIVE: ___________________________________________ (STRING 100)

IF NOT OBVIOUS, ASK FOR EACH:

D9i. And what type of place is [FILL NAME OF PROVIDER IN (ONE / TWO / THREE / FOUR / FIVE ]?

COMPANY WHERE RESPONDENT WORKS 1

COMMUNITY COLLEGE/2 YR COLLEGE 2

4 YR COLLEGE OR UNIVERSITY 3

STATE UNEMPLOYMENT OR EMPLOYMENT OFFICE 4

ONE-STOP CENTER 5

ADULT EDUC / ADULT HS / COMMUNITY SCHOOL / NIGHT SCHOOL 7

PRIVATE COMPANY THAT PROVIDES TRAINING 8

COMMUNITY BASED ORG / NON-PROFIT ORG 9

SOME PLACE ELSE (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

ASK FOR EACH:

D9j. What type of job, trade or occupation does the course or program qualify you to perform?

__________________________(STRING 65)

DON’T KNOW d

REFUSED r

IF D1E = 1 or D3 = 5

D9k. Who offered the courses focusing on study, workplace, or general life skills?

IF PROVIDER UNKNOWN, PROBE: Where did you take these classes?

ONE: ___________________________________________ (STRING 100)

TWO: ___________________________________________ (STRING 100)

THREE: _________________________________________ (STRING 100)

FOUR: __________________________________________ (STRING 100)

FIVE: ___________________________________________ (STRING 100)

IF NOT OBVIOUS, ASK FOR EACH:

D9l. And what type of place is [FILL NAME OF PROVIDER IN (ONE / TWO / THREE / FOUR / FIVE ]?

COMPANY WHERE RESPONDENT WORKS 1

COMMUNITY COLLEGE/2 YR COLLEGE 2

4 YR COLLEGE OR UNIVERSITY 3

STATE UNEMPLOYMENT OR EMPLOYMENT OFFICE 4

ONE-STOP CENTER 5

ADULT EDUC / ADULT HS / COMMUNITY SCHOOL / NIGHT SCHOOL 7

PRIVATE COMPANY THAT PROVIDES TRAINING 8

COMMUNITY BASED ORG / NON-PROFIT ORG 9

SOME PLACE ELSE (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D1A = 1 OR D3 = 1

D10. In this next set of questions we are going to focus on when you took the adult education course/courses. Again, if you don’t know the exact information, your best guess is fine.

PROGRAMMER NOTE: REPEAT D10A –D10L FOR EACH ADULT BASIC EDUCATION TRAINING PROGRAM SPECIFIED IN D4

D10a. When did you start taking the adult basic education course offered by [FILL PROVIDER]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

If respondent can remember when in the month he or she started but not the exact day, then code response as B=beginning, M=middle, and E=end of the month in the Day response box. If respondent does not know when in the month they started, then accept month and year only.

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

D10b. Did you complete the course, are you still taking it, or did you stop taking it?

COMPLETED THE COURSE 1

STILL TAKING THE COURSE 2

STOPPED TAKING THE COURSE/DROPPED OUT 3

DON’T KNOW d

REFUSED r

IF D10B = 1,2 (FILL “DID” IF 1, “WILL” IF 2)

D10c. When (did/will) that course end?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D10B = 3

D10d. When did you stop taking the course?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D10B = 3

D10e. What was the main reason that you stopped taking the course?

POOR GRADES 1

COURSES OR PROGRAM POORLY TAUGHT 2

STARTED OTHER SCHOOL/TRAINING 3

NOT ENOUGH MONEY TO CONTINUE 4

NOT ENOUGH TIME TO CONTINUE 5

NOT INTERESTED / DIDN’T LIKE PROGRAM 6

DIDN’T THINK IT WOULD HELP ME FIND A JOB 7

ILLNESS 8

PREGNANCY 9

CHILD CARE ISSUES 10

OTHER FAMILY REASONS 11

TRANSPORTATION / LOGISTICAL PROBLEMS 12

PERSONAL PROBLEMS 13

FOUND JOB/RE-EMPLOYED 14

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D10B = 1

D10f. Did you take and pass a test for a GED or receive some other type of certificate?

YES – GED 1

YES – OTHER 2

NO – TOOK GED TEST BUT DID NOT PASS IT 3

NO – TOOK OTHER TEST BUT DID NOT PASS IT OR RECEIVE A CERTIFICATE 4

NO – DID NOT TAKE A TEST 5

NO – NO CERTIFICATE IS OFFERED 6

DON’T KNOW d

REFUSED r

IF “YES” IN D1A (FILL “paid” IF D10B = 1,3. FILL “is paying” IF D10B = 2)

D10g. Finally, who (paid/is paying) for the course tuition or fees? Please do not include the payment for books and other materials.

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET.

SELECT ALL THAT APPLY

RESPONDENT / RESPONDENT’S FAMILY (Out of Pocket) 1

SCHOLARSHIP OR FUNDING FROM PROVIDER 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

TUITION IS FULLY COVERED BUT DON’T KNOW SOURCE…… 7

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF >1 RESPONSE TO D10G

D10h. Of these, which paid the largest share of the costs?

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

RESPONDENT / RESPONDENT’S FAMILY (Out of Pocket) 1

SCHOLARSHIP OR FUNDING FROM PROVIDER 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

OTHER (SPECIFY) 99

(STRING 65)

EQUAL 77

DON’T KNOW d

REFUSED r

IF D10G = 1

IF “YES” IN D1A (FILL “do” IF D10B = 2. FILL “did” IF D10B = 1,3.)

D10i. How much (do/did) you or your family pay out of pocket for this course?

$ | | | , | | | |

DON’T KNOW d

IF D10G = 1

IF “YES” IN D1A (FILL “do” IF D10B = 2. FILL “did” IF D10B = 1,3.)

D10j. What portion of the tuition (do/did) you or your family cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

______________________________(String 65)

DON’T KNOW d

REFUSED r

IF D10G = 6

IF “YES” IN D1A (FILL “is/are receiving” IF D10B = 2. FILL “was/received” IF D10B = 1,3

D10k. What (is/was) the total dollar amount of student loans you (are receiving/received) to pay for this course?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D10G = 6

IF “YES” IN D1A (FILL “do” IF D10B = 2. FILL “did” IF D10B = 1,3

D10l. What portion of the tuition (do/did) the student loans cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

____________________(STRING 65)

DON’T KNOW d

REFUSED r

IF D1B = 1 OR D3 = 2

D11. In this next set of questions we are going to focus on when you took the high school diploma preparation courses. Again, if you don’t know the exact information, your best guess is fine.

PROGRAMMER NOTE: REPEAT D11A – D11M FOR EACH HIGH SCHOOL DIPLOMA PREPARATION COURSE SPECIFIED IN D5

D11a. When did you start taking the high school diploma preparation course offered by [FILL PROVIDER]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

IF A RESPONDENT CAN REMEMBER WHEN IN THE MONTH HE OR SHE STARTED BUT NOT THE EXACT DAY THEN CODE RESPONDENT AS B=BEGINNING, M=MIDDLE, E=END OF THE MONTH IN THE DAY RESPONSE BOX. IF RESPONDENT DOES NOT KNOW WHEN IN THE MONTH THEY STARTED, THEN ACCEPT MONTH AND YEAR ONLY.

| | | / I_I_I / | | | | | MONTH / DAY/ YEAR

DON’T KNOW d

REFUSED r

D11b. Did you complete the course, are you still taking classes, or did you stop attending?

COMPLETED THE COURSE 1

STILL TAKING THE COURSE 2

STOPPED TAKING THE COURSE/DROPPED OUT 3

DON’T KNOW d

REFUSED r

IF D11B = 1,2 (FILL “DID” IF 1, “WILL” IF 2)

D11c. When (did/will) the course end?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D11B = 3

D11d. When did you stop taking the high school diploma preparation course?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I__I_ I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D11B = 3

D11e. What was the main reason that you stopped taking classes?

POOR GRADES 1

COURSES OR PROGRAM POORLY TAUGHT 2

STARTED OTHER SCHOOL/TRAINING 3

NOT ENOUGH MONEY TO CONTINUE 4

NOT ENOUGH TIME TO CONTINUE 5

NOT INTERESTED / DIDN’T LIKE PROGRAM 6

DIDN’T THINK IT WOULD HELP ME FIND A JOB 7

ILLNESS 8

PREGNANCY 9

CHILD CARE ISSUES 10

OTHER FAMILY REASONS 11

TRANSPORTATION / LOGISTICAL PROBLEMS 12

PERSONAL PROBLEMS 13

FOUND JOB/RE-EMPLOYED 14

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D11B = 1

D11f. Were you awarded your high school diploma?

YES 1

NO – ADDITIONAL CLASSES ARE REQUIRED 2

NO – FINISHED BUT DID NOT PASS THE COURSEWORK 3

DON’T KNOW d

REFUSED r

IF D11F = 1

D11g. When were you awarded your high school diploma?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D11B = 1,3: FILL “paid” ; IF D11B = 2: FILL “is paying”

D11h. Finally, who (paid/is paying) for the course tuition or fees? Please do not include the payment for books and other materials.

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

SELECT ALL THAT APPLY

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM PROVIDER 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

TUITION IS FULLY COVERED BUT DON’T KNOW SOURCE…… 7

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF >1 RESPONSE TO D11H

D11i. Of these, which paid the largest share of the costs?

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM PROVIDER 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

OTHER (SPECIFY) 99

(STRING 65)

EQUAL 7

DON’T KNOW d

REFUSED r

IF D11H = 1 IF “YES” IN D1B (FILL “do” IF D11B = 2. FILL “did” IF D11B = 1,3)

D11j. How much (do/did) you or your family pay out of pocket for this course?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D11H = 1

IF “YES” IN D1B (FILL “do” IF D11B = 2. FILL “did” IF D11B = 1,3)

D11k. What portion of the tuition (do/did) you or your family cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

______________________(STRING 65)

DON’T KNOW d

REFUSED r

IF D11H = 6

IF “YES” IN D1B (FILL “is/are receiving” IF D11B = 2. FILL “was/received” IF D11B = 1,3)

D11l. What (is/was) the total dollar amount of student loans you (are receiving/received) to pay for this course?

IF D11H = 61

IF “YES” IN D1B (FILL “do” IF D11B = 2. FILL “did” IF D11B = 1,3)

D11m. What portion of the tuition (do/did) the student loans cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

_____________________(STRING 65)

DON’T KNOW d

REFUSED r

IF “YES” IN D1C OR D3 = 3 (COLLEGE CREDIT COURSE)

D12. In this next set of questions we are going to focus on when you took the college courses for credit towards a degree. Again, if you don’t know the exact information, your best guess is fine.

PROGRAMMER NOTE: REPEAT D12A-D12Q FOR EACH COLLEGE COURSE SPECIFIED IN D6

D12a. When did you start taking the college courses offered by [FILL PROVIDER]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

D12b. Did you complete the curriculum, are you still taking classes, or did you stop taking classes?

COMPLETED THE COURSE 1

STILL TAKING THE COURSE 2

STOPPED TAKING THE COURSE/DROPPED OUT 3

DON’T KNOW d

REFUSED r

IF D12B = 1,2 (FILL “DID” IF 1, “WILL” IF 2)

D12c. When (did/will) the required coursework end?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / YEAR

DON’T KNOW d

REFUSED r

IF D12B = 3

D12d. When did you stop taking the college classes?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D12B = 3

D12e. What was the main reason that you stopped taking the classes?

POOR GRADES 1

COURSES OR PROGRAM POORLY TAUGHT 2

STARTED OTHER SCHOOL/TRAINING 3

NOT ENOUGH MONEY TO CONTINUE 4

NOT ENOUGH TIME TO CONTINUE 5

NOT INTERESTED / DIDN’T LIKE PROGRAM 6

DIDN’T THINK IT WOULD HELP ME FIND A JOB 7

ILLNESS 8

PREGNANCY 9

CHILD CARE ISSUES 10

OTHER FAMILY REASONS 11

TRANSPORTATION / LOGISTICAL PROBLEMS 12

PERSONAL PROBLEMS 13

FOUND JOB/RE-EMPLOYED 14

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D12B = 1

D12f. Were you awarded a college degree?

YES 1

NO – ADDITIONAL CLASSES ARE REQUIRED 2

NO – FINISHED BUT DID NOT PASS THE COURSEWORK 3

DON’T KNOW d

REFUSED r

IF D12F = 1: “What type of degree?

IF D12B = 2 OR D12F = 2:“What type of degree are you pursuing?

IF D12B = 3 OR D12F = (3, DK OR R): “What type of degree were you pursuing?”

D12g. (What type of degree? / What type of degree are you pursuing? / What type of degree were you pursuing?)

(STRING 65)

ASSOCIATES DEGREE 1

BACHELOR’S DEGREE 2

MASTER’S DEGREE 3

DOCTORATE / PhD 4

PROFESSIONAL DEGREE (MD, JD, ETC.) 5

DON’T KNOW d

REFUSED r

FILL “paid” IF D12B = 1,3. FILL “is paying” IF D12B = 2

D12h. Finally, who (paid/is paying) for the course tuition or fees? Please do not include the payment for books and other materials.

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

SELECT ALL THAT APPLY

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM PROVIDER 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

TUITION IS FULLY COVERED BUT DON’T KNOW SOURCE…… 7

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF >1 RESPONSE TO D12H

D12i. Of these, which paid the largest share of the costs?

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

CODE ONE ONLY

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM PROVIDER 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

OTHER (SPECIFY) 99

(STRING 65)

EQUAL 7

DON’T KNOW d

REFUSED r

IF D12H = 1

IF “YES” IN D1C (FILL “do” IF D12B = 2. FILL “did” IF D12B = 1,3)

D12j. How much (do/did) you or your family pay out of pocket for this training?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D12H =1

IF “YES” IN D1C (FILL “do” IF D12B = 2. FILL “did” IF D12B = 1,3)

D12k. What portion of the tuition (do/did) you or your family cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

________________________(STRING 65)

DON’T KNOW d

REFUSED r

IF D12H = 6

IF “YES” IN D1C (FILL “is/are receiving” IF D12B = 2. FILL “was/received” IF D12B = 1,3)

D12l. What (is/was) the total dollar amount of student loans you (are receiving/received) to pay for this training?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D12H = 6

IF “YES” IN D1C (FILL “do” IF D12B = 2. FILL “did” IF D12B = 1,3)

D12m. What portion of the tuition (do/did) the student loans cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

______________________________(STRING 65)

DON’T KNOW d

REFUSED r

F D12F= 1: “is the degree?”

IF D12B = 2 OR D12F = 2: “are you working towards?”

IF D12B = 3 OR D12F = (3, DK OR R): “were you working towards?”

D12n. In what major field of study (is the degree? / are you working towards? / were you working towards?)

(STRING 100)

DON’T KNOW d

REFUSED r

IF D12F = 1

D12o. Since receiving the [FILL DEGREE FROM D12G], have you obtained a job in your major field of study?

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D12O = 1

D12p. Which job was that?

PROGRAMMER NOTE: FILL SCREEN WITH EMPLOYER NAMES FROM B6 & B7

INTERVIEWER: IF NECESSARY, REMIND RESPONDENT OF JOBS LISTED IN B6/B7

(STRING 100)

DON’T KNOW d

REFUSED r

B2=1 OR B5 >=1

D12q. In your opinion, how useful (is/was) your knowledge from your degree to you in your (current job / most recent job since RA)? Is it useful, somewhat useful, or is it not useful?

USEFUL 1

SOMEWHAT USEFUL 2

NOT USEFUL 4

TOO SOON TO KNOW 3

DON’T KNOW d

REFUSED r

IF D1D = 1 OR D3 = 4

D13. In this next set of questions we are going to focus on when you took the vocational courses or job-specific training programs. Again, if you don’t know the exact information, your best guess is fine.

PROGRAMMER NOTE: REPEAT D13A - D13T FOR EACH VOCATIONAL COURSE OR JOB-SPECIFIC TRAINING PROGRAM SPECIFIED IN D7

D13a. When did you start taking the courses or training programs offered by [FILL PROVIDER]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

INTERVIEWER: COLLECT YEAR IF RESPONDENT CANNOT RECALL MONTH

| | | / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

D13b. Did you complete the training by finishing all of the coursework or program requirements, are you still taking the training, or did you stop taking the training?

COMPLETED THE COURSE 1

STILL TAKING THE COURSE 2

STOPPED TAKING THE COURSE/DROPPED OUT 3

DON’T KNOW d

REFUSED r

IF D13B = 1,2 (FILL “DID” IF 1, “WILL” IF 2)

D13c. When (did/will) the training program end?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D13B = 3

D13d. When did you stop taking the training program or course?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / I_I_I / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D13B = 3

D13e. What was the main reason that you stopped taking the training?

POOR GRADES 1

COURSES OR PROGRAM POORLY TAUGHT 2

STARTED OTHER SCHOOL/TRAINING 3

NOT ENOUGH MONEY TO CONTINUE 4

NOT ENOUGH TIME TO CONTINUE 5

NOT INTERESTED / DIDN’T LIKE PROGRAM 6

DIDN’T THINK IT WOULD HELP ME FIND A JOB 7

ILLNESS 8

PREGNANCY 9

CHILD CARE ISSUES 10

OTHER FAMILY REASONS 11

TRANSPORTATION / LOGISTICAL PROBLEMS 12

PERSONAL PROBLEMS 13

FOUND JOB/RE-EMPLOYED 14

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D13B = 1

D13f. Were you awarded a training certificate, license, or credential?

YES 1

NO – PROGRAM DID NOT OFFER ONE 2

NO – ADDITIONAL CLASSES ARE REQUIRED 3

NO – FINISHED BUT DID NOT PASS THE COURSE/PROGRAM 4

DON’T KNOW d

REFUSED r

IF D13F = 1

D13g. When were you awarded a training certificate, license, or credential?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

INTERVIEWER: COLLECT YEAR IF RESPONDENT CANNOT RECALL MONTH

| | | / | | | / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D13F= 1: “did you receive?”

IF D13B = 2 OR D13F = 3:“are you pursuing?”

IF D13B = 3 OR D13F = 2, 3, DK OR R: “were you pursuing?”

D13h. What type of certificate, license, or credential (did you receive? / are you pursuing? / were you pursuing?”) What type of trade or work (does / will) it qualify you to perform?

(STRING 100)

DON’T KNOW d

REFUSED r

IF D13B = 1,3 FILL “prepared”

IF D13B = 2 FILL “is preparing”

D13i. What is the primary job the vocational training program (prepared/is preparing) you to perform?

(STRING 100)

DON’T KNOW d

REFUSED r

IF D13B = 1

IF D13F = 1: FILL (“and getting your credential”)

D13j. Did you receive a promotion at a job as a result of completing this course or training program (and getting your credential)?

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D13J = 1

D13k. In what way did the training program help you get the promotion?

(STRING 100)

DON’T KNOW d

REFUSED r

IF D13B = 1

IF D13F = 1: FILL (“and getting your credential”)

D13l. Did you get a new job as a result of completing this course or training program (and getting your credential)?

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D13L = 1

D13m. In what way did the training program help you get a new job?

(STRING 100)

DON’T KNOW d

REFUSED r

IF D13B = 1,3 FILL “paid”; IF D13B = 2: FILL “is paying”.

D13n. Finally, who (paid/is paying) for the training program tuition or fees? Please do not include the payment for books and other materials.

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

SELECT ALL THAT APPLY

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM [FILL ARRA GRANT FUNDED PROGRAM] 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

TUITION IS FULLY COVERED BUT DON’T KNOW SOURCE…… 7

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF >1 RESPONSE TO D13N

D13o. Of these, which paid the largest share of the costs?

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM [FILL ARRA GRANT FUNDED PROGRAM] 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

OTHER (SPECIFY) 99

(STRING 65)

EQUAL 7

DON’T KNOW d

REFUSED r

IF D13N = 1

IF “YES” IN D1D (FILL “did” IF D13B = 1,3. FILL “do” IF D13B = 2)

D13p. How much (do/did) you or your family pay out of pocket for this training?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF 13N = 1

IF “YES” IN D1D (FILL “did” IF D13B = 1,3. FILL “do” IF D13B = 2)

D13q. What portion of the tuition (do/did) you or your family cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

_______________________(STRING 65)

DON’T KNOW d

REFUSED r

IF D13N = 6

IF “YES” IN D1D (FILL “was/received” IF D13B = 1,3. FILL “is/are receiving” IF D13B = 2)

D13r. What (is/was) the total amount of student loans you (are receiving/received) to pay for this training?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D13N = 6

IF “YES” IN D1D (FILL “do” IF D13B = 1,3. FILL “did” IF D13B = 2)

D13s. What portion of the tuition (do/did) the student loans cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

_________________(STRING)

DON’T KNOW d

REFUSED r

B2 = 1 OR B5 > = 1

D13t. In your opinion, how useful (is/was) your knowledge from the course or training program to you in your (current job / most recent job since RA)? Is it useful, somewhat useful, or is it not useful?

USEFUL 1

SOMEWHAT USEFUL 2

NOT USEFUL 4

TOO SOON TO KNOW 3

DON’T KNOW d

REFUSED r

IF D1E = 1 OR D3 = 5

In this next set of questions we are going to focus on when you took the study skills, workplace skills, or general life skills course/courses. If you don’t know the exact information, your best guess is fine.

PROGRAMMER NOTE: REPEAT D14A – D14L FOR EACH SCHOOL, WORK, OR GENERAL LIFE SKILLS COURSE SPECIFIED IN D8

D14a. When did you start taking the study, workplace, or general life skills course offered by [FILL PROVIDER]?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / | | | | | MONTH / DAY/ YEAR

DON’T KNOW d

REFUSED r

D14b. Did you complete the course, are you still taking it, or did you stop taking it?

COMPLETED THE COURSE 1

STILL TAKING THE COURSE 2

STOPPED TAKING THE COURSE/DROPPED OUT 3

DON’T KNOW d

REFUSED r

IF D14B = 1,2 (FILL “DID” IF 1, “WILL” IF 2)

D14c. When (did/will) that course end?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D14B = 3

D14d. When did you stop taking the course?

Probe: If you cannot remember the exact day, can you remember if it was in the beginning, middle, or end of the month?

| | | / | | | | | MONTH / DAY / YEAR

DON’T KNOW d

REFUSED r

IF D14B = 3

D14e. What was the main reason that you stopped taking the course?

POOR GRADES 1

COURSES OR PROGRAM POORLY TAUGHT 2

STARTED OTHER SCHOOL/TRAINING 3

NOT ENOUGH MONEY TO CONTINUE 4

NOT ENOUGH TIME TO CONTINUE 5

NOT INTERESTED / DIDN’T LIKE PROGRAM 6

DIDN’T THINK IT WOULD HELP ME FIND A JOB 7

ILLNESS 8

PREGNANCY 9

CHILD CARE ISSUES 10

OTHER FAMILY REASONS 11

TRANSPORTATION / LOGISTICAL PROBLEMS 12

PERSONAL PROBLEMS 13

FOUND JOB/RE-EMPLOYED 14

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF D14B = 1

D14f. Were you awarded a training certificate, license, or credential?

YES 1

NO – PROGRAM DID NOT OFFER ONE 2

NO – ADDITIONAL CLASSES ARE REQUIRED 3

NO –FINISHED BUT DID NOT PASS THE COURSE/PROGRAM 4

DON’T KNOW d

REFUSED r

IF “YES” IN D1E (FILL “paid” IF D14B = 1,3. FILL “is paying” IF D14B = 2)

D14g. Finally, who (paid/is paying) for the course tuition or fees? Please do not include the payment for books and other materials.

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET.

SELECT ALL THAT APPLY

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM [FILL ARRA GRANT FUNDED PROGRAM] 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

TUITION IS FULLY COVERED BUT DON’T KNOW SOURCE…… 7

OTHER (SPECIFY) 99

(STRING 65)

DON’T KNOW d

REFUSED r

IF >1 RESPONSE TO D14G

D14h. Of these, which paid the largest share of the costs?

INTERVIEWER: RECEIPT OF FINANCIAL GIFTS FROM PARENTS, RELATIVES, AND SO ON WOULD BE CONSIDERED OUT-OF-POCKET

RESPONDENT / RESPONDENT’S FAMILY (OUT OF POCKET) 1

SCHOLARSHIP OR FUNDING FROM [FILL ARRA GRANT FUNDED PROGRAM] 2

PELL GRANT OR OTHER GOVT PROVIDED FUNDING 3

RESPONDENT’S CURRENT / FORMER EMPLOYER 4

PRIVATE ORGANIZATION OR OTHER SCHOLARSHIP FUND 5

STUDENT LOANS 6

OTHER (SPECIFY) 99

(STRING 65)

EQUAL 7

DON’T KNOW d

REFUSED r

IF D14G = 1

IF “YES” IN D1E (FILL “did” IF D14B = 1,3. FILL “do” IF D14B = 2)

D14i. How much (do/did) you or your family pay out of pocket for this course?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D14G = 6

IF “YES” IN D1E (FILL “did” IF D14B = 1,3. FILL “do” IF D14B = 2)

D14j. What portion of the tuition (do/did) you or your family cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

___________________(STRING)

DON’T KNOW d

REFUSED r

IF D14G = 6

D14k. What (is/was) the total dollar amount of student loans you (are receiving/received) to pay for this training?

$ | | | , | | | |

DON’T KNOW d

REFUSED r

IF D14G = 6

IF “YES” IN D1E (FILL “did” IF D14B = 1,3. FILL “do” IF D14B = 2)

D14l. What portion of the tuition (do/did) the student loans cover?

INTERVIEWER: ALLOW FOR RANGES IF THE RESPONDENT IS UNSURE OR GIVES A VAGUE ANSWER SUCH AS “NOT MUCH” OR “MOST.”

_________________(STRING)

DON’T KNOW d

REFUSED r

D15. Since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW], have you had a paid or unpaid internship, any on-the-job training or clinical experience or practicum?

NO 0

YES, PAID INTERNSHIP 1

YES, UNPAID INTERNSHIP 2

YES, ON-THE-JOB TRAINING 3

YES, CLINICAL EXPERIENCE OR PRACTICUM 4

DON’T KNOW d

REFUSED r

IF D15 IS YES ON INTERNSHIP OR ON-THE-JOB TRAINING OR CLINICAL EXPERIENCE OR PRACTICUM

D16. Did the (internship / on-the-job training / clinical experience or practicum) turn into a permanent position?

YES 1

NO 0

DON’T KNOW d

REFUSED r

D17. In the next set of questions we are interested in the types of services and assistance you may have received from the places you took courses or attended education or training programs and other places in the community since [RA DATE/DATE OF 18-MONTH INTERVIEW].

PROGRAMMER: REPEAT QUESTIONS D17A-J FOR EACH TRAINING PROVIDER IDENTIFIED IN D9A, D9C, D9E ,D9G AND D9I:

D17a. Did you receive any academic advising from [FILL NAME OF TRAINING PROVIDER]? For example, one-on-one meetings with counselors to discuss course selection and progress toward meeting academic goals.

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D17A = 1

17b. How many times did you receive academic advising from [FILL NAME OF TRAINING PROVIDER] since [RA DATE/DATE OF 18-MONTH INTERVIEW]?

| | | TIMES

DON’T KNOW d

REFUSED r

Probe: If you don’t remember a specific number, please provide a range. Would you say that the number of times was between

1-2 ………………………………………………………………………….1

3-4 ………………………………………………………………………….2

5-6 ………………………………………………………………………….3

6 OR MORE………………………………………………………………..4

DON’T KNOW …………………………………………………………….d

REFUSED……………………………………………………...................r

D17c. Did you receive any financial aid advising from [FILL NAME OF TRAINING PROVIDER]? For example, one-on-one meetings with your counselor to help you determine if you had the financial resources to attend training and support yourself or your family while in training.

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D17C = 1

D17d. How many times did you receive financial aid advising from [FILL NAME OF TRAINING PROVIDER] since [RA DATE/DATE OF 18-MONTH INTERVIEW]?

| | | TIMES

DON’T KNOW d

REFUSED r

Probe: If you don’t remember a specific number, please provide a range. Would you say that the number of times was between

1-2 ………………………………………………………………………….1

3-4 ………………………………………………………………………….2

5-6 ………………………………………………………………………….3

6 OR MORE………………………………………………………………..4

DON’T KNOW …………………………………………………………….d

REFUSED……………………………………………………...................r

IF D17D = 1

D17e. Did you receive any tutoring from [FILL NAME OF TRAINING PROVIDER]?

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D17E = 1

17f. How many times did you receive tutoring from [FILL NAME OF TRAINING PROVIDER] since [RA DATE/DATE OF 18-MONTH INTERVIEW]?

| | | TIMES

DON’T KNOW d

REFUSED r

Probe: If you don’t remember a specific number, please provide a range. Would you say that the number of times was between

1-2 ………………………………………………………………………….1

3-4 ………………………………………………………………………….2

5-6 ………………………………………………………………………….3

6 OR MORE………………………………………………………………..4

DON’T KNOW …………………………………………………………….d

REFUSED……………………………………………………...................r

D17g. Did you receive any career counseling from [FILL NAME OF TRAINING PROVIDER]? For example, tests to see what jobs you were suited for, information about education or job training programs, information on how to change careers, or information about what jobs are available in your local area.

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D17G = 1

D17h. How many times did you receive career counseling from [FILL NAME OF TRAINING PROVIDER] since [RA DATE/DATE OF 18-MONTH INTERVIEW]?

| | | TIMES

DON’T KNOW d

REFUSED r

Probe: If you don’t remember a specific number, please provide a range. Would you say that the number of times was between

1-2 ………………………………………………………………………….1

3-4 ………………………………………………………………………….2

5-6 ………………………………………………………………………….3

6 OR MORE………………………………………………………………..4

DON’T KNOW …………………………………………………………….d

REFUSED……………………………………………………...................r

D17i. Finally, did you receive any job placement assistance from [FILL NAME OF TRAINING PROVIDER]? For example, assistance in searching for work, referrals to jobs or employers, providing labor market information, or help with your resume or interviewing skills.

YES 1

NO 0

DON’T KNOW d

REFUSED r

IF D17I = 1

D17j. How many times did you receive job placement assistance from [FILL NAME OF TRAINING PROVIDER] since [RA DATE/DATE OF 18-MONTH INTERVIEW]?

| | | TIMES

DON’T KNOW d

REFUSED r

Probe: If you don’t remember a specific number, please provide a range. Would you say that the number of times was between

1-2 ………………………………………………………………………….1

3-4 ………………………………………………………………………….2

5-6 ………………………………………………………………………….3

6 OR MORE………………………………………………………………..4

DON’T KNOW …………………………………………………………….d

REFUSED……………………………………………………...................r

D18. Turning now to other types of assistance. Since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW] did you receive any of the following types of assistance from any organization, including but not limited to the education or training providers we already talked about. . .

SELECT ALL THAT APPLY

Information on what a good work ethic is, such as what to do when you can’t make it to work on time or you need to miss work? 1

Information on how to communicate well with your boss and co-workers? 2

Information on how to manage any anger and frustrations that you might have? 3

Information on how to manage your money and plan your finances? 4

Other life skills, such as parenting and/or dealing with housing, legal, or health issues? 5

Any other type of assistance? 6

SPECIFY

(STRING 65)

DON’T KNOW d

REFUSED r

D19. Finally, I have a few questions about some additional services you may have received that helped you get a new job, keep an existing job, or that helped you participate in a training program. Since [RA DATE/ DATE OF THE 18-MONTH INTERVIEW] did you receive any of the following types of assistance from any organization?

SELECT ALL THAT APPLY

Clothes or uniforms? 1

Child care assistance? 2

Assistance with transportation....................... 3

Job placement assistance?................................................................. 4

Career counseling?....................................................................... 5

Tools? 6

Books or supplies? 7

DON’T KNOW d

REFUSED r

PROGRAMMERS

D20 SHOULD BE ASKED ONLY IN THE FIRST FOLLOW-UP INTERVIEW

IN THE 18-MONTH INTERVIEW: ASK OF EVERYONE

IN 36-MONTH INTERVIEW: ASK ONLY OF THOSE WHO DID NOT COMPLETE AN 18-MONTH INTERVIEW

D20. In this next question we are interested in hearing the reasons people decide to take courses and attend training programs. Around [RA DATE], you expressed an interest in applying to [FILL ARRA GRANT FUNDED PROGRAM], which focused on the [green jobs/healthcare] field. Please think back to that time and tell me why you were interested in that field?

INTERVIEWER PROBE, AS NEEDED: Any other reasons?

SELECT ALL THAT APPLY

IF GREEN JOBS, INCLUDE THE FOLLOWING LIST:

TO SAVE THE ENVIRONMENT / PLANET 1

TO GET A BETTER PAYING JOB 2

COULDN’T FIND JOB SO TOOK TRAINING 3

IT WAS THE ONLY TRAINING I COULD FIND 4

IT WAS AFFORDABLE 5

OFFERS GOOD JOB STABILITY 6

IT WAS AFFORDABLE 7

Other, Specify1 8

(STRING (NUM))

Other, Specify2 9

(STRING (NUM))

Other, Specify3 10

(STRING (NUM))

IF HEALTHCARE, INCLUDE THE FOLLOWING LIST:

TO HELP PEOPLE 11

TO GET A BETTER PAYING JOB 12

COULDN’T FIND JOB SO TOOK TRAINING 13

IT WAS THE ONLY TRAINING I COULD FIND 14

IT WAS AFFORDABLE 15

OFFERS GOOD JOB STABILITY 16

IT WAS AFFORDABLE 17

Other, Specify1 18

(STRING (NUM))

Other, Specify2 19

(STRING (NUM))

Other, Specify3 20

(STRING (NUM))

DO NOT REMEMBER, DON’T KNOW d

REFUSED r

D21. And which of these reasons would you say was your main or primary reason for pursuing in the [green jobs/health care] field?

CATI: FILL RESPONSES FROM D20

INTERVIEWER, IF NECESSARY, READ RESPONSES

(STRING 255)

DON’T KNOW d

REFUSED r

E. FINANCIAL HARDSHIP

ALL

IF 18 MONTH INTERVIEW, REFER TO RANDOM ASSIGNMENT (RA) DATE.

IF 36 MONTH INTERVIEW AND RESPONDENT HAS COMPLETED 18 MONTH INTERVIEW, REFER TO 18 MONTH INTERVIEW DATE

IF 36 MONTH INTERVIEW AND RESPONDENT HAS NOT COMPLETED 18 MONTH INTERVIEW, REFER TO RA DATE

E1. Because many people have been facing financial difficulties these days, in this section we are interested in asking some very general questions about your household’s finances. By household we mean people who live together and share finances. Since [RA DATE/DATE OF THE 18-MONTH INTERVIEW], have you ever had difficulty covering all of your household expenses?

YES 1

NO 0

DON’T KNOW d

REFUSED r

E2. Now, please think about the past month only. Has your household been able to cover all household expenses in the past month very easily, easily, with some difficulty, or with great difficulty?

VERY EASILY 1

EASILY 2

WITH SOME DIFFICULTY 3

WITH GREAT DIFFICULTY 4

DON’T KNOW d

REFUSED r

E3 These next questions are about your experiences with housing. Since [RA DATE/DATE OF THE 18-MONTH INTERVIEW], have you ever owned a home?

YES 1 GO TO E3A

NO 0 GO TO E4

DON’T KNOW d GO TO E4

REFUSED r GO TO E4

E3a. Since [RA DATE/18-MONTH INTERVIEW DATE], have you…


	YES	NO	NOT APPLICABLE	DON’T KNOW	REFUSED
a. had your house foreclosed on?	1	0	n	d	r
b. received a notice that your mortgage was in default?	1	0	n	d	r
c. missed or been late on a mortgage payment?	1	0	n	d	r

E4. Since [RA DATE/DATE OF THE 18-MONTH INTERVIEW], have you ever rented a residence?

INTERVIEWER IF ASKED FOR A DEFINITION: BY RESIDENCE, WE MEAN A HOUSE, APARTMENT, GROUP OF ROOMS, OR A SINGLE ROOM THAT YOU LIVED IN FOR AN EXTENDED PERIOD OF TIME.

YES 1 GO TO E4A

NO 0 GO TO E5

DON’T KNOW d GO TO E5

REFUSED r GO TO E5

E4a. Since [RA DATE], have you…


	YES	NO	DON’T KNOW	REFUSED
a. been evicted?	1	0	d	r
b. received a notice of eviction?	1	0	d	r
c. missed a rent payment or been charged a late fee on your rent?	1	0	d	r

E5. Since [RA DATE], have you…


	YES	NO	NOT APPLICABLE	DON’T KNOW	REFUSED
a. had your utilities disconnected?	1	0	n	d	r
b. been charged a late fee on any monthly credit payments?	1	0	n	d	r
c. declared personal bankruptcy?	1	0	n	d	r
d. postponed a major purchase that was planned or needed such as a car or major appliance?	1	0	n	d	r

e. received any assistance from churches, food banks, or other private community organizations?	1	0	n	d	r

E6. Since [RA DATE], did you or anyone in your household…


	YES	NO	NOT APPLICABLE	DON’T KNOW	REFUSED
a. make an early withdrawal from a retirement investment account such as a 401(k), 403(b), or IRA?	1	0	n	d	r
b. take early retirement to get benefits from a pension plan?	1	0	n	d	r

F. CURRENT FAMILY STATUS & DEMOGRAPHICS

ALL

ALL OF THE QUESTIONS IN SECTION F ARE TO BE ASKED ONLY FOR THOSE WHERE THE INFORMATION IS MISSING FROM THE BASELINE INFORMATION FORM AND/OR THE 18-MONTH SURVEY.

F1. The questions in this section are for classification purposes only.

F1a. How old are you?

INTERVIEWER: IF respondent is 100 or older, CODE AS 99

| | | NUMBER (18-99)

DON’T KNOW d

REFUSED r

F2. Do you consider yourself to be of Hispanic, Latino, or Spanish origin?

YES 1

NO 0

DON’T KNOW d

REFUSED r

F3. I’m going to read you a list of five race categories. Please choose one or more races that you consider yourself to be. Would you say you are White, Black or African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Pacific Islander?

SELECT ALL THAT APPLY

White 1

Black or African American 2

American Indian or Alaska Native 3

Asian 4

Native Hawaiian or Pacific Islander 5

OTHER (specify) __________________________(string 80)

DON’T KNOW d

REFUSED r

CODE WITHOUT ASKING IF KNOWN, OTHERWISE ASK

F4. Are you male or female?

MALE 1

FEMALE 2

DON’T KNOW d

REFUSED r

G. INCOME AND RECEIPT OF PUBLIC BENEFITS

ALL

IF 18 MONTH INTERVIEW, REFER TO RANDOM ASSIGNMENT (RA) DATE.

IF 36 MONTH INTERVIEW AND RESPONDENT HAS COMPLETED 18 MONTH INTERVIEW, REFER TO 18 MONTH INTERVIEW DATE

IF 36 MONTH INTERVIEW AND RESPONDENT HAS NOT COMPLETED 18 MONTH INTERVIEW, REFER TO RA DATE

IF R LIVES IN MI OR TX, FILL “TANF” IN G1a

IF R LIVES IN CA, FILL “CalWORKs” IN G1a

IF R LIVES IN MN, FILL “MFIP” in G1a

The next questions are about sources of income. Please remember that the answers to these and all other questions in this survey will be private and will never be associated with your name.

G1. Last month, did you (or anyone in your household) receive any (INSERT ITEM FROM CHART BELOW)… By household, we mean people who live together and share finances.

For each YES response at G1, ASK:

G1a. How much did you and other people in your household receive from (INSERT ITEM) last month altogether?

G1b. How many months in a row have you and other people in your household been receiving (INSERT ITEM)?

For each NO response at G1, ASK:

G1c. At any time since (RA DATE/DATE OF THE 18-MONTH INTERVIEW), have you or anyone in your household received any (INSERT ITEM)?

G1d. How much each month did you and others in your household receive from (INSERT ITEM)?

G1e. For how many months in total did you and others in your household receive (INSERT ITEM)?

G1aa. INTERVIEWER PROBE, AS NEEDED:

TEMPORARY ASSISTANCE TO NEEDY FAMILIES (TANF), ALSO KNOWN AS (STATE WELFARE NAME) AND FORMERLY KNOWN AS AID TO FAMILIES WITH DEPENDENT CHILDREN (AFDC), PROVIDES FINANCIAL HELP FOR CHILDREN AND THEIR PARENTS OR RELATIVES WHO ARE LIVING WITH THEM. MONTHLY CASH PAYMENTS HELP PAY FOR FOOD, CLOTHING, HOUSING, UTILITIES, FURNITURE, TRANSPORTATION, TELEPHONE, LAUNDRY, HOUSEHOLD EQUIPMENT, MEDICAL SUPPLIES NOT PAID FOR BY MEDICAID, AND OTHER BASIC NEEDS.

G1ab. PROBE, AS NEEDED:

THE SUPPLEMENTAL NUTRITION AND ASSISTANCE PROGRAM, OR SNAP, IS THE NEW NAME FOR THE USDA PROGRAM FORMERLY KNOWN AS FOOD STAMPS. IT PUTS MONEY ON AN EBT CARD THAT IS USED TO BUY FOOD IN [FILL STATE NAME]. [IN CA, MN AND MI ADD: “IN YOUR STATE IT IS ALSO CALLED (CALFRESH / FOOD SUPPORT PROGRAM / FOOD ASSISTANCE PROGRAM)”].

G1ac. INTERVIEWER PROBE, AS NEEDED:

THE UNEMPLOYMENT INSURANCE PROGRAM, COMMONLY REFERRED TO AS UI, PROVIDES WORKERS, WHO LOSE THEIR JOBS THROUGH NO FAULT OF THEIR OWN, WITH WEEKLY UNEMPLOYMENT INSURANCE PAYMENTS.

G1ad. INTERVIEWER PROBE, AS NEEDED:

SUPPLEMENTAL SECURITY INCOME (SSI) IS A FED GOVERNMENT BENEFIT PROGRAM PROVIDING CASH TO MEET BASIC NEEDS FOR FOOD, CLOTHING, & SHELTER TO PERSONS WHO ARE BLIND OR OTHERWISE DISABLED, HAVE LITTLE OR NO OTHER INCOME, AND WHO MEET THE LIVING ARRANGEMENT REQUIREMENTS. SOCIAL SECURITY DISABILITY INSURANCE

(SSDI) BENEFITS ARE PAYABLE TO DISABLED WORKERS, DISABLED WIDOW(ER)S OR ADULTS DISABLED SINCE CHILDHOOD, WHO ARE OTHERWISE ELIGIBLE. THE MONTHLY DISABILITY BENEFIT PAYMENT IS BASED ON THE SOCIAL SECURITY EARNINGS RECORD OF THE INSURED WORKER UNDER WHOSE SOCIAL SECURITY NUMBER THE DISABILITY CLAIM IS FILED.

G1ae. THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANT AND CHILDREN, POPULARLY KNOWN AS WIC, IS A NUTRITION PROGRAM THAT HELPS PREGNANT WOMEN, NEW MOTHERS, AND YOUNG CHILDREN EAT WELL, LEARN ABOUT NUTRITION, AND STAY HEALTHY. WIC PROVIDES NUTRITION EDUCATION AND COUNSELING, NUTRITIOUS FOODS, AND HELP ACCESSING HEALTH CARE TO LOW-INCOME WOMEN, INFANTS, AND CHILDREN.

G1af. INTERVIEWER PROBE, AS NEEDED:

GENERAL ASSISTANCE, OR GA, IS A TERM USED TO DENOTE WELFARE PROGRAMS THAT BENEFIT ADULTS WITHOUT DEPENDENTS (SINGLE PERSONS, OR LESS COMMONLY, CHILDLESS MARRIED COUPLES).

TRADE ADJUSTMENT ASSISTANCE (TAA) AND ALTERNATIVE TRADE ADJUSTMENT ASSISTANCE (ATAA) HELP TRADE AFFECTED WORKERS WHO HAVE LOST THEIR JOBS AS A RESULT OF INCREASED IMPORTS OR SHIFTS IN PRODUCTION OUT OF THE UNITED STATES. CERTIFIED INDIVIDUALS MAY BE ELIGIBLE TO RECEIVE ONE OR MORE PROGRAM BENEFITS AND SERVICES DEPENDING ON WHAT IS NEEDED TO RETURN THEM TO EMPLOYMENT.

WORKERS' COMPENSATION IS A FORM OF INSURANCE THAT PROVIDES WAGE REPLACEMENT AND MEDICAL BENEFITS FOR

EMPLOYEES WHO ARE INJURED IN THE COURSE OF EMPLOYMENT.

	G1.		G1a.	G1b.	G1c.		G1d.	G1e.
	Y	N	AMOUNT	TIME RECEIVED	Y	N	AMOUNT	TIME RECEIVED
a. TANF, Temporary Assistance to Needy Families (/also known as [CalWORKS/ the Minnesota Family Investment Program, or MFIP)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
b. SNAP or Food Stamps?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
c. Unemployment Insurance benefits or UI?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
d. SSI, SSDI, or other disability benefits?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
e. WIC benefits?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
f. Other welfare such as General Assistance, Trade Adjustment Assistance (TAA) or Alternative Trade Adjustment Assistance (ATAA) benefits, Worker’s Compensation or Disability Insurance benefits?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
g. Social Security checks from the government for retirement, or survivor’s benefits?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
h. Other retirement benefits such as a government or private pension or annuity Interest and/or dividends?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)
i. Alimony, child support, or rent payments, or financial support from friends or relatives?	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)	01	00	$\| \|, \| \| \| \| ENTER AMOUNT (0 – 9999)	\| \| \| NUMBER OF YEARS (1 - 5) (if >5 record 5) \| \| \| NUMBER OF MONTHS (1 - 12) \| \| \| NUMBER OF WEEKS (1 - 52)

G2. What was the total income for you and all the members of your household, before taxes and other deductions, in [fill (CURRENT YEAR MINUS ONE)]? Please include all of the sources of income we have talked about, plus any others you may have had.

PROBE: By household, we mean people who live together and share finances

PROBE: Please include household income and income from all possible sources such as self-employment, regular jobs, and earnings from odd jobs, side jobs, under-the-table jobs, and other activities, social security, pensions, rent, interest and dividends, unemployment compensation, welfare, other public assistance, food stamps, child support, and money from any other sources. Your best estimate is fine.

PROBE, IF TOTAL INCOME IS REFUSED: Your answers to these questions will help the researchers better understand the problems people face when they are trying to work and make ends meet. Neither your name nor any other information that would identify you is kept with your answers. Could you provide your best estimate?

$ | | | |,| | | | (NUMBER RANGE)

DON’T KNOW d

REFUSED r

IF G2 = d or r

G3. Would you say your total household income in [FILL CURRENT YEAR MINUS ONE] was less than $30,000 or $30,000 or more?

LESS THAN $30,000 1

$30,000 OR MORE 2

DON’T KNOW d

REFUSED r

IF G3 = 2

G4. Would you say it was $30,000 to under $45,000, $45,000 to under $60,000, $60,000 to under $75,000, $75,000 to under $90,000, $90,000 to under $105,000, or $105, 000 or more?

$30,000 TO UNDER $45,000 1

$45,000 TO UNDER $60,000 2

$60,000 TO UNDER $75,000 3

$75,000 TO UNDER $90,000 4

$90,000 TO UNDER $105,000 5

$105,000 OR MORE 6

DON’T KNOW d

REFUSED r

IF G3 = 1

G5. Would you say it was less than $5,000, $5,000 to under $10,000, $10,000 to under $15,000, $15,000 to under $20,000, $20,000 to under $25,000, or $25,000 to under $30,000?

LESS THAN $5,000 1

$5,000 TO UNDER $10,000 2

$10,000 TO UNDER $15,000 3

$15,000 TO UNDER $20,000 4

$20,000 TO UNDER $25,000 5

$25,000 TO UNDER $30,000 6

DON’T KNOW d

REFUSED r

H. CONTACT INFORMATION

ALL

IF 18 MONTH INTERVIEW, ASK H1, H2 & END1

IF 36 MONTH INTERVIEW, ASK END2 ONLY

H1. I would like to thank you for participating in the survey. Please (provide/confirm) the name and address where we should send the $25 check/gift card. We would also like to interview you again in 18 months and I would like to know how to get in touch with you. There will be a $25 check/gift card for completing that survey as well.

PROGRAMMERS; PREFILL WITH SAMPLE DATA

INTERVIEWERS: CONFIRM AND CORRECT, IF NECESSARY. IF MISSING, COLLECT

(STRING 40)

FIRST NAME

(STRING 40)

MIDDLE INITIAL/NAME

(STRING 40)

LAST NAME

___________________________________(STRING 100)

RELATIONSHIP TO RESPONDENT

(STRING 100)

ADDRESS 1

(STRING 100)

ADDRESS 2

(STRING 100)

CITY

(STRING 40)

STATE/TERRITORY

| | | | | | - | | | | |

ZIP CODE (+ 4 IF NEEDED)

| | | | - | | | | - | | | | | PHONE NUMBER - HOME

(200-999) (100-999) (0000-9999)

| | | | - | | | | - | | | | | PHONE NUMBER – CELLULAR

(200-999) (100-999) (0000-9999)

| | | | - | | | | - | | | | | PHONE NUMBER - OTHER

(200-999) (100-999) (0000-9999)

_______________________________________________(STRING 80)

DON’T KNOW d

REFUSED r

H2. Next, I would like to ask you for the name, address, and telephone number of 2 close friends or relatives we can contact in case you move and we cannot easily locate you for your next interview. All information collected will be held in strictest confidence and will only be used to locate you if we cannot reach you.

PROGRAMMERS; PREFILL WITH SAMPLE DATA

INTERVIEWERS: CONFIRM AND CORRECT, IF NECESSARY. IF MISSING, COLLECT

CONTACT 1:

(STRING 40)

FIRST NAME

(STRING 40)

MIDDLE INITIAL/NAME

(STRING 40)

LAST NAME

___________________________________(STRING 100)

RELATIONSHIP TO RESPONDENT

(STRING 100)

ADDRESS 1

(STRING 100)

ADDRESS 2

(STRING 100)

CITY

(STRING 40)

STATE/TERRITORY

| | | | | | - | | | | |

ZIP CODE (+ 4 IF NEEDED)

| | | | - | | | | - | | | | | PHONE NUMBER - HOME

(200-999) (100-999) (0000-9999)

| | | | - | | | | - | | | | | PHONE NUMBER – CELLULAR

(200-999) (100-999) (0000-9999)

| | | | - | | | | - | | | | | PHONE NUMBER - OTHER

(200-999) (100-999) (0000-9999)

_______________________________________________(STRING 80)

DON’T KNOW d

REFUSED r

CONTACT 2:

(STRING 40)

FIRST NAME

(STRING 40)

MIDDLE INITIAL/NAME

(STRING 40)

LAST NAME

___________________________________(STRING 100)

RELATIONSHIP TO RESPONDENT

(STRING 100)

ADDRESS 1

(STRING 100)

ADDRESS 2

(STRING 100)

CITY

(STRING 40)

STATE/TERRITORY

| | | | | | - | | | | |

ZIP CODE (+ 4 IF NEEDED)

| | | | - | | | | - | | | | | PHONE NUMBER - HOME

(200-999) (100-999) (0000-9999)

| | | | - | | | | - | | | | | PHONE NUMBER – CELLULAR

(200-999) (100-999) (0000-9999)

| | | | - | | | | - | | | | | PHONE NUMBER - OTHER

(200-999) (100-999) (0000-9999)

_______________________________________________(STRING 80)

DON’T KNOW d

REFUSED r

IF NO ADDRESS COLLECTED AT H1, FILL “PROVIDE”

IF ADDRESS COLLECTED AT H1, FILL “CONFIRM”

END1. Those are all our questions. Thank you very much for your participation in the survey.

END2. Those are all our questions. Thank you very much for your participation in the survey. Please (provide/confirm) the name and address where we should send the $25 check/gift card.

INTERVIEWER RECORD NAME AND ADDRESS FOR CHECK

PROGRAMMER: IF ADDRESS PRESENT IN H1, PRE-FILL HERE

(STRING 40)

FIRST NAME

(STRING 40)

MIDDLE INITIAL/NAME

(STRING 40)

LAST NAME

(STRING 100)

ADDRESS 1

(STRING1 00)

ADDRESS 2

(STRING 100)

CITY

(STRING 40)

STATE/TERRITORY

| | | | | | - | | | | |

ZIP CODE (+ 4 IF NEEDED)

DON’T KNOW d

REFUSED r

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	American Recovery and Reinvestment Act (ARRA) High Growth and Emerging Industries (HGEI) Grants
Subject	CATI
Author	Mathematica and Abt Staff
File Modified	0000-00-00
File Created	2021-01-30