Participant 6-month survey

Appendix O

6-Month Follow-up Survey

OMB#: 0970-XXXX

Expiration Date: XX/XX/XXXX

Appendix O

6-Month Follow-Up Survey

Updated 10.3.12

RARESID – RA UNIQUE IDENTIFIER FROM SAMPLE FILE

FLNAME – RESPONDENT FULL NAME

RDOB – RESPONDENT DOB

RSSN – RESPONDENT’S LAST FOUR DIGITS OF SSN

RPHONE – TELEPHONE #

RPHONE2 – RESPONDENT ALTERNATE TELEPHONE#

RAMY – RANDOM ASSIGNMENT MONTH AND YEAR (MM/YYYY)

RA_CODE: C: Control; E: Treatment

LANG – RESPONDENT PRIMARY LANGUAGE

LIMIT_ENG – RESPONDENT IDENTIFIED AS LIMITED ENGLISH SPEAKING

RSEX – RESPONDENT SEX

FULLADD – FULL ADDRESS

RCITY – CITY

RSTATE – STATE

RZIP – ZIP

STEDPRO – Local STED Program

EMAIL – RESPONDENT EMAIL ADDRESS

TEXTPHONE – RESPONDENT TELEPHONE# FOR TEXT MESSAGES

ALTCONT1 – ALTERNATE CONTACT NAME AND INFORMATION

ALTCONT2 – ALTERNATE CONTACT NAME AND INFORMATION

RACE – RESPONDENT RACE

T_PHONE1 – UPDATED TELEPHONE# FROM TRACKING

T_PHONE2 – UPDATED TELEPHONE# FROM TRACKING

T_COMMENT – TRACKING NOTES

T_UPDATE1 – UPDATED ADDRESS FROM TRACKING

T_UPDATE2 – UPDATED ADDRESS FROM TRACKING

F_PHONE1 – UPDATED TELEPHONE# FROM FIELD

F_PHONE2 – UPDATED TELEPHONE# FROM FIELD

F_CONTACT1 – UPDATED ALTERNATE CONTACT FROM FIELD

F_CONTACT2 – UPDATED ALTERNATE CONTACT FROM FIELD

F_COMMENT – FIELD NOTES

F_UPDATE1 – UPDATED ADDRESS FROM FIELD

F_UPDATE2 – UPDATED ADDRESS FROM FIELD

FIDNAME1 – FIELD LOCATOR NAME

FIDNAME2 – FIELD LOCATOR NAME

FDATE1 – DATE RELEASED TO FIELD LOCATOR 1

FDATE2 – DATE RELEASED TO FIELD LOCATOR 2

GC_CATI – GIFT CARD RELEASED CATI

GC_FIELD – GIFT CARD RELEASED FIELD

Introduction

QLANG. CHOOSE LANGUAGE

1 ENGLISH

2 SPANISH

QTYPE.

INTERVIEWER: IS THIS A FIELD LOCATOR-BASED INTERVIEW?

1 YES, FIELD LOCATOR-BASED

2 NO, RESPONDENT CALLED IN (GO TO QLINTRO)

3 NO, CALL INITIATED BY PHONE CENTER (GO TO A1_Intro)

4 ANSWERING MACHINE (GO TO QANSW)

QINTID.

INTERVIEWER: ENTER THE FIELD LOCATOR’S 4-DIGIT ID NUMBER.

_____ _______ ________ _______

CATI: ALL GO TO QLINTRO

QANSW.

ANSWERING MACHINE SCRIPT

Hello, my name is Travis/Tracy Davis and I am calling from Decision Information Resources for the [STEDPRO] program. I am trying to reach [FLNAME] for a short paid interview.

Please have [FLNAME] call us at 1-866-986-1968. Thank you.

INTERVIEWER: PRESS “NEXT” TO EXIT AND RECORD CALL DISPOSITION.

CATI: EXIT

QLINTRO.

Hello, my name is Travis/Tracy Davis.

INTERVIEWER: PLEASE PRESS “NEXT” TO CONTINUE.

CATI: IF QTYPE=2, GO TO SRCE2; ELSE GO TO Q2

SRCE2.

Are you…

1 Responding to a ‘Sorry I Missed You’ card that was left at your door? OR

2 Responding to a letter or postcard you received in the mail or voice mail message from Travis/Tracy Davis or someone else?

7 DON’T KNOW

8 REFUSED

CATI: ALL GO TO Q2

CATI: RECORD INTRO SECTION START TIME [SECQSTTM] & START DATE [SECQSTDT]

A1_Intro. Hello this is Travis/Tracy Davis. I’m calling from DIR about a program at [CBONAME]. May I please speak to [FLNAME]?

INTERVIEWER: IF NECESSARY, READ: “[FLNAME] has agreed to help with a study about work assistance.

1 RESPONDENT AVAILABLE – CONTINUE

2 RESPONDENT NOT AVAILABLE – ARRANGE CALLBACK AND ENTER CALL NOTE (GO TO RCONU)

8 REFUSED – ENTER DISPOSITION CODE AND CALL NOTE DESCRIBING SITUATION IN THE CALL RECORD TEXT BOX (GO TO END INTERVIEW)

Q2.

Thank you for taking the time to speak with me today. We are conducting interviews with people who agreed to be in a study about a program offered at [CBONAME] called [STEDPRO]. The study is called the Subsidized and Transitional Employment Demonstration or STED for short. It is funded by the U.S. Department of Health and Human Services and my company, Decision Information Resources, or DIR, is conducting this survey. You may have received a letter recently about the STED study.

We need to talk with people who got into the program and those who did not. Your participation in this study will help policy-makers better understand how to help people find and keep jobs.  This interview will include questions on your employment situation, your use of services, and your overall well being.

This interview should only take 30 minutes.  We will mail you a $25 gift card as a “thank you” for completing the interview. 

All of your responses on this survey will be kept private; the research staff has been trained in protecting private information and your name will not appear in any written reports we produce. All of the study results will be reported for groups of individuals; no results will be analyzed or reported for individuals. Your responses to these questions are also completely voluntary. That means you may choose not to answer any question, or you may stop the interview if you wish, but we hope you don’t. Your responses to these questions will in no way affect your participation in the [STEDPRO] program or affect your receipt of any kinds of public benefits or services.

According to the Paperwork Reduction Act (PRA), an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-XXXX and it expires XX/XX/XXXX.

And finally, this interview might be monitored or recorded for quality control purposes. May we begin?

1 YES

2 NOT NOW (GO TO RCONU)

7 DON’T KNOW (GO TO RCONU)

8 REFUSED (GO TO END INTERVIEW)

Q2a.

I need to make sure that you are the person who agreed to join this study.

Could you please tell me your date of birth?

INTERVIEWER NOTE: DON’T KNOW 97/97/9997 REFUSED 98/98/9998.

______ ______ ______

MM DD YYYY

CATI: INCLUDE DROP DOWN BOX FOR 2-DIGIT MONTH AND 4-DIGIT YEARINCLUDE VALUES FOR DON’T KNOW AND REFUSED

MONTH RANGE: 01-12; 97; 98)

DAY RANGE: 01-31, 97, 98

YEAR RANGE: (1944-2000; 9997; 9998)

CATI: IF Q2a=RDOB IN SAMPLE FILE GO TO Q4

IF Q2a ≠ RDOB IN SAMPLE FILE, CONTINUE

Q2b.

Could you please provide the last four digits of your social security number?

____ ____ ____ ____

99997 DON’T KNOW

99998 REFUSED

CATI:

[IF Q2b=SSN FROM SAMPLE FILE GO TO Q4. (SSN matches)

IF Q2a= 97979997 OR 98989998 AND Q2b=99997 OR 99998, GO TO Q3. (Both DOB and SSN are either DK or REF)

IF (Q2a ≠ RDOB AND Q2b ≠ RSSN) AND (NOT (Q2a= 97979997 OR 98989998 AND Q2b=99997 OR 99998)), GO TO Q2c. (both DOB and SSN do not match DOB and SSN from sample file, and both are not DK/REF, which was handled in prior logic step)

Q2c.

There seems to be technical problem with your file. I will need to call you back.

Is this the best telephone number to reach you at?

[RPHONE1]

1 Yes (GO TO THANK YOU 2)

2 No (GO TO Q2c_1)

CATI: DISPLAY ORIGINAL PHONE NUMBER FOR COMPARISON PURPOSES

Q2c_1.

What number should we call?

__ __ __ - __ __ __- __ __ __ __

CATI: DISPLAY ORIGINAL PHONE NUMBER FOR COMPARISON PURPOSES

CATI: (GO TO THANK YOU 2)

Q3.

It is important to verify that you are a participant in this research study. To do this, it is important for you to tell me your date of birth OR the last four digits of your social security number. Your information is private. It will only be used for this research or related purposes. The interview will take 20-25 minutes. You can choose to answer or not answer any question. You will be sent a $25 gift card as a “thank you” if you do choose to complete the interview.

Do you wish to complete this survey?

1 Yes (GO BACK TO Q2a)

2 No (GO TO END INTERVIEW

THANK YOU 2. (TY2 on CATI)

Thank you for your time and patience. We will contact you as soon as we resolve this problem. Your information is important to us and to the success of this study. Have a nice day/evening.

(PRESS ANY KEY TO END SURVEY)

RCONU.

IF R IS CONFIRMED BUT UNAVAILABLE, READ:

Could you tell me a good time to call back to reach him/her?

Thank you, I will call back then.

IF SPEAKING WITH R, READ:

What is the best time for us to call you back to complete the survey?

IF R NO LONGER LIVES THERE, READ:

Is there a number where he/she can be reached? May I have it please?

INTERVIEWER: MAKE NOTE OF NEW NUMBER AND MAKE PERMANENT MESSAGE. THEN TRY NEW NUMBER.

ENTER NEXT AND SET APPOINTMENT.

END INTERVIEW (END2 in CATI)

Thank you for your time. We are sorry that you do not want to complete the interview. If you change your mind or have any questions, please contact DIR at 1-866-986-1968.

Have a nice day/evening.

(PLEASE PRESS NEXT TO CONTINUE)

Q4.

Are you ready to begin?

1 YES

2 NOT NOW (GO TO RCONU)

7 DON’T KNOW (GO TO RCONU)

8 REFUSED (GO TO END INTERVIEW)

CATI: RECORD INTRO SECTION END TIME [SECQEDTM] AND END DATE [SECQEDDT]

CATI: ALL GO TO A1

A. Employment Status and Income

CATI: RECORD SECTION A START TIME [SECASTTM] & START DATE [SECASTDT]

During this interview I will be asking about the experiences you’ve had and services you may have received since [RAD]. This is the date you agreed to participate in the study. As a result, many of the questions I ask will refer to this date. Let’s begin.

A1.

First, I’m going to ask you a few questions about your work. Are you currently working at a job for pay? Include any work where you are paid including self-employment, temporary work, work as a day laborer, and paid work at an employment program.

1 YES (GO TO A3)

2 NO

7 DON’T KNOW

8 REFUSED

A2.

Did you have at least one paid job, either full or part time, at any time between [RAMY] and today? Again, include any work where you are paid.

1 YES

2 NO (GO TO A12)

7 DON’T KNOW (GO TO A12)

8 REFUSED (GO TO A12)

CATI: FOR A3 THROUGH A7, USE FIRST TEXT FILL OPTION IF A1=1, ELSE USE SECOND OPTION.

A3.

The next questions refer to your (current/most recent) job you worked at. If you (work/worked) at two or more jobs, please focus on the job where you (work/worked) the most hours.

How many hours per week (do/did) you usually work at this job?

INTERVIEWER, IF NEEDED: Your best guess is fine.

_______

HOURS

(RANGE: 1-90)

997 DON’T KNOW

998 REFUSED

A4.

What (is/was) your wage (now/just before you left), before taxes? Please include tips, commissions, and regular overtime pay. Please include wages from all jobs, even odd jobs or informal work.

IF R’S JOB IS ON AN IRREGULAR SCHEDULE OR A COMMISSION BASIS, PROBE FOR HOW MUCH R MAKES IN A TYPICAL WEEK.

$ ___ ___ ___ , ___ ___ ___ . ___ ___  (GO TO A5)

AMOUNT

(RANGE: $1-$50,000.00)

999999.97 DON’T KNOW (GO TO A6)

999999.98 REFUSED (GO TO A6)

A5.

(Is / Was) that:

01 per hour,

02 per week,

03 every 2 weeks,

04 twice a month,

05 once a month,

06 per day or per task, or

07 some other way?, SPECIFY

97 DON’T KNOW

98 REFUSED

CATI: IF A5=6, 7 ASK A5a. ELSE GO TO A6

A5a.

What would you estimate you (make/made) in a week?

$___ , ___ ___ ___ . ___ ___

AMOUNT

(RANGE: $1-$1,000.00)

9999.97 DON’T KNOW

9999.98 REFUSED

A6.

What type of employer (are/were) you working for? Please pick one from the following:

1 self-employed,  (GO TO A10)

2 a for-profit company or employer,

43 a non-profit company or employer

54 a government employer, or

65 some other work arrangement?(SPECIFY___________)

97 DON’T KNOW

98 REFUSED

A7.

What (is/was) the name of the place where you (work/worked)?

interviewer: record verbatim

_______________

PLACE WORKED

97 DON’T KNOW

98 REFUSED

A8.

Did you get help from people at a program, agency, or organization in your community to find or get this job?

1 YES

2 NO (GO TO A10)

7 DON’T KNOW (GO TO A10)

8 REFUSED (GO TO A10)

CATI: ALLOW MULTIPLE RESPONSES IN A9, UP TO THREE.

A9.

What organizations or programs did you get this help from? Was it from…

INTERVIEWER: SELECT AS MANY AS APPLY UP TO THREE.

INTERVIEWER, IF NECESSARY: [STEDPRO] was the program offered by [CBONAME].

interviewer: probe: Where else?

1 the [STEDPRO] program,

2 a welfare office,

3 a parole office,

4 a child support agency,

5 a workforce center, WIA or one-stop,

6 an unemployment office, or

7 some other source? (SPECIFY________________________)

97 DON’T KNOW

98 REFUSED

A10.

Since [RAMY], how many weeks have you been employed in any job?

INTERVIEWER: IF LESS THAN 1 WEEK, ENTER 1.

INTERVIEWER, IF NEEDED SAY: Counting all jobs since [RAMY]

_______________  (GO TO A12)

NUMBER OF WEEKS

(RANGE: 1-52)

97 DON’T KNOW (GO TO A11)

98 REFUSED (GO TO A11)

A11.

Was it …

1 all the time,

2 most of the time,

3 half the time,

4 some of the time, or

5 seldom?

7 DON’T KNOW

8 REFUSED

A12.

I’d like to talk to you about your family income for a few minutes.

What was the total income of all members of your household including yourself from all sources in the [PRIOR MONTH]? Include income from your job, the jobs of other household members, SNAP/Food Stamps, child support, TANF, SSI, and Unemployment insurance. Be sure to include income from work inside or outside the home such as child care/babysitting, doing hair, cooking, car repair, carpentry, or other jobs like that.

INTERVIEWER PROBE: Your best estimate is fine. Please don’t include tax returns or Earned Income Tax Credit or EITC payments in your answer.

INTERVIEWER: ROUND TO THE NEAREST WHOLE NUMBER.

$ ___ ___ ___ ,___ ___ ___  (GO TO B1)

AMOUNT

(RANGE: $1-$10,000)

999997 DON’T KNOW (GO TO A13)

999998 REFUSED (GO TO A13)

A13 .

Would you say it was…

1 $500 or less

2 $501-$1000

3 $1001-$1500

4 $1501-$2000

5 $2001-$2500, or

6 $2501 or more?

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION A END TIME [SECAEDTM] & END DATE [SECAEDDT]

B. Service Participation

CATI: RECORD SECTION B START TIME [SECBSTTM] & START DATE [SECBSTDT]

CATI: IF A8=1, GO TO B3a, ELSE CONTINUE

B1.

The next few questions are about your involvement with any organizations or programs in your community that help people find a job and help with problems that might interfere with employment.

Since [RAMY] have you received assistance from any organization or program in your community to help you find or keep a job, or to help you deal with problems that interfered in your ability to work?

interviewer: if necessary SAY: This would include help with finding a job; dealing with child care, transportation, or housing problems; or other issues that would make it hard for you to work.

1 YES

2 NO (GO TO B3a)

7 DON’T KNOW (GO TO B3a)

8 REFUSED (GO TO B3a)

CATI: ALLOW MULTIPLE RESPONSES IN B2, UP TO THREE.

B2.

What organizations or programs did you get this help from? Was it from…

INTERVIEWER: SELECT AS MANY AS APPLY UP TO THREE.

INTERVIEWER, IF NECESSARY: [STEDPRO] was the program offered by [CBONAME].

interviewer: probe: Where else?

1 the [STEDPRO] program,

2 a welfare office,

3 a parole office,

4 a child support agency,

5 a workforce center, WIA or one-stop,

6 an unemployment office, or

7 some other source? (SPECIFY________________________)

97 DON’T KNOW

98 REFUSED

B3a.

Since [RAMY] have you taken any adult basic education or GED courses?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

B3b.

Since [RAMY] have you taken any courses or participated in any training for a specific job or skill, sometimes called ‘vocational training’?

1 YES

2 NO (GO TO B3c)

7 DON’T KNOW (GO TO B3c)

8 REFUSED (GO TO B3c)

BB3bSub1.

What kind of job, trade, or occupation was this training for?

interviewer: record verbatim

_______________

JOB, TRADE, OR OCCUPATION

97 DON’T KNOW

98 REFUSED

B3c.

Since [RAMY] have you taken any courses for English as a second language?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

B3d.

Since [RAMY] have you taken any college classes for credit?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

B3e.

Since [RAMY] have you taken any life skills or anger management classes?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

B3f.

Since [RAMY] have you taken any other courses or participated in any other training not mentioned?

1 YES

2 NO (GO TO B5)

7 DON’T KNOW (GO TO B5)

8 REFUSED (GO TO B5)

B3g.

What was it?

INTERVIEWER: RECORD VERBATIM

_____________________

CLASS/COURSE NAME

97 DON’T KNOW

98 REFUSED

B4. Omitted

CATI: FOR B5,

IF B3a=1, B3b=1, B3c=1, B3d=1, B3e=1, OR B3f =1, ASK B5.

ELSE GO TO C1

B5.

Where did you take the classes?

interviewer: record verbatim

interviewer: If more THAN ONE TRAINING or training location, record them all. use “/” to indicate a new location is being reported.

_______________

CLASS LOCATION

97 DON’T KNOW

98 REFUSED

CATI: RECORD SECTION B END TIME [SECBEDTM] & END DATE [SECBEDDT]

C. Material and Financial Hardship

CATI: RECORD SECTION C START TIME [SECCSTTM] & START DATE [SECCSTDT]

C1.

Now I have some questions about your current financial situation. Sometimes due to circumstances beyond your control, it can be difficult to meet all of your financial obligations. As I read each question, please let me know if you have faced any of the following situations.

In the past 12 months, has there been a time when…

	YES	NO	DON’T KNOW	REF	NOT APPL.
a. …you did not pay the full amount of the rent or mortgage because you could not afford it?	1	2	7	8
b. …the bank or mortgage company foreclosed on your mortgage?	1	2	7	8	6
c. …you were evicted from your home or apartment for not paying the rent or mortgage?	1	2	7	8
d. …you filed in court for bankruptcy?	1	2	7	8
e. …you did not pay the full amount of the gas, oil, or electricity bills?	1	2	7	8
f. …you had service turned off by the gas or electric company, or the oil company would not deliver oil?	1	2	7	8
g. …you had cellular or land telephone service disconnected because payments were not made?	1	2	7	8
h. ...you could not fill or postponed filling a prescription for drugs when they were needed because you could not afford it?	1	2	7	8

CATI: “NOT APPLICABLE” RESPONSE OPTION APPLIES ONLY TO C1b.

C2.

Since [RAMY] have you ever needed to go to the doctor or dentist but didn’t because you didn’t think you could afford to pay for it?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

C3.

In general, how do your family finances usually work out at the end of the month? Is there…

1 some money left over,

2 just enough to make ends meet, or

3 not enough money to make ends meet?

7 DON’T KNOW

8 REFUSED

C4.

How much do you agree or disagree with the following statement? My financial situation is better than it was last year at this time. Would you say you…

1 strongly disagree,

2 somewhat disagree,

3 slightly disagree,

4 slightly agree,

5 somewhat agree, or

6 strongly agree?

7 DON’T KNOW

8 REFUSED

C5.

When it comes to making ends meet, how much help did your household get in the past 12 months from food pantries, churches, family services or other organizations? Did you get…

1 no help at all,

2 some help, or

3 a lot of help?

7 DON’T KNOW

8 REFUSED

C6.

On a scale of 0 to 10, where 0 means “never” and 10 means “all the time,” how often do you worry about being able to meet normal monthly living expenses?

______

NUMBER

(RANGE: 0-10)

97 DON’T KNOW

98 REFUSED

C7.

Getting enough food can be a problem for some households. Which of these statements best describes the food eaten in your household in the past week? Would you say there was…

1 enough of the kind of foods you want,

2 enough, but not always the kinds of food you want,

3 sometimes not enough to eat, or

4 often not enough to eat?

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION C END TIME [SECCEDTM] & END DATE [SECCEDDT]

D. Mental and Physical Health

CATI: RECORD SECTION D START TIME [SECDSTTM] & START DATE [SECDSTDT]

D1.

Now I have several questions about your health. In general, would you say your health is…

INTERVIEWER, IF ASKED: This question refers to your overall health which includes both your mental and physical health.

1 excellent,

2 very good,

3 good,

4 fair, or

5 poor?

7 DON’T KNOW

8 REFUSED

D2.

Compared to one year ago, how would you rate your health now? Would you say it is…

1 much better than one year ago,

2 somewhat better now than one year ago,

3 about the same,

4 somewhat worse now than one year ago, or

5 much worse now than one year ago?

7 DON’T KNOW

8 REFUSED

D3.

An important objective of this survey is to assess your overall well being. These next questions are about feelings you may have experienced over the past month.

During the past month, how often did you feel…	Often	Some-times	Hardly Ever	Never?	DON’T KNOW	REF
a. …so sad that nothing could cheer you up? Would you say you felt that way…	1	2	3	4	7	8
b. ...nervous?	1	2	3	4	7	8
c. …restless or fidgety?	1	2	3	4	7	8
d. …hopeless? Would you say you felt that way…	1	2	3	4	7	8
e. …that everything was an effort?	1	2	3	4	7	8
f. …worthless?	1	2	3	4	7	8

D4.

Taken all together, how would you say things are these days? Would you say that you are…

1 very happy,

2 pretty happy, or

3 not too happy?

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION D END TIME [SECDEDTM] & END DATE [SECDEDDT]

E. Locus of Control

CATI: RECORD SECTION E START TIME [SECESTTM] & START DATE [SECESTDT]

E1.

The next questions are about how you handle problems in life and work. Please rate your agreement with the following statements.

	Strongly Disagree	Some-What Disagree	Slightly Disagree	Slightly Agree	Some-What Agree	Strongly Agree	DON’T KNOW	REF
a. I can do just about anything I really set my mind to. Would you say you…	1	2	3	4	5	6	7	8
b. When I really want to do something, I usually find a way to succeed at it.	1	2	3	4	5	6	7	8
c. Whether or not I am able to get what I want is in my own hands.	1	2	3	4	5	6	7	8
d. What happens to me in the future mostly depends on me. Would you say you…	1	2	3	4	5	6	7	8
e. I can do the things that I want to do.	1	2	3	4	5	6	7	8

E2.

Using a 0 to 10 scale, where 0 means "no control at all" and 10 means "very much in control," how would you rate the amount of control you have over your work situation these days?

INTERVIEWER, IF NEEDED, SAY: “On a scale of 0 to 10.”

_______________

NUMBER

(RANGE: 0-10)

97 DON’T KNOW

98 REFUSED

E3.

Using that same scale of 0 to 10, how would you rate the amount of control you have over your financial situation these days?

INTERVIEWER, IF NEEDED, SAY: Where 0 means "no control at all" and 10 means “very much in control."

_______________

NUMBER

(RANGE: 0-10)

97 DON’T KNOW

98 REFUSED

CATI: RECORD SECTION E END TIME [SECESTTM] & END DATE [SECEEDDT]

F. Work Self-Efficacy

CATI: RECORD SECTION F START TIME [SECFSTTM] & START DATE [SECFSTDT]

F1.

The next few questions are about work skills. Whether or not you are currently working, please rate the following statements about your work skills according to this scale:

Strongly Disagree, Somewhat Disagree, Slightly Disagree, Slightly Agree, Somewhat Agree, or Strongly Agree.

	Strongly Disagree	Slightly Disagree	Slightly Agree	Strongly Agree			DON’T KNOW	REF
a. I can get to work on time. Would you say you…	1	2	3	4			7	8
b. I can meet my employer’s expectations.	1	2	3	4			7	8
c. I can work well with others.	1	2	3	4			7	8
d. I can have a good relationship with my supervisor. Would you say you…	1	2	3	4			7	8
e. I can work well as part of a team.	1	2	3	4			7	8
f. I can complete the tasks assigned.	1	2	3	4			7	8
g. I can learn new skills if necessary.	1	2	3	4			7	8

CATI: RECORD SECTION F END TIME [SECFEDTM] & END DATE [SECFEDDT]

G. Job Search Self-Efficacy

CATI: RECORD SECTION G START TIME [SECGSTTM] & END DATE [SECGEDDT]

G1.

Now, I’d like to ask how confident you feel about doing things. For each of the following questions, please let me know how much confidence you have: not at all, a little, some, pretty much, or a great deal. How confident are you that you could …

	Not At All	A Little	Some	Pretty Much	A Great Deal	DON’T KNOW	REF
a. Make a good list of all the skills that you have and can be used to find a job. Would you say…	1	2	3	4	5	7	8
b. Talk to friends and other contacts to find out about potential employers who need your skills.	1	2	3	4	5	7	8
c. Talk to friends and other contacts to discover promising job openings that are suitable for you.	1	2	3	4	5	7	8
d. Complete a good job application and resume. Would you say…	1	2	3	4	5	7	8
e. Contact and persuade potential employers to consider you for a job.	1	2	3	4	5	7	8
f. Make the best impression and get your points across in a job interview.	1	2	3	4	5	7	8

CATI: RECORD SECTION G END TIME [SECGEDTM] & END DATE [SECGEDDT]

H. Social Isolation/Social Support and Social Networks

CATI: RECORD SECTION H START TIME [SECHSTTM] & START DATE [SECHEDDT]

H1.

The next set of questions is about support systems such as your friends and family.

People sometimes look to others for companionship, assistance, or other types of support. How often is each of the following kinds of support available to you if you need it?

	None Of The Time	A Little Of The Time	Some Of The Time	Most Of The Time	All Of The Time	DON’T KNOW	REF
a. Someone you can count on to listen to you when you need to talk. Would you say that kind of support is available…	1	2	3	4	5	7	8
b. Someone to give you information to help you understand a situation….	1	2	3	4	5	7	8
c. Someone to give you good advice about a crisis….	1	2	3	4	5	7	8
d. Someone to confide in or talk to about yourself or your problems. Would you say that kind of support is available…	1	2	3	4	5	7	8
e. Someone whose advice you really want….	1	2	3	4	5	7	8
f. Someone to share your most private worries and fears with…	1	2	3	4	5	7	8
g. Someone to turn to for suggestions about how to deal with a personal problem. Would you say that kind of support is available…	1	2	3	4	5	7	8
h. Someone who understands your problems…	1	2	3	4	5	7	8

H2.

Suppose you needed a favor like a ride, a babysitter, or to borrow something small. Is there someone you could ask for help?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

H3.

Suppose you had a personal problem, and you wanted to talk to someone about it. Is there someone you could ask for help or advice?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

H4.

Suppose you had to borrow $250 for a few weeks because of an emergency. Is there someone you could ask for help?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

H5.

Please rate the following statements.

There are disagreements about money in my home. Would you say this happens…

1 never,

2 rarely,

3 sometimes,

4 often, or

5 always?

7 DON’T KNOW

8 REFUSED

H6.

I tend to argue with others about money. Would you say this happens…

1 never,

2 rarely,

3 sometimes,

4 often, or

5 always?

7 DON’T KNOW

8 REFUSED

H7.

Financial problems hurt my relationships. Would you say this happens…

1 never,

2 rarely,

3 sometimes,

4 often, or

5 always?

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION H END TIME [SECHEDTM] & END DATE [SECHEDDT]

CATI: RECORD SECTION I START TIME [SECHSTTM] & START DATE [SECISTDT]

I. Role Models

I1.

Thinking about everyone that you would count as a friend, not just your close friends, do you have a friend who graduated from college?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

I2.

Thinking about everyone that you would count as a friend, not just your close friends, do you have a friend who earns more than $30,000 a year?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: RECORD SECTION I END TIME [SECIEDTM] & END DATE [SECIEDDT]

J. Social Network Roster and Relationship Origin

CATI: RECORD SECTION J START TIME [SECJSTTM] & START DATE [SECJSTDT]

Now I‘m going to ask you some questions about your relationships with other people.

J1.

From time to time, most people discuss things that are important to them with others. These may include good or bad things that happen to you, problems you are having, or important concerns you may have.  I’d like to ask you about the people with whom you often discuss things that are important to you. You may refer to these people in any way you want; for example you may use just their first names or nicknames or initials. I am not interested in the identities of these people. I just need to have some way to refer to them so that when I ask you a follow-up question we both know who we are talking about.

Over the last 6 months, who are the people with whom you most often discussed things that were important to you?

interviewer prompt: This could be a person you tend to talk to about things that are important to you.

CATI:

RECORD AS MANY NAMES IN J1 AS RESPONDENT OFFERS, UP TO 10.

CAPTURE ALL NAMES IN J1 BEFORE CONTINUING WITH J2. 

CATI: IF FIRST PERSON IN J1 = 96, 97 OR 98, GO TO Z1.

CATI: WHEN PERSON 2-10 = 96, 97 or 98, GO TO J2.

interviewer: enter names in order in which they are identified by respondent.

interviewer: After each name, prompt: Who else?

1 NAME GIVEN, SPECIFY_________________

96 NO ONE ELSE

97 DON’T KNOW

98 REFUSED

J2.

People can have many different connections to others. For example, a woman can be your co-worker and also be your neighbor. Or a man could be your brother and also a member of your church. Now, I would like to go through the names you just gave me. Please list all the ways that person is connected to you. How is [NAME FROM LIST] connected to you?

CATI:

FOR EACH NAME OFFERED IN J1, ALLOW UP TO FOUR CONNECTIONS IN J2. 

PRESENT EACH NAME ONE AT A TIME IN THE ORDER IT WAS COLLECTED.

ALSO PRESENT INTERVIEWER A CHECK BOX TO INDICATE “DONE” WITH A NAME.

WHEN INTERVIEWER CHECKS “DONE”, PRESENT NEXT NAME.

WHEN INTERVIEWER CHECKS “DONE” AND NO MORE NAMES ARE AVAILABLE, GO TO Z1.

INTERVIEWER: AFTER EACH CONNECTION, PROBE: What other ways is [NAME FROM LIST] connected to you?......What else?

INTERVIEWER: MARK UP TO FOUR CONNECTIONS FOR A NAME. CHECK “DONE” BOX TO START NEXT NAME.

FAMILY OR SEXUAL PARTNER

1 SPOUSE

2 EX-SPOUSE

3 ROMANTIC/SEXUAL PARTNER

4 PARENT

5 PARENT IN-LAW

6 OTHER IN-LAW

7 CHILD

8 STEP-CHILD

9 BROTHER OR SISTER

10 OTHER RELATIVE

FRIEND/NEIGHBOR

11 FRIEND

12 NEIGHBOR

OTHER CONNECTION

13 CO-WORKER OR BOSS

14 MINISTER, PRIEST, OR OTHER CLERGY

15 MEMBER OF THE SAME CONGREGATION

16 MEMBER OF THE SAME CLUB OR ACTIVITY GROUP

17 PSYCHIATRIST, PSYCHOLOGIST, COUNSELOR, OR THERAPIST

18 CASEWORKER/SOCIAL WORKER

19 JOB PLACEMENT/TRAINING PROGRAM STAFF

20 OTHER

97 DON’T KNOW

98 REFUSED

CATI: RECORD SECTION J END TIME [SECJEDTM] & END DATE [SECJEDDT]

SECTION Z: CONTACT INFORMATION

CATI: RECORD START DATE (SECZSTDT) AND TIME (SECZSTTM)

Z1.

Those are all the questions I have to ask you today. Thank you for the time you’ve spent talking with me and for your participation in this study. In order to send your gift card, I need to confirm your name and address.

I have your name listed as [FLNAME] and spelled as (INTERVIEWER: SPELL NAME). Is that correct?

1 YES (GO TO Z4)

2 NO (GO TO Z3)

3 REFUSED (GO TO Z2)

Z2.

In order to send your gift card, I am required to verify the spelling of

your name. I have your name listed as [FLNAME] and spelled as

(INTERVIEWER: SPELL NAME). Is that correct?

1 YES (GO TO Z4)

2 NO (GO TO Z3)

3 REFUSED (GO TO Z4)

CATI: PROVIDE TEXT BOX FOR ENTRY OF CORRECTED NAME WHILE ORIGINAL NAME IS DISPLAYED FOR COMPARISON PURPOSES

Z3.

INTERVIEWER: ENTER CORRECTED NAME.

[FLNAME]

Z4. Is this your current address? [FULLADD, RCITY, RSTATE, RZIP]

INTERVIEWER: READ ADDRESS TO R, SPELLING EACH WORD.

INTERVIEWER, IF R REFUSES SAY: We won’t be able to send your gift card without an address.

1 YES (GO TO Z6)

2 NO (GO TO Z5)

3 REFUSED (GO TO Z6)

CATI: PROVIDE TEXT BOX FOR ENTRY OF CORRECTED ADDRESS WHILE ORIGINAL ADDRESS IS DISPLAYED FOR COMPARISON PURPOSES

CATI: CREATE CDMO USING DATA ENTERED AT Z5 TO REPLACE:

FULLADD – FULL ADDRESS

RCITY – CITY

RSTATE – STATE

RZIP – ZIP

Z5. Please tell me your address.

ADDRESS ____________

CITY ________________

STATE _______________

ZIP __________________

8 REFUSED

INTERVIEWER: ENTER CORRECTED ADDRESS. READ BACK

THE ADDRESS INFORMATION TO R, SPELLING THE WORDS.

INTERVIEWER, IF R REFUSES SAY: We won’t be able to send your gift card without an address.

Z6. Is there another address you would like me to use to send your $25 gift card?

1 YES

2 NO (GO TO Z8)

8 REFUSED (GO TO Z8)

CATI: PROVIDE TEXT BOX FOR ENTRY OF SUPPLEMENTAL ADDRESS

Z7.

What address would you like me to use?

Street: ________________________

City:__________________________

State: _________________________

Zip: __________________________

Z8.

I also need to confirm your phone number in case we have any questions

about the interview. [CATI: DISPLAY RPHONE]

INTERVIEWER: READ THE PHONE NUMBER. Is this correct?

1 YES (GO TO Z10)

2 NO (GO TO Z9)

8 REFUSED (GO TO Z11)

CATI: PROVIDE TEXT BOX FOR ENTRY OF CORRECTED PHONE NUMBER. DISPLAY ORIGINAL PHONE NUMBER FOR COMPARISON PURPOSES

Z9.

INTERVIEWER: ENTER CORRECTED PHONE NUMBER. READ BACK TO R

TO CONFIRM.

Z10.

Is this a home, work, or cell phone number?

1. Home

2 Work

3 Cell

8 REFUSED

Z11.

This study will be going on for a few more years. We are interested in learning what helps people improve their circumstances and what gets in the way of making that happen. We may need to contact you again in the future. If you happen to move between now and then, it would help if we could gather some additional information.

CATI: If Z8=8 OR Z10=8, GO TO Z16,

IF Z8 ≠ 8 AND Z10≠8, GO TO Z12.

 

Z12. Is there an additional phone number or cell phone we could reach you at?

1 YES (GO TO Z13)

2 NO

8 REFUSED (GO TO Z15)

CATI: IF Z12 = 2 AND Z10 = 3 (No additional phone # and 1^st # is cell phone), GO TO Z15; IF Z12 = 2 AND Z10 ≠3, GO TO Z16.

Z13.

CATI: PROVIDE TEXT BOX FOR ENTRY OF SECOND PHONE NUMBER

INTERVIEWER: ENTER PHONE NUMBER. READ BACK TO R TO CONFIRM.

Z14.

Is this a home, work, or cell phone number?

1. Home

2 Work

3 Cell

8 REFUSED

Z15.

CATI: IF Z10 = 3 OR Z14 = 3, ASK Z15,

IF Z10 ≠ 3 AND Z14 ≠ 3, GO TO Z16.

In the future, may we call or send a text message to the cell phone number you provided?

1 YES

2 NO

8 REFUSED

Z16.

Is there an e-mail address you could provide?

1 YES (GO TO Z17)

2 NO (GO TO Z18)

8 REFUSED (GO TO Z18)

Z17.

CATI: PROVIDE TEXT BOX FOR ENTRY OF EMAIL ADDRESS; IF Z17=2 DISPLAY: “PLEASE CORRECT EMAIL ADDRESS AND CONFIRM WITH RESPONDENT. ONCE THE EMAIL IS CONFIRMED AS CORRECT, CHOOSE 1 AND CONTINUE.”

INTERVIEWER: ENTER EMAIL ADDRESS. READ THE EMAIL ADDRESS. Is this correct?

1 YES

2 NO

8 REFUSED

Z18.

We would like to get the name of one or two other people who would probably know where we could reach you. Many people give their mother’s or sister’s name. Others give the name of a very close friend. Who would be a good person for us to contact if we were trying to find you for an interview in the future?

(PROMPT: “Who else?” AFTER EACH CONTACT).

INTERVIEWER: TRY TO GET THREE REFERENCES. CONTINUE PROMPT UNTIL R INDICATES THERE IS NO ONE ELSE.

CATI: PROVIDE THE SERIES Z19-Z22 FOR UP TO THREE OTHER CONTACTS. PROGRAM SO THAT THESE FIELDS CAN BE LEFT BLANK IF NECESSARY. USE THE LABELING CONVENTION OF “_1”, “_2”, OR “_3” TO DIFFERENTIATE BETWEEN THE THREE CONTACTS. FOR EXAMPLE, THE FIRST CONTACT NAME WOULD BE “Z19_1’.

Z19.

What is their name? Would you spell that for me?

NAME_____________________________

Z20.

And what is their relationship to you?

RELATIONSHIP____________________

Z21.

Where would we contact him/her?

STREET

CITY

STATE

ZIPCODE

Z22.

Is there a phone number?

PHONE NUMBER ____________________

THANK.

Thank you very much for your time and assistance. You should receive your gift card in

about 3 weeks.

If you have any questions about the study or your gift card, you can contact Jim Cooper at DIR, the company in charge of conducting this survey. His toll-free number is 1-888-864-1425, ext 138.

INTERVIEWER: PRESS NEXT TO END SURVEY.

CATI: RECORD END DATE (SECTZEDDT) AND TIME (SECZEDTM)

CATI: CALCULATE SECTION TIMES