Download:
pdf |
pdf
Attachment
A
Basic CPS Items Booklet
Demographic Items
Caseid: 00000000
Item: HHNUM_VR
DO NOT ASK
Is this a Replacement Household?
(1) Yes
(2) No
_
Caseid: 00000000
Item: VERADD
I have your address listed as ...
(house number)(house number suffix)(street name)
(unit designation)
(GQ unit info)
(Non-city style address)
(physical description)
(city), (state) (zip) (zip 4)
(Building name)
(1)
(2)
SAME address
address has changed.
_
Caseid: 00000000
IB-1
April 2004
Item: MAILAD
Is this also your mailing address?
(house number)(house number suffix)(street name)
(unit designation)
(GQ unit info)
(physical description)
(Non-city style address)
(city), (state) (zip) (zip 4)
(1) Yes
(2) No
_
Caseid: 00000000
Item: RESP1
|
HOUSEHOLD ROSTER
| R LN NAME
| (person 1)
| (person 2)
NEW RESPONDENT MUST BE A
| (person 3)
HOUSEHOLD MEMBER AND
| (person 4)
15+ OR A PROXY
| (person 5)
| (person 6)
ENTER LINE NUMBER (1-16)
| (person 7)
IF CURRENT RESPONDENT
| (person 8)
| (person 9)
ENTER (N) IF ALL PERSONS
| (person 10)
UNDER 15
| (person 11)
| (person 12)
(ENTER (A) FOR SOMEONE NOT
| (person 13)
LISTED)
| (person 14)
| (person 15)
_
| (person 16)
ENTER LINE NUMBER OF
NEW RESPONDENT
M
AGE
Caseid: 00000000
IB-2
April 2004
Item: STRBLT
Was this structure built before April of 2000?
(1) Yes
(2) No
(3) Not asked
_
(The address is a mobile home, trailer, tent or other unit not in a structure,
or the unit is in a group quarters.)
Caseid: 00000000
Item: BUILD
Are there any other living quarters–either occupied or vacant–at this address?
(1) Yes
(2) No
_
Caseid: 00000000
Item: TENUR-SCRN
Are your living quarters...
READ ANSWER CATEGORIES
(1) Owned or being bought by you or someone in your household?
(2) Rented for cash?
(3) Occupied without payment of cash rent?
_
Caseid: 00000000
Item: ACCESS
IB-3
April 2004
DO NOT READ TO RESPONDENT
Indicate if access to the household is:
(1) Direct
(2) Through another unit
_
Caseid: 00000000
Item: LIVQRT@1
DO NOT READ TO RESPONDENT
INTERVIEWER CHECK ITEM
Enter type of Housing Unit.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
House, apartment, flat
HU in nontransient hotel, motel, etc.
HU permanent in transient hotel, motel, etc.
HU in rooming house
Mobile home or trailer with no permanent room added
Mobile home or trailer with one or more permanent rooms added
HU not specified above
(0) Other Unit
_
Caseid: 00000000
Item: OTHUNT@1
DO NOT READ TO RESPONDENT
IB-4
April 2004
INTERVIEWER CHECK ITEM
Enter type of Other Unit.
(8)
(9)
(10)
(11)
(12)
Quarters not HU in rooming or boarding house
Unit not permanent in transient hotel, motel, etc.
Unoccupied tent site or trailer site
Student quarters in college dormitory
OTHER unit not specified above
_
-RPNAME-
What are the names of all persons living or staying here?
Start with the name of the person or one of the persons who owns/rents this home.
[Is this name's usual place of residence?
(1) Yes
IB-5
April 2004
(2) No
(3) No, but PROXY respondent]
[ASK ONLY IF NECESSARY
What is name's sex?
(1) Male
(2) Female]
FIRST NAME
(enter person 1)
(enter person 2)
(enter person 3)
(enter person 4)
(enter person 5)
(enter person 6)
(enter person 7)
(enter person 8)
(enter person 9)
(enter person 10)
(enter person 11)
(enter person 12)
(enter person 13)
(enter person 14)
(enter person 15)
(enter person 16)
Anyone else?
LAST NAME
_
HHMEM
SEX
(1-yes, 2-no)
Caseid: 00000000
Item: STLLIV
I have listed READ NAMES
|
HOUSEHOLD ROSTER
| M LN NAME
| (person 1)
IB-6
RELATION
April 2004
Do all of these persons still
live here?
_
ENTER LINE NUMBER FOR
MEMBERSHIP CHANGE
(P) ALL CORRECT
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
Caseid: 00000000
Item: NEWLIV
Is there anyone else living or
staying here now?
(P) No one else living
or staying here
((A) ADD Person NOT
LISTED above)
Enter LINE NUMBER to
UNDELETE someone listed
above
_
|
HOUSEHOLD ROSTER
| M LN NAME
| (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
RELATION
Caseid: 00000000
Item: MCHILD@1 (MCHILD@2)
I have listed:
READ NAMES
|
| M LN NAME
| (person 1)
Have I missed any (other) babies
| (person 2)
IB-7
HOUSEHOLD ROSTER
RELATION
April 2004
or small children?
| (person 3)
| (person 4)
(P) NO ONE ELSE TO ADD | (person 5)
((A) ADD Person NOT listed) | (person 6)
_
| (person 7)
| (person 8)
Have I missed anyone (else) who
| (person 9)
usually lives here but is away
| (person 10)
now traveling, at school, or in
| (person 11)
a hospital?
| (person 12)
| (person 13)
(P) NO ONE ELSE TO ADD | (person 14)
((A) ADD Person NOT listed) | (person 15)
_
| (person 16)
Caseid: 00000000
Item: (MLODGE@1/ MLODGE@2)
|
HOUSEHOLD ROSTER
| M LN NAME
| (person 1)
| (person 2)
| (person 3)
(P) NO ONE ELSE TO ADD | (person 4)
((A) ADD Person NOT listed) | (person 5)
| (person 6)
_
| (person 7)
| (person 8)
| (person 9)
Have I missed anyone else
| (person 10)
staying here?
| (person 11)
| (person 12)
(P) NO ONE ELSE TO ADD | (person 13)
((A) ADD Person NOT listed) | (person 14)
| (person 15)
_
| (person 16)
Have I missed any (other) lodgers,
boarders, or persons you employ
who live here?
RELATION
Caseid: 00000000
Item: TABX_1A
What is the exact address of this other living quarters?
Enter (S) for same
IB-8
April 2004
Old Address: (house number) (house number suffix) (street name)
(unit description)
(non-city address)
(physical description)
(city) (state) (zip) (zip4)
(building name)
New Address: (house number) (house number suffix) (street name)
(unit description)
(non-city address)
(physical description)
[r] (H) [n] Help
(building name)
_
Caseid: 00000000
Item: TABX_1A2
(house number) (house number suffix) (street name)
(unit description)
(non-city address)
(physical description)
(city) (state) (zip) (zip4)
IB-9
April 2004
(building name)
Is this address already listed on your listing sheet?
(1) Yes
(2) No
_
Caseid: 00000000
Item: TABX_3
DO NOT READ TO RESPONDENT
(house number) (house number suffix) (street name)
(unit description)
(non-city address)
(physical description)
(city) (state) (zip) (zip4)
(building name)
Are the additional living quarters within the basic address of the original sample unit?
(1) Yes
(2) No
_
Caseid: 00000000
Item: TABX_5
DO NOT READ TO RESPONDENT
(house number) (house number suffix) (street name)
(unit description)
(non-city address)
IB-10
April 2004
(physical description)
(city) (state) (zip) (zip4)
(building name)
Are the additional living quarters in a group quarters?
_
(1) Yes
(2) No
Caseid: 00000000
Item: TABX_7
Do the occupants or intended occupants of the additional living quarters have direct
access from the outside or through a common hall?
(1) Yes
(2) No
_
Caseid: 00000000
Item: CHANGE
Since our last interview, has any household member had any changes in Marital Status?
CURRENT RESPONDENT: (name)
F12 AND THEN "PAGE DOWN" FOR NEXT PAGE
Enter LINE NUMBER to CHANGE something displayed below _
(P) All correct - Proceed
(A) ADD a new person
IB-11
April 2004
LN NAME
(person 1)
(person 2)
(person 3)
(person 4)
(person 5)
(person 6)
(person 7)
(person 8)
(person 9)
(person 10)
(person 11)
(person 12)
(person 13)
(person 13)
(person 14)
(person 15)
(person 16)
M RELATION PR SX AGE MAR SP AN ED RC OR
SSN
Caseid: 00000000
Item: REL1
SHOW FLASH CARD
How (are/is) (name/you) related to (name of reference person)?
(20)
(21)
(22)
(23)
(24)
Spouse (Husband/Wife)
Unmarried Partner
Child
Grandchild
Parent (Mother/Father)
IB-12
April 2004
(25)
(26)
(27)
(28)
(29)
(30)
Brother/Sister
Other relative (Aunt, Cousin, Nephew, Mother-in-law, etc.)
Foster child
Housemate/Roommate
Roomer/Boarder
Other nonrelative
_
Caseid: 00000000
Item: REL2
(Earlier you said (name/you) (were/was) not related to (you/reference person))
(Are/Is) (name/you) related to anyone else in this household?
(1) Yes
(2) No
_
Caseid: 00000000
Item: (REL3@1 / REL3@2 / REL3@3 / REL3@4)
Who (are/is) (name/you) related to?
PROBE: Anyone else?
ENTER (N) FOR NO MORE/ (M) FOR MISTAKE
F12 AND THEN "PAGE DOWN" FOR NEXT PAGE
ENTER LINE NUMBER for each household member to whom
(name/you) is related.
_
_
_
_
"Pgdn = NEXT screen" for next page
IB-13
April 2004
HOUSEHOLD ROSTER
LN NAME
(person 1)
(person 2)
(person 3)
(person 4)
(person 5)
(person 6)
(person 7)
(person 8)
(person 9)
(person 10)
(person 11)
(person 12)
(person 13)
(person 14)
(person 15)
(person 16)
RELATION
SUBFAMILY
Caseid: 00000000
Item: PARENT1
ENTER LINE NUMBER OF
PARENT OF
(name)
-- ASK IF NECESSARY
(0) NO ONE LISTED ABOVE
_
|
| LN NAME
| (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
IB-14
HOUSEHOLD ROSTER
RELATION
April 2004
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
Caseid: 000000
Item: HHMEM1
VERIFY OR ASK: Is this (name's/your) usual place of residence?
(1) Yes
(2) No
(3) No, but PROXY respondent
_
Caseid: 00000000
Item: HHMEM2
(Do/Does) (name/you) have a usual place of residence elsewhere?
(1) Yes
(2) No
_
Caseid: 00000000
Item: (AGE1@MON / AGE1@DAY / AGE1@YR)
What is (name's/your) date of birth?
(First, the month.)
(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
ENTER MONTH
_
ENTER DAY
_
(9) September
(10) October
(11) November
(12) December
(1-31)
IB-15
April 2004
ENTER YEAR
_
(1899-1998)
Caseid: 00000000
Item: AGE2
As of last week, that would make (name/you) ((age)/approximately (age)/less than 1/over 98)
(years/year) old. Is that correct?
(1) Yes, age is correct. PROCEED
(2) No, age is NOT correct. RECHECK BIRTHDATE
_
Caseid: 00000000
Item: MARITAL1
(Are/Is) (name/you) now married, widowed, divorced, separated or never married?
((1) Married - spouse PRESENT)
(2) Married - spouse ABSENT
(3) Widowed
(4) Divorced
(5) Separated
(6) Never married
IB-16
April 2004
_
Caseid: 00000000
Item: SPOUSE1
ENTER LINE NUMBER OF
SPOUSE OF
(name)
-- ASK IF NECESSARY
(0) NO ONE LISTED ABOVE
_
|
| LN NAME
| (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
HOUSEHOLD ROSTER
RELATION
Caseid: 00000000
Item: SEX1
ENTER APPROPRIATE SEX.
ASK ONLY IF NECESSARY:
What is (name's/your) sex?
(1) Male
(2) Female
_
Caseid: 00000000
Item: AF1
IB-17
April 2004
Did (name/you) ever serve on active duty in the U. S. Armed Forces?
(1) Yes
(2) No
_
Caseid: 00000000
Item: AF2
IF NECESSARY: Previously I was told that (name/you) served on active duty in the U. S.
Armed Forces.
When did (you/he/she) serve?
((1)
((2)
((3)
((4)
(5)
(6)
Vietnam Era---(Aug. '64 - Apr. '75))
Korean War----(June '50 - Jan. '55))
WW II------------(Sep. '40 - July '47))
WW I-------------(Apr. '17 - Nov. '18))
Other service---(All other periods)
Nonveteran
_
Caseid: 00000000
Item: AF3
(Are/Is) (name/you) (still/now) in the Armed Forces?
(1) Yes
(2) No
_
Caseid: 00000000
Item: EDUCA1
IB-18
April 2004
What is the highest level of school (name/you) (has/have) completed or the highest degree
(name/you) (has/have) received?
(31)
(32)
(33)
(34)
(35)
(36)
(37)
(38)
(39)
Less than 1st grade
(43) Bachelor's degree
1st, 2nd, 3rd or 4th grade
(For example: BA, AB, BS)
5th or 6th grade
(44) Master's degree (For example:
7th or 8th grade
MA, MS, MEng, MEd, MSW, MBA)
9th grade
(45) Professional School Degree (For
10th grade
example: MD,DDS,DVM,LLB,JD)
11th grade
(46) Doctorate degree
12th grade NO DIPLOMA
(For example: PhD, EdD)
HIGH SCHOOL GRADUATE- high school DIPLOMA
or the equivalent (For example: GED)
(40) Some college but no degree
(41) Associate degree in college - Occupational/vocational program
(42) Associate degree in college -- Academic program
_
Caseid: 00000000
Item: EDUCA4
People can get a High-School diploma in a variety of ways, such as graduating from High
School or by getting a GED or other equivalent.
How did (you/name) get (your/his/her) High-School diploma?
(1) Graduation from High School
(2) GED or other equivalent
_
Caseid: 00000000
Item: EDUCA5
IB-19
April 2004
What was the highest grade of regular school (you/name) completed before receiving
(your/his/her) GED?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Less than 1st grade
1st, 2nd, 3rd, or 4th grade
5th or 6th grade
7th or 8th grade
9th grade
10th grade
11th grade
12th grade NO DIPLOMA
_
Caseid: 00000000
Item: EDUCA6
How many years of college CREDIT (have/has) (you/name) completed?
(Have/Has) (you/name) COMPLETED...
(1)
(2)
(3)
(4)
(5)
Less than 1 year (include 0 years completed)?
The first, or FRESHMAN year?
The second, or SOPHOMORE year?
The third, or JUNIOR year?
Four or more years?
_
Caseid: 00000000
Item: EDUCA7
Since completing (your/his/her) Bachelor's degree (have/has) (you/name) taken any
GRADUATE or PROFESSIONAL school courses for credit?
(1) Yes
(2) No
_
Caseid: 00000000
Item: EDUCA8
Did (you/name) complete SIX or MORE graduate or professional school courses?
IB-20
April 2004
(1) Yes
(2) No
_
Caseid: 00000000
Item: EDUCA9
Was (your/name's) Master's Degree program a 1-year, 2-year, or 3-year program?
(1) 1-year program
(2) 2-year program
(3) 3-year program (or longer)
_
Caseid: 00000000
Item: (HSPNON)
[fill AREIS] [fill TEMPNAME] Spanish, Hispanic, or Latino?
(1) Yes
(2) No
Caseid: 00000000
Item: ORISPN
SHOW FLASH CARD
[fill AREIS] [fill TEMPNAME] Mexican, Mexican American, Chicano, Puerto Rican, Cuban,
Cuban American, or some other Spanish, Hispanic, or Latino group?
IF MULTIPLE ANSWER - PROBE “Which group do/does [fill HESHE] most closely identify
with?”
IB-21
April 2004
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Mexican
Mexican American
Chicano
Puerto Rican
Cuban
Cuban American
Other Spanish, Hispanic, or Latino group
_
Caseid: 00000000
Item: OROTSP
SHOW FLASH CARD
What is the name of [fill HISHER] other Spanish, Hispanic, or Latino group?
(1)
(2)
(3)
(4)
(5)
Argentinean
Baleric Islands
Basque
Belize or British Honduras or Belice
Bolivian
(23)
(24)
(25)
(26)
(27)
Latin American
Latino
Nicaraguan
Panamanian
Paraguayan
(6)
(7)
(8)
(9)
(10)
Brazilian
Canary Islands
Castilian
Catalan
Central American
(28)
(29)
(30)
(31)
(32)
Peruvian
Portuguese
Salvadoran
Sephardic
South American
(33)
(34)
South American Indian
Spanish
(11) Central American Indian
(12) Chilean
IB-22
April 2004
(13) Colombian
(14) Costa Rican
(15) Dominican
(35)
(36)
(37)
Spanish American
Spanish American Indian
Spanish Basque
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(38)
(39)
(40)
(41)
Spaniard
Uruguayan
Venezuelan
Both Spanish, Hispanic, or Latino
and some other group
Other
Ecuadorian
Filipino
Guatemalan
Guamanian or Chamorro
Haitian
Hispanic
Honduran
(42)
Caseid: 00000000
Item: OROTSS
Specify “Other” Spanish, Hispanic, or Latino group.
@
Caseid: 00000000
Item: RACEA
SHOW FLASH CARD
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
Please choose one or more races ([fill HESHE]/[fill TEMPNAME]/you) consider(s) ([fill
HIMHER]/[fill TEMPNAME]) to be.
DO NOT PROBE – Unless response is Hispanic or is a Hispanic orgin
(1)
(2)
(3)
(4)
(5)
(6)
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other – DO NOT READ
Caseid: 00000000
Item: RACEB
IB-23
April 2004
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
I’m going to read you a list of five race categories. Please choose one ore more races that ([fill
HESHE]/[fill TEMPNAME]/you) consider(s) ([fill HIMHER]/[fill TEMPNAME]) to be:
White; Black or African American; American Indian or Alaska Native; Asian; OR Native
Hawaiian or Other Pacific Islander.
DO NOT PROBE – Unless response is Hispanic or is a Hispanic orgin
(1)
(2)
(3)
(4)
(5)
(6)
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Other – DO NOT READ
Caseid: 00000000
Item: RACEAS
READ EACH ITEM
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
Which of the following Asian groups [fill AREIS] [fill TEMPNAME]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian – DO NOT READ
Caseid: 00000000
Item: RACEPI
READ EACH ITEM
ENTER ALL THAT APPLY
IB-24
April 2004
ENTER (N) FOR NO MORE
Which of the following Native Hawaiian or Other Pacific Islander groups [fill AREIS] [fill
TEMPNAME]?
(1)
(2)
(3)
(4)
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander – DO NOT READ
Caseid: 00000000
Item: RACEOT
READ ONLY IF NECESSARY:
What is [fill HISHER] race?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
Aleut
African American
African Nation, Ethnic Group, or Tribe
American
American Indian or Alaska Native
Anglo-Saxon
Arab
Asian
Asian Indian
Black
Brazilian
Caucasian
Chicano
Chinese
Creole
Cuban or Cuban American
Eskimo
IB-25
(21)
Guamanian or Chamorro
(22)
Hispanic
(23)
Jamaican
(24)
Japanese
(25)
Korean
(26)
Latin American
(27) Latino
(28)
Mexican or Mexican
American
(29)
Native American
(30)
Native Hawaiian or Other
Pacific Islander
(31)
Negro
(32)
Puerto Rican
(33)
Samoan
(34) Scotch-Irish
(35)
Spanish
April 2004
(18) European
(19) Filipino
(20) German
(36)
(37)
(38)
(39)
(40)
Vietnamese
West Indian
White
No race given
Other – DO NOT READ
Caseid: 00000000
Item: RACEOS
Specify “Other” race:
@
Caseid: 00000000
Item: SSN1
What is (name's/your) Social Security or Railroad Retirement number?
ENTER (N) FOR NONE
_
-
-
Caseid: 00000000
Item: (NAT@1 / NAT@2 / NAT@3)
page 1 of 4
In what country (were/was) (name/you) born?
_
Country Name
In what country was (your/his/her) mother born?
_
Country Name
In what country was (your/his/her) father born?
_
Country Name
(1) United States
(2) Puerto Rico
(3) Outlying Area of the U.S. (American Samoa, Guam, U.S. Virgin Islands, Northern Marianas,
Other U.S. Territory.)
IB-26
April 2004
(4) Canada
(17) Guyana
(5) Cambodia
(18) Haiti
(6) China
(19) Honduras
(7) Colombia
(20) Hong Kong
(8) Cuba
(21) Hungary
(9) Dominican Republic
(22) India
(10) Ecuador
(23) Iran
(11) El Salvador
(24) Ireland/Eire
(12) England
(25) Italy
"Pgdn = NEXT screen" for next page; ' q ' to quit
Caseid: 00000000
Item: (NAT@1 / NAT@2 / NAT@3)
(30)
Nicaragua
Peru
(32)
Philippines
(33)
Poland
(34) Portugal
(35) Russia
(36)
Scotland
(37)
Korea/South Korea
(38)
Taiwan
(31)
page 2 of 4
In what country (were/was) (name/you) born?
_
Country Name
In what country was (your/his/her) mother born?
_
Country Name
In what country was (your/his/her) father born?
_
Country Name
(13)
(14)
(15)
(16)
France
Germany
Greece
Guatemala
(26)
(27)
(28)
(29)
Jamaica
Japan
Laos
Mexico
(39)
Thailand
(40)
Trinidad & Tobago
(41) Vietnam
(42)
Yugoslavia
(200) Afghanistan
(108) Finland
(233) Saudi Arabia
(375) Argentina
(421) Ghana
(234) Singapore
(185) Armenia
(138) Great Britain
(156) Slovakia/Slovak Rep.
(102) Austria
(340) Grenada
(449) South Africa
(501) Australia
(126) Holland
(134) Spain
(130) Azores
(211) Indonesia
(136) Sweden
(333) Bahamas
(213) Iraq
(137) Switzerland
PgUp = PREVIOUS screen; Pgdn = NEXT screen; or ' q '
IB-27
April 2004
Caseid: 00000000
Item: (NAT@1 / NAT@2 / NAT@3)
page 3 of 4
In what country (were/was) (name/you) born?
_
Country Name
In what country was (your/his/her) mother born?
_
Country Name
In what country was (your/his/her) father born?
_
Country Name
(202) Bangladesh
(214) Israel
(237) Syria
(334) Barbados
(216) Jordan
(240) Turkey
(310) Belize
(427) Kenya
(195) Ukraine
(103) Belgium
(183) Latvia
(387) Uruguay
(300) Bermuda
(222) Lebanon
(180) USSR
(376) Bolivia
(184) Lithuania
(388) Venezuela
(377) Brazil
(224) Malaysia
(353) Caribbean
(205) Burma
(436) Morocco
(318) Central America
(378) Chile
(126) Netherlands
(389) South America
(311) Costa Rico
(514) New Zealand
(304) North America
(155) Czech Republic
(440) Nigeria
(148) Europe
(105) Czechoslovakia
(142) Northern Ireland
(252) Middle East
(106) Denmark
(127) Norway
(468) North Africa
PgUp = PREVIOUS screen; Pgdn = NEXT screen; or 'q'
Caseid: 00000000
IB-28
April 2004
Item: (NAT@1 / NAT@2 / NAT@3)
page 4 of 4
In what country (were/was) (name/you) born?
_
Country Name
In what country was (your/his/her) mother born?
_
Country Name
In what country was (your/his/her) father born?
_
Country Name
(338)
(415)
(417)
(507)
Dominica
Egypt
Ethiopia
Figi
(229) Pakistan
(253) Palestine
(317) Panama
(132) Romania
(462) Other Africa
(245) Asia
(527) Pacific Islands
(555) Elsewhere
"PgUp = PREVIOUS screen" for prior page; 'q' to quit
Caseid: 00000000
Item: S_CITIZN
(Are/Is) (name/you) a CITIZEN of the United States?
(1) Yes
(2) No, not a citizen
_
Caseid: 00000000
Item: S_CITYA
(Were/Was) (you/name) born a citizen of the United States?
(1) Yes
(2) No
_
Caseid: 00000000
Item: S_CITYB
Did (you/name) become a citizen of the United States through naturalization?
(1) Yes
IB-29
April 2004
(2) No
_
Caseid: 00000000
Item: S_INUSYR
When did (you/name) come to live in the United States?
(ENTER (B) IF BEFORE 1900)
ENTER (N) IF RESPONDENT REPORTS THE NUMBER OF YEARS AGO
INSTEAD OF THE ACTUAL YEAR
ENTER YEAR (1900-1998)
_
Caseid: 00000000
Item: S_FAMINC
SHOW FLASH CARD
Which category represents (your/name of reference person/the total combined income) (total
combined income during the past 12 months/of all members of (your/this) FAMILY during the
past 12 months)?
This includes money from jobs, net income from business, farm or rent, pensions, dividends,
interest, social security payments and any other money income received (by members of this
FAMILY who are 15 years of age or older.)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
_
Less than $5,000
5,000 to 7,499
7,500 to 9,999
10,000 to 12,499
12,500 to 14,999
15,000 to 19,999
20,000 to 24,999
25,000 to 29,999
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
30,000 to 34,999
35,000 to 39,999
40,000 to 49,999
50,000 to 59,999
60,000 to 74,999
75,000 to 99,999
100,000 or 149,999
$150,000 or more
Caseid: 00000000
Item: S_TELHHD
IB-30
April 2004
Since households included in this survey are interviewed (again/again during each of the next 3
months), we attempt to conduct the followup interviews by telephone.
Is there a telephone in this house/apartment?
(1) Yes
(2) No
(B) BATTERY problem
_
Caseid: 00000000
Item: S_TELAVL
Is there a telephone elsewhere on which people in this household can be contacted?
(1) Yes
(2) No
(B) BATTERY problem
_
Caseid: 00000000
Item: TELWHR
Where is this phone located?
(B) BATTERY problem
_
Caseid: 000000000
Item: TELIN-SCRN
Is a telephone interview acceptable?
IB-31
April 2004
(1) Yes
(2) No
(B) BATTERY problem
_
Caseid: 00000000
Item: (TELPHN@AR / TELPHN@NUM / TELPHN@EXT / TELPHN@HO)
What is the telephone number of the phone where you would like to be called?
(B) BATTERY problem
CURRENT TELEPHONE NUMBER:
(S) Same Area Code
in Area Code: _
(number)
(D) None or Don't know
(N) FOR NONE
New Number:
EXT:
IS THIS A HOME OR OFFICE NUMBER?
(1) Home
(2) Office
_
Caseid: 00000000
Item: (PHON2_SCRN@AR / PHON2_SCRN@NUM / PHON2_SCRN@EXT / PHON2_SCRN@HO /
PHON2_SCRN@LNO)
Is there a secondary telephone number where you could be called?
(B)
BATTERY problem
IB-32
April 2004
CURRENT TELEPHONE NUMBER:
(S) Same Area Code
in Area Code: _
(number)
(D) None or Don't know
(N) FOR NONE
New Number:
EXT:
IS THIS A HOME OR OFFICE NUMBER?
_
(1) Home
(2) Office
Whose secondary phone number is this?
_
ENTER LINE NUMBER
(PRESS SHIFT-F1 FOR HH ROSTER)
Caseid: 00000000
Item: (BSTTI@1 / BSTTI@2)
When is the best time to contact you?
(B) BATTERY problem
DO NOT READ CATEGORIES
(1) Morning (9am-12 noon)
(2) Noon/lunchtime (11am-1pm)
(3) Afternoon (12 noon-4pm)
(4) Suppertime/early
evening/dinnertime(4pm-7pm)
(5) Evening (6pm-9pm)
(6) Anytime (9am-9pm)
(7) Late evening/night (7pm-9pm)
(8) Daytime (9am-4pm)
(9) After 5pm
_
ENTER SPECIFIC BEST TIME TO CALL
_
Caseid: 00000000
Item: NOSUN_SCRN
READ IF NECESSARY: Since we only interview for one week each month, interviewing on Sunday
helps us complete our work.
IB-33
April 2004
Would a possible Sunday interview be acceptable?
(1) Yes
(2) No
(B) BATTERY problem
_
Caseid: 00000000
Item: APPT
I'd like to schedule a DATE to complete the interview.
What DATE AND TIME would be best to visit again?
TODAY IS: (month, day, year)
ENTER (B) FOR BATTERY PROBLEM
_
Caseid: 00000000
Item: THANKYOU
(Next month during the week of the 19th we will again be contacting/(calling). Is there any
reason, such as moving, why we would not be able to contact someone in this household? /
This is the fourth regularly scheduled interview for this houshold, for the Current Population
Survey. We will interview you again in eight months. / This is the last regularly scheduled
interview for this household, for the Current Population Survey.)
((P) Proceed / (1) Yes)
((2) No)
INTERVIEW NUMBER: (number 1-8)
IB-34
April 2004
NOTE:
Inform the respondent that a supervisor may call them to conduct reinterview.
Explain reinterview as needed.
_
Caseid: 00000000
Item: REASON
What is the reason?
(1)
(2)
(3)
(4)
Temporarily Absent, on vacation
New Telephone Number at present address
Moving
Other - specify
_
IB-35
April 2004
Basic CPS Items Booklet
Labor Force Items
Caseid: 00000000
Item: LABFOR
Press ENTER to move to the next field
I am going to ask a few questions about work-related activities (THE WEEK BEFORE
LAST/LAST WEEK). By (the week before last/last week) I mean the week beginning on
Sunday, (DATE), and ending on Saturday, (DATE).
PRESS ENTER TO PROCEED
_
Caseid: 00000000
Item: BUS
(Do you/Does name/Does anyone in this household) have a business or a farm?
(1) Yes
(2) No
_
Caseid: 00000000
IB-36
April 2004
Item: (BUSL@1 / BUSL@2 / BUSL@3 / BUSL@4)
Whose business
or farm is it?
ENTER LINE NUMBER
OR (N) FOR NO MORE
PROBE: Anyone else?
_
_
_
_
|
| LN NAME
| (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
HOUSEHOLD ROSTER
M RELATION AGE
Caseid: 00000000
Item: WK
(THE WEEK BEFORE LAST/LAST WEEK), did (name/you) do ANY work for (pay?/either
pay or profit?)
(1)
(2)
(3)
(4)
(5)
Yes
No
Retired
Disabled
Unable to work
_
Caseid: 00000000
Item: BUS1
IB-37
April 2004
(THE WEEK BEFORE LAST/LAST WEEK), did (name/you) do any unpaid work in the
family business or farm?
(1) Yes
(2) No
_
Caseid: 00000000
Item: BUS2
(Do/Does) (name/you) receive any payments or profits from the business?
(1) Yes
(2) No
_
Caseid: 00000000
Item: RET
Last month (name/you) (was/were) reported to be retired. (Are/Is) (you/he/she) still retired?
(1) Yes
(2) No
(3) Was not retired last month
_
Caseid: 00000000
Item: DIS
IB-38
April 2004
(Last month (you/name) (were/was) reported to have a) (disability. Does/Does) (your/his/her)
disability continue to prevent (you/him/her) from doing any kind of work for the next 6
months(?) (including work in the family business or farm?)
(1) Yes
(2) No
(3) Did not have disability last month
_
Caseid: 00000000
Item: RET1
(Do/Does) (name/you) currently want a job, either full or part-time?
(1) Yes or maybe, it depends
(2) No
(3) Has a job
_
Caseid: 00000000
Item: DIS1
Does (your/his/her) disability prevent (you/him/her) from accepting any kind of work during
the next six months?
(1) Yes
(2) No
_
Caseid: 00000000
Item: DIS2
IB-39
April 2004
(Do/Does) (name/you) have a disability that prevents (you/him/her) from accepting any kind of
work during the next six months?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ABS
(THE WEEK BEFORE LAST/LAST WEEK),(in addition to the business )did (name/you)
have a job either full or part time?
Include any job from which (name/you) (was/were) temporarily absent.
(1)
(2)
((3)
((4)
((5)
Yes
No
Retired)
Disabled)
Unable)
_
Caseid: 00000000
Item: LAY
(THE WEEK BEFORE LAST/LAST WEEK), (was/were) (name/you) on layoff from a job?
(1)
(2)
(3)
(4)
(5)
Yes
No
Retired
Disable
Unable to work
_
Caseid: 00000000
Item: ABSRSN
IB-40
April 2004
What was the main reason (you/he/she) (was/were) absent from work (THE WEEK BEFORE
LAST/LAST WEEK)?
((1)
((2)
((3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
On layoff (temporary or indefinite))
Slack work/business conditions)
Waiting for a new job to begin)
Vacation/personal days
Own illness/injury/medical problems
Child care problems
Other family/personal obligation
Maternity/paternity leave
Labor dispute
Weather affected job
School/training
Civic/military duty
Does not work in the business
Other (specify)
_
Caseid: 00000000
Item: ABSPC
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: ABSPD
(Are/Is) (you/he/she) being paid by (your/his/her) employer for any of the time off (the week
before last/last week)?
(1) Yes
(2) No
_
Caseid: 00000000
Item: MJ
IB-41
April 2004
(THE WEEK BEFORE LAST/LAST WEEK), did (name/you) have more than one (job/job or
business), including part-time, evening or weekend work?
(1) Yes
(2) No
_
Caseid: 00000000
Item: MJNUM
Altogether, how many (jobs/jobs or businesses) did (you/he/she) have?
(2) 2 jobs
(3) 3 jobs
(4) 4 or more jobs
_
Caseid: 00000000
Item: HRUSL1
How many hours per week (do/does) (name/you) USUALLY work at (your/his/her) (job?/main
job? By main job we mean) (the one at which (you/he/she) usually) ((work/works) the most
hours.)
ENTER NUMBER OF HOURS
(00-99)
(V)
Hours each week
Hours vary each week
_
Caseid: 00000000
Item: HRUSL2
IB-42
April 2004
How many hours per week (do/does) (you/he/she) USUALLY work at (your/his/her) other
(job/jobs)?
ENTER NUMBER OF HOURS
(00-99)
(V)
Hours each week
Hours vary each week
_
Caseid: 00000000
Item: HRFTPT
(Do/Does) (you/he/she) usually work 35 hours or more per week (at (your/his/her) job/in the
family business/at all (your/his/her) jobs combined)?
(1) Yes
(2) No
(3) Hours vary
_
Caseid: 00000000
Item: HRWANT
(Do/Does) (name/you) want to work a full-time workweek of 35 hours or more per week?
(1) Yes
(2) No
(3) Regular hours are full-time
_
Caseid: 00000000
Item: HRRSN1
IB-43
April 2004
Some people work part time because they cannot find full-time work or because business is
poor. Others work part time because of family obligations or other personal reasons. What is
(name's/your) MAIN reason for working part time?
(PROBE IF NECESSARY: What is (name's/your) main reason for working PART TIME
instead of FULL TIME?)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Slack work/business conditions
Could only find part-time work
Seasonal work
Child care problems
Other family/personal obligations
Health/medical limitations
School/training
Retired/Social Security limit on earnings
Full-time workweek is less than 35 hours
Other - specify
_
Caseid: 00000000
Item: HRSPC1
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: HRRSN2
What is the main reason (you/he/she) (do/does) not want to work full time?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Child care problems
Other family/personal obligations
Health/medical limitations
School/training
Retired/Social Security limit on earnings
Full time workweek less than 35 hours
Other
_
Caseid: 00000000
Item: HRSPC2
ENTER VERBATIM RESPONSE
IB-44
April 2004
_
Caseid: 00000000
Item: (HROFF@1 / HROFF@2)
Now I have some questions about the exact number of hours (name/you) worked (THE WEEK
BEFORE LAST/LAST WEEK).
(THE WEEK BEFORE LAST/LAST WEEK), did (you/he/she) lose or take off any hours from
(work/(your/his/her) MAIN job), for ANY reason such as illness, slack work, vacation, or
holiday?
(1) Yes
(2) No
_
(If HROFF@1 = 1, then fill: (HROFF@2)
How many hours did (name/you) take off?
ENTER NUMBER OF HOURS
_ )
Caseid: 00000000
Item: (HROT@1 / HROT@2)
(THE WEEK BEFORE LAST/LAST WEEK), did (name/you) work any overtime or extra
hours (at (your/his/her) MAIN job )that (you/he/she) (do/does) not usually work?
IB-45
April 2004
(1) Yes
(2) No
_
(IF HROT@1 = 1, the fill: (HROT@2)
How many ADDITIONAL hours did (you/he/she) work?
ENTER NUMBER OF HOURS
_ )
Caseid: 00000000
Item: HRACT1
((LAST WEEK/THE WEEK BEFORE LAST)/So, for (LAST WEEK/THE WEEK BEFORE
LAST)), how many hours did (you/he/she) ACTUALLY work at (your/his/her) (job?/MAIN
job?)
ENTER NUMBER OF HOURS
(00 - 99)
_
Caseid: 00000000
Item: HRACT2
(THE WEEK BEFORE LAST/LAST WEEK), how many hours did (you/he/she) ACTUALLY
work at (your/his/her) other (job?/jobs?)
ENTER NUMBER OF HOURS
_
(00 - 99)
Caseid: 00000000
Item: HRRSN3
What is the main reason (name/you) worked less than 35 hours (THE WEEK BEFORE
LAST/LAST WEEK)?
IB-46
April 2004
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Slack work/business conditions
Seasonal work
Job started or ended during week
Vacation/personal day
Own illness/injury/medical appointment
Holiday (legal or religious)
Child care problems
Other family/personal obligations
Labor dispute
Weather affected job
School/training
Civic/Military duty
Other reason
_
Caseid: 00000000
Item: HRSPC3
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: HRAVL
(THE WEEK BEFORE LAST/LAST WEEK), could (name/you) have worked full-time if the
hours had been available?
(1) Yes
(2) No
_
Caseid: 00000000
Item: HRCK9
DO NOT ASK THE RESPONDENT
Did (name of person talking about) provide any of the hours information you just collected?
IB-47
April 2004
(1) Yes
(2) No
_
Caseid: 00000000
Item: HRCK10
DO NOT ASK THE RESPONDENT
Did anyone other than (name of respondent) provide any of the hours information you just
collected?
(1) Yes
(2) No
_
Caseid: 00000000
Item: HRCK11
DO NOT ASK THE
RESPONDENT
Who Was that?
|
| LN NAME
| (person 1)
| (person 2)
| (person 3)
IB-48
HOUSEHOLD ROSTER
M RELATION
AGE
April 2004
ENTER LINE NUMBER
_
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
Caseid: 00000000
Item: LAYDT
Has (name's/your) employer given (you/him/her) a date to return to work?
(1) Yes
(2) No
_
Caseid: 00000000
Item: LAY6M
(Have/Has) (you/he/she) been given any indication that (you/he/she) will be recalled to work
within the next 6 months?
(1) Yes
(2) No
_
Caseid: 00000000
Item: LAYAVL
Could (you/he/she) have returned to work (THE WEEK BEFORE LAST/LAST WEEK) if
(you/he/she) had been recalled?
(1) Yes
(2) No
IB-49
April 2004
_
Caseid: 00000000
Item: LAYAVR
Why is that?
(1) Own temporary illness
(2) Going to school
(3) Other
_
Caseid: 00000000
Item: LAYAVS
ENTER SPECIFIC REASON
_
Caseid: 00000000
Item: LAYLK
Even though (you/he/she) (expect/expects) to be called back to work, (have/has) (you/he/she)
been looking for work during the last 4 weeks?
(1) Yes
(2) No
_
Caseid: 00000000
Item: (LAYDR@1 / LAYDR@2)
As of the end of (THE WEEK BEFORE LAST/LAST WEEK), how long (had/has)
(you/he/she) been on layoff?
(1) Weeks
(2) Months
(3) Years
IB-50
April 2004
_
DO NOT READ TO RESPONDENT
ENTER NUMBER OF (WEEKS / MONTHS / YEARS)
_
Caseid: 00000000
Item: LAYDR3
We would like to have that in weeks, IF possible.
Exactly how many weeks had (name/you) been on layoff?
ENTER NUMBER OF WEEKS
_
Caseid: 00000000
Item: LAYFT
Is the job from which (name/you) (are/is) on layoff a full-time job of 35 hours or more per
week?
(1) Yes
(2) No
_
Caseid: 00000000
Item: LK
(Have/Has) (name/you) been doing anything to find work during the last 4 weeks?
(1) Yes
(2) No
((3) Retired)
IB-51
April 2004
((4) Disabled)
((5) Unable to work)
_
Caseid: 00000000
Item: LKM1
What are all of the things (you/he/she) (have/has) done to find work during the last 4
weeks?
DO NOT READ ANSWER CATEGORIES
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
_
Caseid: 00000000
Item: LKMSP1
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKM2
Anything ELSE?
WHAT ARE ALL OF THE THINGS (NAME/YOU) (HAVE/HAS) DONE TO FIND
WORK DURING THE LAST 4 WEEKS?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
IB-52
April 2004
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
_
Caseid: 00000000
Item: LKMSP2
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKM3
Anything ELSE?
WHAT ARE ALL OF THE THINGS (NAME/YOU) (HAVE/HAS) DONE TO FIND
WORK DURING THE LAST 4 WEEKS?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
PASSIVE
IB-53
April 2004
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
_
Caseid: 00000000
Item: LKMSP3
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKM4
Anything ELSE?
WHAT ARE ALL OF THE THINGS (NAME/YOU) (HAVE/HAS) DONE TO FIND
WORK DURING THE LAST 4 WEEKS?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
PASSIVE
(10) Looked at ads
IB-54
April 2004
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
_
directly/interview
Contacted public employment agency
Contacted private employment agency
Contacted friends or relatives
Contacted school/university
employment center
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
Caseid: 00000000
Item: LKMSP4
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKM5
Anything ELSE?
WHAT ARE ALL OF THE THINGS (NAME/YOU) (HAVE/HAS) DONE TO FIND
WORK DURING THE LAST 4 WEEKS?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
PASSIVE
(10) Looked at ads
(11) Attended job training
IB-55
April 2004
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
_
Contacted public employment agency
Contacted private employment agency
Contacted friends or relatives
Contacted school/university
employment center
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
programs/courses
(13) Other passive
(12) Nothing
Caseid: 00000000
Item: LKMSP5
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKM6
Anything ELSE?
WHAT ARE ALL OF THE THINGS (NAME/YOU) (HAVE/HAS) DONE TO FIND
WORK DURING THE LAST 4 WEEKS?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
IB-56
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
April 2004
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
(13) Other passive
(12) Nothing
_
Caseid: 00000000
Item: LKMSP6
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKDK1
You said (name/you) (have/has) been trying to find work. How did (you/he/she) go
about looking?
DO NOT READ ANSWER CATEGORIES
(1)
(2)
(3)
(4)
(5)
ACTIVE
Contacted employer
directly/interview
Contacted public employment agency
Contacted private employment agency
Contacted friends or relatives
Contacted school/university
IB-57
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
April 2004
(6)
(7)
(8)
(9)
_
employment center
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
(12) Nothing
Caseid: 00000000
Item: LKDKS1
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKDK2
Anything ELSE?
YOU SAID (name/you) (HAVE/HAS) BEEN TRYING TO FIND WORK HOW DID
(YOU/HE/SHE) GO ABOUT LOOKING?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
IB-58
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
April 2004
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
(12) Nothing
_
Caseid: 00000000
Item: LKDKS2
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKDK3
Anything ELSE?
YOU SAID (name/you) (HAVE/HAS) BEEN TRYING TO FIND WORK. HOW DID
(YOU/HE/SHE) GO ABOUT LOOKING?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
(1)
(2)
(3)
(4)
(5)
ACTIVE
Contacted employer
directly/interview
Contacted public employment agency
Contacted private employment agency
Contacted friends or relatives
Contacted school/university
IB-59
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
April 2004
(6)
(7)
(8)
(9)
_
employment center
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
(12) Nothing
Caseid: 00000000
Item: LKDKS3
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKDK4
Anything ELSE?
YOU SAID (name/you) (HAVE/HAS) BEEN TRYING TO FIND WORK. HOW DID
(YOU/HE/SHE) GO ABOUT LOOKING?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
IB-60
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
April 2004
(6)
(7)
(8)
(9)
_
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
(12) Nothing
Caseid: 00000000
Item: LKDKS4
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKDK5
Anything ELSE?
YOU SAID (name/you) (HAVE/HAS) BEEN TRYING TO FIND WORK. HOW DID
(YOU/HE/SHE) GO ABOUT LOOKING?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
IB-61
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
April 2004
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
(12) Nothing
_
Caseid: 00000000
Item: LKDKS5
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKDK6
Anything ELSE?
YOU SAID (name/you) (HAVE/HAS) BEEN TRYING TO FIND WORK. HOW DID
(YOU/HE/SHE) GO ABOUT LOOKING?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
IB-62
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
April 2004
(8) Placed or answered ads
(9) Other active
(12) Nothing
_
Caseid: 00000000
Item: LKDKS6
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKPS1
Can you tell me more about what (you/he/she) did to search for work?
DO NOT READ ANSWER CATEGORIES
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
_
IB-63
April 2004
Caseid: 00000000
Item: LKPSP1
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKPS2
Anything Else?
CAN YOU TELL ME MORE ABOUT WHAT (YOU/HE/SHE) DID TO SEARCH FOR
WORK?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
IB-64
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
April 2004
(9) Other active
_
Caseid: 00000000
Item: LKPSP2
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKPS3
Anything Else?
CAN YOU TELL ME MORE ABOUT WHAT (YOU/HE/SHE) DID TO SEARCH FOR
WORK?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
ACTIVE
Contacted employer
directly/interview
Contacted public employment agency
Contacted private employment agency
Contacted friends or relatives
Contacted school/university
employment center
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
IB-65
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
April 2004
_
Caseid: 00000000
Item: LKPSP3
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKPS4
Anything Else?
CAN YOU TELL ME MORE ABOUT WHAT (YOU/HE/SHE) DID TO SEARCH FOR
WORK?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
_
IB-66
April 2004
Caseid: 00000000
Item: LKPSP4
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKPS5
Anything Else?
CAN YOU TELL ME MORE ABOUT WHAT (YOU/HE/SHE) DID TO SEARCH FOR
WORK?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
ACTIVE
(1) Contacted employer
directly/interview
(2) Contacted public employment agency
(3) Contacted private employment agency
(4) Contacted friends or relatives
(5) Contacted school/university
employment center
(6) Sent out resumes/filled out applications
(7) Checked union/professional registers
(8) Placed or answered ads
(9) Other active
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
_
IB-67
April 2004
Caseid: 00000000
Item: LKPSP5
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKPS6
Anything Else?
CAN YOU TELL ME MORE ABOUT WHAT (YOU/HE/SHE) DID TO SEARCH FOR
WORK?
DO NOT READ ANSWER CATEGORIES
ENTER (N) FOR NO ADDITIONAL ANSWER
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
_
ACTIVE
Contacted employer
directly/interview
Contacted public employment agency
Contacted private employment agency
Contacted friends or relatives
Contacted school/university
employment center
Sent out resumes/filled out applications
Checked union/professional registers
Placed or answered ads
Other active
IB-68
PASSIVE
(10) Looked at ads
(11) Attended job training
programs/courses
(13) Other passive
(12) Nothing
April 2004
Caseid: 00000000
Item: LKPSP6
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKAVL
(THE WEEK BEFORE LAST/LAST WEEK), could (you/he/she) have started a job if one had
been offered?
(1) Yes
(2) No
_
Caseid: 00000000
Item: LKAVR
Why is that?
(1)
(2)
(3)
(4)
Waiting for new job to begin
Own temporary illness
Going to school
Other (specify)
_
Caseid: 00000000
Item: LKAVS
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKLL1
BEFORE (name/you) started looking for work, what (was/were) (you/he/she) doing: working,
going to school or something else?
IB-69
April 2004
(1)
(2)
(3)
(4)
Working
School
Left military service
Something else
_
Caseid: 00000000
Item: LKLL1S
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: LKLL2
Did (you/he/she) lose or quit that job, or was it a temporary job that ended?
(1) Lost job
(2) Quit job
(3) Temporary job ended
_
Caseid: 00000000
Item: LKLW
When did (you/he/she) last work at (a/that) job or business?
(1) Within the last 12 months
(2) More than 12 months ago
(3) Never worked
_
Caseid: 00000000
Item: (LKDAT@M / LKDAT@Y)
IB-70
April 2004
ASK IF NECESSARY, OTHERWISE VERIFY
What was the month and year that (you/he/she) last worked?
(1)
(2)
(3)
(4)
January
February
March
April
ENTER MONTH
ENTER YEAR
(5) May
(6) June
(7) July
(8) August
(9) September
(10)
October
(11)
November
(12) December
_
_
(last 12 months -- i.e. 1997-1998)
Caseid: 00000000
Item: LKDAER
Date entered is (in the future/longer than 12 months ago.)
ENTER (B) TO BACKUP AND CHANGE ENTRY
_
Caseid: 00000000
Item: (LKDR@1 / LKDR@2)
(As of the end of (THE WEEK BEFORE LAST/LAST WEEK), how long had (you/he/she)
been looking for work?
(1) Weeks
(2) Months
(3) Years
_
DO NOT READ TO RESPONDENT
ENTER NUMBER OF (WEEKS / MONTHS / YEARS)
_
IB-71
April 2004
Caseid: 00000000
Item: LKDR3
(We would like to have that in weeks if possible.
Exactly how many weeks (have/has) (name/you) been looking for work?
ENTER NUMBER OF WEEKS
_
Caseid: 00000000
Item: LKFT
(Have/Has) (you/he/she) been looking for full-time work of 35 hours or more per week?
(1) Yes
(2) No
(3) Doesn't matter
_
Caseid: 00000000
Item: DWWNT
(Do/Does) (name/you) currently want a job, either full or part time?
(1)
(2)
((3)
((4)
((5)
Yes, or maybe, it depends
No
Retired)
Disabled)
Unable)
_
Caseid: 00000000
Item: DWRSN
IB-72
April 2004
What is the main reason (you/he/she) (was/were) not looking for work during the LAST 4
WEEKS?
DO NOT READ LIST
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Believes no work available in line of work or area
Couldn't find any work
Lacks necessary schooling, training, skills or experience
Employers think too young or too old
Other types of discrimination
Can't arrange child care
Family responsibilities
In school or other training
Ill-health, physical disability
Transportation problems
Other
_
Caseid: 00000000
Item: DWRSP
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: DWLK
Did (name/you) look for work at any time during the last 12 months?
(1) Yes
(2) No
_
Caseid: 00000000
Item: DWWK
Did (you/he/she) actually WORK at a job or business during the last 12 months?
(1) Yes
(2) No
_
IB-73
April 2004
Caseid: 00000000
Item: DW4WK
Did (you/he/she) do any of this work during the last 4 weeks?
(1) Yes
(2) No
_
Caseid: 00000000
Item: DWLKWK
And since (name/you) LEFT that job or business (have/has) (you/he/she) looked for work?
(1) Yes
(2) No
_
Caseid: 00000000
Item: DWAVL
(THE WEEK BEFORE LAST/LAST WEEK), could (you/he/she) have started a job if one had
been offered?
(1) Yes
(2) No
_
Caseid: 00000000
Item: DWAVR
Why is that?
IB-74
April 2004
(1) Own temporary illness
(2) Going to school
(3) Other (SPECIFY)
_
Caseid: 00000000
Item: DWAVS
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: JHWK
(Have/Has) (name/you) worked at a job or business at any time during the past 12 months?
(1) Yes
(2) No
_
Caseid: 00000000
Item: JHDP1
Did (you/he/she) do any of this work during the last 4 weeks?
(1) Yes
(2) No
_
Caseid: 00000000
Item: JHRSN
What is the main reason (you/he/she) left (your/his/her) last job?
(1) Personal, family (including pregnancy)
(2) Return to school
IB-75
April 2004
(3)
(4)
(5)
(6)
(7)
(8)
Health
Retirement or old age
Temporary, seasonal or intermittent job completed
Slack work or business conditions
Unsatisfactory work arrangements (hours, pay, etc)
Other (specify)
_
Caseid: 00000000
Item: JHRSP
ENTER VERBATIM REASON
_
Caseid: 00000000
Item: JHWANT
(Do/Does) (name/you) intend to look for work during the next 12 months?
(1) Yes, or it depends
(2) No
_
Caseid: 00000000
Item: IODP1
Last month, it was reported that (name/you) worked for (input company name).
(Do/Does) (you/he/she) still work for (input company name)(at (your/his/her) MAIN job?)
(1) Yes
(2) No
_
Caseid: 00000000
Item: IODP2
Have the usual activities and duties of (your/his/her) job changed since last month?
(1) Yes
IB-76
April 2004
(2) No
_
Caseid: 00000000
Item: IODP3
Last month (name/you) (was/were) reported as (a/an) (input occupation) and (your/his/her)
usual activities were (input duties 1) (input duties 2).
Is this an accurate description of (your/his/her) current job?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IO1INT
(Now I have a few questions about the) (job/main job) (at which (you/he/she) last worked/at
which (you/he/she) worked (LAST WEEK/THE WEEK BEFORE LAST)/from which
(you/he/she) (were/was) absent (LAST WEEK/THE WEEK BEFORE LAST)/from which
(you/he/she) (are/is) on layoff.)
(Were/Was)/(LAST WEEK/THE WEEK BEFORE LAST), (were/was) (name/you) employed
by government, by a private company, a non-profit organization, or (was/were) (you/he/she)
self employed(or working in the family business?)
(1) Government
(2) Private for profit company
(3) Non-profit organization including tax exempt
and charitable organizations
(4) Self employed
((5) Working in the family business)
_
Caseid: 00000000
Item: IO1GVT
Would that be the federal, state, or local government?
(1) Federal
(2) State
IB-77
April 2004
(3) Local (county, city, township)
_
Caseid: 00000000
Item: IO1INC
(Is/Was) this business incorporated?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IO1WP
(Was/Were) (name/you) working for pay?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IO1NMP
What is the name of the (company/non-profit organization) for which (you/he/she)
(work/works/worked)(at (your/his/her) MAIN job?)
DO NOT READ TO RESPONDENT:
(name of company, business, organization or other employer)
_
Caseid: 00000000
Item: IO1NMG
What is the name of the government agency for which (you/he/she) (work/works/worked)(at
(your/his/her) MAIN job?)
_
IB-78
April 2004
Caseid: 00000000
Item: IO1NMB
(What is the name of (your/name's) business?/What is the name of the business for which)
((you/name) (work?/works?/worked?))
_
Caseid: 00000000
Item: IO1IND
What kind of business or industry is this?
READ IF NECESSARY: What do they make or do where (you/he/she)
(work?/works?/worked?)
(**THIS CASE WAS REFERRED LAST MONTH.**)
(PLEASE PROVIDE MORE DETAILED INFORMATION FOR THE CODERS.)
_
Caseid: 00000000
Item: IO1MFG
ASK IF NECESSARY:
Is this business or organization mainly manufacturing, retail trade, wholesale trade, or
something else?
(1)
(2)
(3)
(4)
Manufacturing
Retail trade
Wholesale trade
Something else
_
Caseid: 00000000
IB-79
April 2004
Item: IO1OCC
What kind of work (do/does/did) (name/you) do, that is, what (is/was) (your/his/her)
occupation? (For example: plumber, typist, farmer)
(**THIS CASE WAS REFERRED LAST MONTH.**)
(PLEASE PROVIDE MORE DETAILED INFORMATION FOR THE CODERS.)
_
Caseid: 00000000
Item: (IO1DT@1 / IO1DT@2)
What (are/were) (your/his/her) usual activities or duties at this job?
(For example: typing, keeping account books, filing, selling cars, operating printing press,
laying brick.)
(**THIS CASE WAS REFERRED LAST MONTH.**)
(PLEASE PROVIDE MORE DETAILED INFORMATION FOR THE CODERS.)
_
Caseid: 00000000
Item: PDEMP1
(/Previously it was reported (you/name) (were/was))
( /self-employed or worked in the family business.)
(Do/Does) (you/name) usually have any paid employees?
(1) Yes
(2) No
_
Caseid: 00000000
Item: NMEMP1
IB-80
April 2004
Excluding all owners, how many paid employees does (your/name's) business usually have?
_
Caseid: 00000000
Item: NMEMPV
You indicated (you/name) (have/has) (NMEMP1) paid employees, is that correct?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IOPRO1
Press ENTER to move to the next field
Now I have a few questions about (your/his/her) second job.
(READ IF NECESSARY: By second job I mean the one that) ((name/you) (work/works) the
second most hours.)
PRESS ENTER TO PROCEED
_
Caseid: 00000000
Item: IO2INT
(THE WEEK BEFORE LAST/LAST WEEK) at (your/name's) second job, (was/were)
(name/you) employed by government, by a private company or organization, or (was/were)
(you/he/she) self employed(or working in the family business?)
(1)
(2)
(3)
(4)
((5)
Government
Private for profit company
Non-profit organization including tax exempt and charitable organizations
Self employed
Working in a family business)
_
Caseid: 00000000
Item: IO2GVT
Would that be the federal, state, or local government?
IB-81
April 2004
(1) Federal
(2) State
(3) Local (county, city, township)
_
Caseid: 00000000
Item: IO2INC
Is this business incorporated?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IO2WP
(Was/Were) (name/you) working for pay?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IO2NMP
What is the name of the (company/non-profit organization) for which (name/you)
(work/works) at (your/his/her) SECOND job?
DO NOT READ TO RESPONDENT:
(name of company, business, organization or other employer)
_
IB-82
April 2004
Caseid: 00000000
Item: IO2NMG
What is the name of the government agency for which (name/you) (work/works) at
(your/his/her) SECOND job?
_
Caseid: 00000000
Item: IO2NMB
(What is the name of the business for which/What is the name of (your/name's) business?)
((name/you) (work/works)?)
_
Caseid: 00000000
Item: IO2IND
What kind of business or industry is this?
READ IF NECESSARY:
What do they make or do where (name/you) (work/works)?
_
Caseid: 00000000
Item: IO2MFG
ASK IF NECESSARY:
Is this business or organization mainly manufacturing, retail trade, wholesale trade, or
something else?
(1)
(2)
(3)
(4)
Manufacturing
Retail trade
Wholesale trade
Something else
IB-83
April 2004
_
Caseid: 00000000
Item: IO2OCC
What kind of work (do/does) (you/he/she) do at (your/his/her) SECOND job, that is, what is
(your/his/her) occupation?
(For example: plumber, typist, farmer.)
_
Caseid: 00000000
Item: (IO2DT@1 / IO2DT@2)
What (are/is) (your/his/her) usual activities or duties at this job?
DO NOT READ TO RESPONDENT:
(For example: types, keeps account books, files, sells cars, operates printing press, lays brick.)
_
Caseid: 00000000
Item: PDEMP2
(Do/Does) (you/name) usually have any paid employees?
(1) Yes
(2) No
_
Caseid: 00000000
Item: NMEMP2
Excluding all owners, how many paid employees does (your/name's) business usually have?
_
Caseid: 00000000
Item: NEMPV2
IB-84
April 2004
DO NOT READ TO RESPONDENT
Number of employees:
Is this number correct?
(NMEMP2)
(1) Yes
(2) No
_
Caseid: 00000000
Item: IOCK10
DO NOT ASK THE RESPONDENT
Did (name of person talking to) provide any of the I/O information you just collected?
(1) Yes
(2) No
_
Caseid: 00000000
Item: IOCK11
DO NOT ASK THE RESPONDENT
Did anyone other than (name of respondent) provide any of the I/O information you just
collected?
(1) Yes
(2) No
_
IB-85
April 2004
Caseid: 00000000
Item: IOCK12
DO NOT ASK THE
RESPONDENT
Who Was that?
ENTER LINE NUMBER
_
|
| LN NAME
| (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
HOUSEHOLD ROSTER
M RELATION
AGE
Caseid: 00000000
Item: ERNP
Press ENTER to move to the next field
This month I have a few questions about earnings.
PRESS ENTER TO PROCEED
_
IB-86
April 2004
Caseid: 00000000
Item: ERNPR
For (name's/your) job, what is the easiest way for you to report (your/his/her) total earnings
BEFORE taxes or other deductions: hourly, weekly, annually, or on some other basis?
READ IF NECESSARY:
We use this information to compare the amount that people earn in different types of jobs.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Hourly
Weekly
Bi-weekly
Twice monthly
Monthly
Annually
Other (specify)
_
Caseid: 00000000
Item: ERNPRS
ENTER VERBATIM RESPONSE
_
Caseid: 00000000
Item: ERNUOT
(Do/Does) (name/you) usually receive overtime pay, tips, or commissions(at (your/his/her)
MAIN job?)
(1) Yes
(2) No
IB-87
April 2004
_
Caseid: 00000000
Item: ERNHRT
(EXCLUDING overtime pay, tips and commissions)
(What/what) is (your/his/her) hourly rate of pay on (this/(your/his/her) MAIN) job?
ENTER DOLLAR AMOUNT
$_ .
Caseid: 00000000
Item: ERNHRE
What is your best estimate of (your/his/her) hourly rate of pay?
ENTER DOLLAR AMOUNT
$_ .
Caseid: 00000000
Item: ERNRG1
DO NOT ASK THE RESPONDENT
HOURLY EARNINGS RECORDED AS: (entry in ERNH1O) HOURLY
IS THIS ENTRY CORRECT?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ERNHCO
IB-88
April 2004
DO NOT ASK THE RESPONDENT
INCORRECT ENTRY WAS RECORDED AS: (entry in ERNH1O) HOURLY
CORRECT ENTRY IS: $_ .
Caseid: 00000000
Item: ERNHR
How many hours (do/does) (name/you) usually work per week at this rate?
ENTER NUMBER OF HOURS
_
Caseid: 00000000
Item: (ERNOT@P) / (ERNOT@A / ERNOT@H)
(How/At (your/his/her) MAIN job, how) much (do/does) (you/he/she) usually receive JUST in
overtime pay, tips or commissions, before taxes or other deductions?
(1)
(2)
(3)
(4)
(5)
(6)
Per hour
Per day
Per week
Per month
Per year
Other
_
(fill ERNOT@A:
DO NOT READ TO RESPONDENT
ENTER DOLLAR AMOUNT
$_
.
)
OR
(fill ERNOT@H:
DO NOT READ TO RESPONDENT
ENTER DOLLAR AMOUNT
IB-89
April 2004
$_ .
)
Caseid: 00000000
Item: ERNOTE
What is your best estimate of how much (you/he/she) usually earns WEEKLY, JUST in
overtime pay, tips, or commissions, before taxes or other deductions?
ENTER DOLLAR AMOUNT
$_
Caseid: 00000000
Item: ERNRG2
DO NOT ASK
Usual (hourly/weekly/monthly/annual) earnings in overtime pay, tips or commissions recorded
as: (ERNOTO)
IS THIS ENTRY CORRECT?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ERNOCO
DO NOT READ TO RESPONDENT
INCORRECT ENTRY WAS RECORDED AS: (ERNOTO)
CORRECT ENTRY IS:
$_
Caseid: 00000000
Item: ERNOCH
IB-90
April 2004
DO NOT READ TO RESPONDENT
INCORRECT ENTRY WAS RECORDED AS: (entry in ERNOTO)
CORRECT ENTRY IS:
$_ .
Caseid: 00000000
Item: ERNOH
How many hours (do/does) (name/you) usually work per week at this rate?
ENTER NUMBER OF HOURS
_
Caseid: 00000000
Item: ERNOHE
What is your best estimate of the number of hours per week (you/he/she) usually (work/works)
at this rate?
ENTER NUMBER OF HOURS
_
Caseid: 00000000
Item: ERNVR1
I have estimated (your/his/her) usual WEEKLY earnings (as/for (your/his/her) main job as)
$(AMOUNT) before taxes or other deductions.
Does that sound correct?
(1) Yes
(2) No
_
IB-91
April 2004
Caseid: 00000000
Item: (ERNVR@a / ERNVR@b / ERNVR@c / ERNVR@d)
I have recorded:
1. (ERNH1O) as (your/his/her) hourly rate of pay.
2. (ERNHRO) as the number of hours (you/he/she) usually worked at this rate.
(3. (ERNOTO) as the amount (you/he/she) usually) (earned
(weekly/hourly/monthly/annually) in overtime pay, tips and) (commissions.)
(4. (ERNOH) as the number of hours per week) ((you/he/she) usually work at this rate.)
Which piece or pieces of information do not seem to be correct?
DO NOT READ TO RESPONDENT:
Enter number(s) corresponding to line(s) requiring correction.
All information is correct. ENTER (P) TO PROCEED
ENTER (N) FOR NO MORE
_
_
_
_
Caseid: 00000000
Item: ERNH1C
What is (name's/your) hourly rate of pay on this job, excluding overtime pay, tips or
commissions?
ENTER DOLLAR AMOUNT
$_ .
Caseid: 00000000
Item: ERNHC
How many hours (do/does) (name/you) usually work per week at the rate of
(ERNH1O/ERNH1C)?
ENTER HOURS
(00-99)
IB-92
April 2004
_
Caseid: 00000000
Item: ERNOTC
How much (do/does) (name/you) usually earn (weekly/monthly/annually) just in overtime pay,
tips or commissions?
ENTER DOLLAR AMOUNT
$_
.
Caseid: 00000000
Item: ERNOHC
How much (do/does) (name/you) usually earn hourly just in overtime pay, tips or
commissions?
ENTER DOLLAR AMOUNT
$_ .
Caseid: 00000000
Item: ERNH2C
How many hours (do/does) (name/you) usually work per week at the rate of
(ERNOTO/ERNOHC)?
ENTER HOURS
(00-99)
_
Caseid: 00000000
Item: ERNWK1
Then, including overtime pay, tips and commissions, what are (name's/your) usual WEEKLY
earnings on (this/(your/his/her) main) job, before taxes or other deductions?
CORRECT ENTRY IS:
$_
IB-93
April 2004
Caseid: 00000000
Item: ERNVR3
I have estimated (your/his/her) total WEEKLY earnings (as/for (your/his/her) main job, as) as
$(ERNX2) WEEKLY before taxes or other deductions.
Does that sound correct?
(1) Yes
(2) No (Irreconcilable difference)
_
Caseid: 00000000
Item: ERNWK
(Including overtime pay, tips and commissions,) (What/what) are (name's/your) usual weekly
earnings on (this job,/(your/his/her) MAIN job,) before taxes or other deductions?
ENTER DOLLAR AMOUNT
$_
Caseid: 00000000
Item: ERNMON
(Including overtime pay, tips and commissions,) (What/what) are (name's/your) usual monthly
earnings on (this job/(your/his/her) MAIN job), before taxes or other deductions?
ENTER DOLLAR AMOUNT
$_
Caseid: 00000000
Item: ERNANN
(Including overtime pay, tips and commissions,) (What/what) are (name's/your) usual annual
earnings on (this job,/(your/his/her) MAIN job,) before taxes or other deductions?
ENTER DOLLAR AMOUNT
IB-94
April 2004
$_
Caseid: 00000000
Item: ERNBWK
(Including overtime pay, tips and commissions,) (What/what) are (name's/your) usual
bi-weekly earnings on (this job,/(your/his/her) MAIN job,) before taxes or other deductions?
ENTER DOLLAR AMOUNT
$_
Caseid: 00000000
Item: ERNDKP
What is your best estimate of (your/his/her) usual (weekly/bi-weekly/monthly/annual) earnings
before taxes or other deductions?
ENTER DOLLAR AMOUNT
$_
Caseid: 00000000
Item: ERNRG3
DO NOT READ TO RESPONDENT
(****** REPORTED EARNINGS ARE GREATER THAN $72,000 ******)
(weekly/bi-weekly/monthly/annual) earnings recorded as: (ERNAMT)
(weekly/bi-weekly/monthly/annual)
IS THIS ENTRY CORRECT?
(1) Yes
(2) No
_
IB-95
April 2004
Caseid: 00000000
Item: ERNRGP
DO NOT READ TO RESPONDENT
INCORRECT ENTRY WAS RECORDED AS: (ERNAMT)
(weekly/bi-weekly/monthly/annually)
CORRECT ENTRY IS:
$_
Caseid: 00000000
Item: ERNVR4
I have recorded (your/his/her) total earnings (for (your/his/her) (as/main job as) $(ERNAMT)
(weekly/bi-weekly/monthly/annually) before taxes or other deductions. Is that correct?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ERNCOR
(Including overtime pay, tips and commissions,) (What/what) are (your/his/her) usual
(weekly/bi-weekly/monthly/annual) earnings on (this/(your/his/her) main) job, before taxes or
other deductions?
ENTER DOLLAR AMOUNT
$_
IB-96
April 2004
Caseid: 00000000
Item: ERNRG4
DO NOT READ TO RESPONDENT
(weekly/bi-weekly/monthly/annual) earnings recorded as: (ERNAMT)
(weekly/bi-weekly/monthly/annual)
IS THIS ENTRY CORRECT?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ERNRP2
DO NOT READ TO RESPONDENT
INCORRECT ENTRY WAS RECORDED AS: (ERNAMT)
(weekly/bi-weekly/monthly/annually)
CORRECT ENTRY IS:
$_
Caseid: 00000000
Item: ERNWKP
How many weeks a year (do/does) (name/you) get paid for?
NUMBER OF WEEKS
_
Caseid: 00000000
Item: ERNRT
(Even though you told me it is easier to report (((your/his/her) earnings
(weekly/bi-weekly/monthly/annually),) (Are/Is)/(are/is)) (you/he/she) PAID AT AN
HOURLY RATE on (this/(your/his/her) MAIN) job?
(1) Yes
(2) No
IB-97
April 2004
_
Caseid: 00000000
Item: ERNH2
(EXCLUDING overtime pay, tips and commissions,) (What/what) is (your/his/her) hourly rate
of pay on (this/(your/his/her) MAIN) job?
ENTER DOLLAR AMOUNT
$_ .
Caseid: 00000000
Item: ERNRG5
DO NOT READ TO RESPONDENT
Hourly earnings recorded as: (ERNH2) hourly
IS THIS ENTRY CORRECT?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ERNRP3
DO NOT READ TO RESPONDENT
INCORRECT ENTRY WAS RECORDED AS: (ERNH2) hourly
CORRECT ENTRY IS:
$_ .
Caseid: 00000000
Item: ERNLAB
On this job, (are/is) (name/you) a member of a labor union or of an employee association
similar to a union?
(1) Yes
(2) No
_
IB-98
April 2004
Caseid: 00000000
Item: ERNCOV
On this job, (are/is) (name/you) covered by a union or employee association contract?
(1) Yes
(2) No
_
Caseid: 00000000
Item: ERNCKW
DO NOT ASK THE RESPONDENT
Did (name of person talking about) provide any of the earnings information you just collected?
(1) Yes
(2) No
_
Caseid: 00000000
Iteem: ERNCKX
DO NOT ASK THE RESPONDENT
Did anyone other than (name of respondent) provide any of the earnings information you just
collected?
(1) Yes
(2) No
_
Caseid: 00000000
IB-99
April 2004
Item: ERNCKY
DO NOT ASK THE
RESPONDENT
Who Was that?
ENTER LINE NUMBER
_
|
| LN NAME
| (person 1)
| (person 2)
| (person 3)
| (person 4)
| (person 5)
| (person 6)
| (person 7)
| (person 8)
| (person 9)
| (person 10)
| (person 11)
| (person 12)
| (person 13)
| (person 14)
| (person 15)
| (person 16)
HOUSEHOLD ROSTER
M RELATION
AGE
Caseid: 00000000
Item: NLFJH
When did (name/you) last work at a job or business?
(1) Within last 12 months
(2) More than 12 months ago
(3) Never worked
_
Caseid: 00000000
Item: NLFRET
(Are/Is) (name/you) retired FROM A JOB OR BUSINESS?
(1) Yes
(2) No
_
Caseid: 00000000
Item: NLFACT
IB-100
April 2004
What best describes (name's/your) situation at this time? For example, (are/is) (you/he/she)
disabled, ill, in school, taking care of house or family, or something else?
(1)
(2)
(3)
(4)
(5)
(6)
Disabled
Ill
In school
Taking care of house or family
In retirement
Something else/other
_
Caseid: 00000000
Item: NLFSPC
ENTER VERBATIM RESPONSE
_
IB-101
April 2004
“This month we want to learn about people who have physical, mental, or emotional
conditions that cause serious difficulty with their daily activities. Please answer for
household members who are 15 years old or over.”
1. Is anyone deaf or does anyone have serious difficulty hearing?
Yes => Go to 1a
No => Go to 2
DK => Go to 2
R => Go to 2
1a. Who is it?
(Fill)
1b. Is anyone else deaf or does anyone else have serious difficulty hearing?
Yes => Ask 1a
No => Go to 2
2. Is anyone blind or does anyone have serious difficulty seeing even when wearing
glasses?
Yes => Go to 2a
No => Go to 3
DK => Go to 3
R => Go to 3
2a. Who is it?
(Fill)
2b. Is anyone else blind or does anyone else have serious difficulty seeing even when
wearing glasses?
Yes => Ask 2a
No => Go to 3
3. Because of a physical, mental, or emotional condition, does anyone have serious
difficulty concentrating, remembering, or making decisions?
Yes => Go to 3a
No => Go to 4
DK => Go to 4
R => Go to 4
3a. Who is it?
(Fill)
3b. Does anyone else have serious difficulty concentrating, remembering, or making
decisions?
Yes => Ask 3a
No => Go to 4
4. Does anyone have serious difficulty walking or climbing stairs?
Yes => Go to 4a
No => Go to 5
DK => Go to 5
R => Go to 5
4a. Who is it?
(Fill)
4b. Does anyone else have serious difficulty walking or climbing stairs?
Yes => Ask 4a
No => Go to 5
5. Does anyone have difficulty dressing or bathing?
Yes => Go to 5a
No => Go to 6
DK => Go to 6
R => Go to 6
5a. Who is it?
(Fill)
5b. Does anyone else have difficulty dressing or bathing?
Yes => Ask 5a
No => Go to 6
6. Because of a physical, mental, or emotional condition, does anyone have difficulty
doing errands alone such as visiting a doctor’s office or shopping?
Yes => Go to 6a
No => Go to end of interview
DK => Go to end of interview
R => Go to end of interview
6a. Who is it?
(Fill)
6b. Does anyone else have difficulty doing errands alone such as visiting a doctor’s
office or shopping?
Yes => Ask 6a
No => Go to end of interview
| File Type | application/pdf |
| Author | POLIVKA_A |
| File Modified | 2007-12-18 |
| File Created | 2004-04-27 |