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pdfEvaluation of the UC Provisions of ARRA
Mathematica Policy Research
APPENDIX A
UI RECIPIENT SURVEY
Evaluation of the UC Provisions of ARRA
Mathematica Policy Research
Evaluation of the Unemployment
Compensation Provisions of the
American Recovery and
Reinvestment Act of 2009
Recipient Survey Instrument
October 2, 2012
Contract Number:
GS10F0050L/DOLF109631341
Evaluation of the Unemployment
Mathematica Reference Number:
06863.426
American Recovery and
Submitted to:
U.S. Department of Labor
CPPR
200 Constitution Ave., NW
Washington, DC 20210
Project Officer: Steven Richardson
Submitted by:
Mathematica Policy Research
P.O. Box 2393
Princeton, NJ 08543-2393
Telephone: (609) 799-3535
Facsimile: (609) 799-0005
Project Director: Karen Needels
Compensation Provisions of the
Reinvestment Act of 2009
Recipient Survey Instrument
October 2, 2012
CONTENTS
Section
Page
A.
INTRODUCTION AND SCREENING ..........................................................................1
B.
UI COLLECTION HISTORY......................................................................................17
C.
PRE-UI EMPLOYMENT ............................................................................................20
D.
POST CLAIM WORK SEARCH ACTIVITIES ............................................................31
E.
EDUCATION AND TRAINING PROGRAMS .............................................................36
F.
JOBS SINCE PRE-UI CLAIM JOB, INCLUDING CURRENT EMPLOYMENT........... 45
G.
MARITAL STATUS AND FINANCIAL WELL-BEING.................................................54
H.
PRE- AND POST-CLAIM INCOME (OTHER THAN UI BENEFITS) .......................... 56
I.
HEALTH STATUS AND HEALTH INSURANCE COVERAGE .................................. 62
J.
DEMOGRAPHICS ....................................................................................................65
K.
FAMILY SIZE AND NUMBER OF CHILDREN ..........................................................66
L.
WORK MOBILITY .....................................................................................................68
M.
TRACKING INFORMATION .....................................................................................70
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OMB Approval No.: 1225-0089
Expiration Date: 09/30/2015
06863.426
EVALUATION OF THE UNEMPLOYMENT COMPENSATION PROVISIONS OF THE
AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009
RECIPIENT SURVEY
NOTE TO REVIEWERS: IN GENERAL, TEXT IN UPPERCASE IS NOT READ TO THE
RESPONDENT.
SECTION A – INTRODUCTION AND SCREENING
A1.
Hello
May I speak with [fill SAMPLE MEMBER NAME]?
SPEAKING TO [FILL FIRSTNAME] ............................. 01 (A3)
PERSON ASKS WHAT CALL IS ABOUT .................... 02 (WHAT ABOUT A2)
NOT A GOOD TIME, SCHEDULE CALLBACK ............ 03 (CALLBACK)
[FILL FIRSTNAME] HAS A HEALTH PROBLEM ......... 04 (HEALTHPROB Q3)
[FILL FIRSTNAME] IS IN AN INSTITUTION ................ 05 (INSTITUTION Q10)
[FILL FIRSTNAME] HAS MOVED ................................ 06 (KNOW WHERE Q17)
[FILL FIRSTNAME] DOES NOT SPEAK ENGLISH ..... 07 (LANG Q20)
NEVER HEARD OF [FILL FULLNAME]/
WRONG NUMBER ...................................................... 08 (THANKS Q36 STATUS 530)
HUNG UP DURING INTRODUCTION ......................... 09 (STATUS 640)
REFUSED.................................................................... r
(STATUS 220)
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A2.
What about
I’m calling from Mathematica Policy Research about a survey we are conducting for the
U.S. Department of Labor. [fill FirstName] should have received a letter from Department
of Labor about the study. May I speak with [fill SAMPLE MEMBER NAME]?
[FILL FIRSTNAME] COMES TO THE PHONE............. 01 (A3)
NOT A GOOD TIME, SCHEDULE CALLBACK ............ 02 (CALLBACK)
[FILL FIRSTNAME] HAS A HEALTH PROBLEM/
IS DECEASED ............................................................. 03 (HEALTHPROB Q3)
[FILL FIRSTNAME] IS IN AN INSTITUTION ................ 04 (INSTITUTION Q10)
[FILL FIRSTNAME] HAS MOVED ................................ 05 (KNOW WHERE Q17)
[FILL FIRSTNAME] DOES NOT SPEAK ENGLISH ..... 06 (LANG Q20)
ASKS ABOUT LETTER ............................................... 07 (A13)
NEVER HEARD OF [FILL FULLNAME]/
WRONG NUMBER ...................................................... 08 (THANKS Q36 STATUS 530)
HUNG UP DURING INTRODUCTION ......................... 09 (STATUS 640)
SUPERVISOR REVIEW .............................................. 10 (STATUS 380)
REFUSED.................................................................... r
(STATUS 220)
HealthProb (Q3)
ENTER TYPE OF HEALTH PROBLEM.
HEARING PROBLEM .................................................. 01 (AMP TTY Q4)
SPEECH PROBLEM.................................................... 02 (AMP TTY Q4)
PHYSICAL PROBLEM ................................................. 03 (CALLLATER Q8)
COGNITIVE PROBLEM ............................................... 04 (THANKS Q36 STATUS 410)
TOO OLD/FRAIL.......................................................... 05 (CALLLATER Q8)
IN A COMA .................................................................. 06 (THANKS Q36 STATUS 410)
DECEASED ................................................................. 07 (DECEASED Q9)
REFUSED.................................................................... r
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(STATUS 220)
AmpTTY (Q4)
I can get on a phone that will amplify my voice or [fill FirstName]’s voice, or we could use
a TTY service. Would either of these enable [fill HimHer] to complete the interview?
YES – USE AMPLIFIER PHONE ................................. 01 (RESPAVAIL Q5)
YES – USE TTY CAPABILITY ..................................... 02 (RESPAVAIL Q5)
NO ............................................................................... 00 (THANKS Q36 STATUS 410)
DON’T KNOW .............................................................. d
(CALLBACK)
REFUSED.................................................................... r
(STATUS 220)
RespAvail (Q5)
Is [fill FirstName] available now?
YES ............................................................................. 01 (IF AMPTTY (Q4) = 1
THEN AMPPHONE (Q6)
ELSE CALLTTY (Q7))
NO ............................................................................... 00 (CALLBACK)
AmpPhone (Q6)
Please hold while I get the amplifier phone.
INTERVIEWER: SET UP AMPLIFIER/WEAK SPEECH EQUIPMENT AND ASK
GATEKEEPER TO CALL [fill FirstName] TO THE PHONE.
[FILL FIRSTNAME] COMES TO THE PHONE............. 01 (SAMPMEMB Q31)
CALLBACK .................................................................. 02 (CALLBACK)
CallTTY (Q7)
I will call back in a few minutes after I have the help of the TTY operator.
ARRANGE CALL WITH OPERATOR .......................... 01 (SAMPMEMB Q31)
IF UNSUCCESSFUL SET CALLBACK ........................ 02 (CALLBACK)
CallLater (Q8)
Will [fill FirstName] be able to talk on the telephone if I call back in the next few weeks?
YES/MAYBE – CALLBACK .......................................... 01 (CALLBACK)
NO ............................................................................... 00 (THANKS Q36 STATUS 419)
DON’T KNOW .............................................................. d
(CALLBACK)
REFUSED.................................................................... r
(STATUS 220)
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Deceased (Q9)
I am very sorry to hear that [fill HeShe] passed away. I am calling about a survey we are
conducting for the U.S. Department of Labor. So that I can update my records, could you
please tell me when [fill HeShe] passed away?
Thank you. Please accept my condolences. Good-bye.
| | |/| | |/|
MONTH DAY
(01-12)
(01-31)
| | |
YEAR
|
(2004-2012)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
[Status 440]
Institution (Q10)
ENTER TYPE OF INSTITUTION.
HOSPITAL ................................................................... 01 (HOMESOON Q11)
NURSING HOME......................................................... 02
ASSISTED LIVING FACILITY ...................................... 03
GROUP HOME ............................................................ 04
JAIL OR PRISON......................................................... 05 (THANKS Q36 STATUS 421)
HomeSoon (Q11)
So I know when to call back, do you expect [fill FirstName] to come home from the
hospital within a month or so?
YES, ARRANGE CALLBACK....................................... 01 (CALLBACK)
NO ............................................................................... 00 (THANKS Q36 STATUS 421)
KnowWhere (Q17)
Do you or anyone there know how we can reach [fill FirstName]?
YES ............................................................................. 01 (NEW PHONE Q18)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
[GO TO THANKS (Q36) STATUS S30]
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New Phone (Q18)
May I please have [fill HisHer] telephone number, beginning with the area code?
| | | |-|
(AREA CODE)
|
|
|-|
|
|
|
|
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
[GO TO NEW ADDR (Q19)]
Is this a home, cell, or work telephone number?
CODE ALL THAT APPLY
HOME .......................................................................... 01
CELL............................................................................ 02
WORK ......................................................................... 03
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
Could you please tell me another telephone number where we might be able to reach
[fill NAME]?
SECOND PHONE NUMBER:
| | | |-| | | |-| | | | |
(AREA CODE)
NO OTHER NUMBER ................................................. 00 (NEW ADDR Q19)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(NEW ADDR Q19)
Is this a home, cell, or work telephone number?
CODE ALL THAT APPLY
HOME .......................................................................... 01
CELL............................................................................ 02
WORK ......................................................................... 03
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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New Addr (Q19)
May I please have [fill HisHer] address?
_________________________________________________________
HOUSE NUMBER / STREET NAME
APT. #
________________________
CITY
_______
____________
STATE
ZIP CODE
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
[GO TO A8]
(A8) TollFree#
Let me give you a toll-free number where [fill SAMPLE MEMBER] can reach someone to
complete the survey and receive [$40/$30] for participating. The toll-free number is
XXX-XXX-XXXX. Thank you.
[GO TO Thanks (Q36) if New Phone equals DK/RF
then Status 530, else Status 899]
Lang (Q20)
CODE LANGUAGE NEEDED TO COMPLETE INTERVIEW IF KNOWN.
ARABIC ....................................................................... 01
BOSNIAN .................................................................... 02
CAMBODIAN ............................................................... 03
CHINESE ..................................................................... 04
CREOLE ...................................................................... 05
HINDI ........................................................................... 06
HMONG ....................................................................... 07
ITALIAN ....................................................................... 08
(THANKS Q36
STATUS 400)
LAOTIAN ..................................................................... 09
POLISH ....................................................................... 10
PORTUGUESE ............................................................ 11
RUSSIAN ..................................................................... 12
SPANISH ..................................................................... 13 (THANKS Q36 STATUS 401)
TAGALOG ................................................................... 14 (THANKS Q36 STATUS 400)
VIETNAMESE .............................................................. 15 (THANKS Q36 STATUS 400)
OTHER (SPECIFY) [specify] ........................................ 16 (OTHERLANG Q21)
___________________________________________
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
[GO TO Thanks (Q36) Status 400]
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OtherLang (Q21)
SPECIFY OTHER LANGUAGE.
LANGUAGE: _______________________
SAY: We will try and call back with someone who speaks your language.
[GO TO else Thanks (Q36) Status 400]
A3.
My name is (NAME) and I’m calling from Mathematica Policy Research. Recently, you
should have received a letter about a survey we are conducting for the U.S. Department
of Labor. We are calling people who filed for unemployment benefits and need to hear
about your experiences. This survey is for research purposes only and will help to
improve services for workers in the future. All of the information you provide will be kept
strictly confidential. The interview takes about 30 minutes and we will mail you a check
for [$40/$30] when the survey is completed.
IF HAS QUESTIONS/DON’T KNOW WHAT WE’RE TALKING ABOUT – SEE FAQ
BEGIN INTERVIEW ..................................................... 01 (A4)
NOT A GOOD TIME, SCHEDULE CALLBACK ............ 02 (CALLBACK)
HUNG UP DURING INTRODUCTION ......................... 03 (STATUS 640)
NEVER COLLECTED UNEMPLOYMENT ................... 04 (Q32)
ASKS ABOUT LETTER ............................................... 05 (A12)
SUPERVISOR REVIEW .............................................. 06 (STATUS 380)
REFUSED.................................................................... r
(STATUS 200)
Never Collected (Q32)
According to [fill STATE] Unemployment Insurance Agency records, you filed for
unemployment benefits on [fill INITIAL UI CLAIM DATE].
YES, BEGIN INTERVIEW ............................................ 01 (A4)
NO, SUPERVISOR REVIEW ....................................... 02 (STATUS 380)
NOT A GOOD TIME, SCHEDULE CALLBACK ............ 03 (CALLBACK)
HUNG UP DURING INTRODUCTION ......................... 04 [STATUS 640]
REFUSED.................................................................... r
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[STATUS 200]
A4.
BLAISE SCREEN: SHOW DOB FROM UI CLAIMS RECORDS.
To get started I need to verify that I am speaking with the correct person. Could you
please tell me your date of birth?
PROBE IF RESPONDENT RESISTS: I have your year of birth as [fill YEAR], would you
please tell me the month and day?
IF NECESSARY: READ DOB ALOUD AND CONFIRM.
RECORD: | | | / | | | / |
MONTH DAY
|
| |
YEAR
|
[IF MATCHES SAMPLE INFO Start Survey (B1), IF DOES NOT
MATCH SAMPLE INFO, ASK (A5)]
REFUSED.................................................................... r
A5.
(A5)
BLAISE SCREEN: SHOW LAST 4-DIGITS OF SS# FROM UI CLAIMS RECORDS.
Also for verification purposes, please tell me the last four-digits of your social security
number.
IF NECESSARY: READ LAST 4-DIGITS ALOUD AND CONFIRM.
|
|
|
|
| LAST FOUR SSN DIGITS [IF MATCHES SAMPLE INFO - START SURVEY
(B1), IF DOES NOT MATCH
SAMPLE INFO, READ A9]
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
A9.
I am sorry. Before I continue with the interview I will need to check with my supervisor.
Thank you for your time.
GO TO END
Thanks (Q36)
Thank you very much for your time.
ENTER 1 TO CONTINUE
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SAMPLE MEMBER AND LETTER
A12.
The letter was addressed to you from ___________, Federal Project Officer for the
U.S. Department of Labor. It explained that this study is sponsored by the
U.S. Department of Labor. The purposes are to help the government provide better
services to people looking for jobs and be more responsive to those who are
unemployed. It also mentioned that we would mail you a check for [$40/$30] when the
survey is completed.
May we begin the interview?
IF NECESSARY: The letter was sent from the U.S. Department of Labor, and was
printed on letterhead with the U.S. Department of Labor’s name on the top.
BEGIN INTERVIEW ..................................................... 01 (A4)
NOT A GOOD TIME, SCHEDULE CALLBACK ............ 02 (CALLBACK)
HUNG UP DURING INTRODUCTION ......................... 03 (STATUS 640)
SUPERVISOR REVIEW .............................................. 04 (STATUS 380)
REQUESTS ANOTHER LETTER ................................ 05 (SEND LETTER)
REFUSED.................................................................... r
(STATUS 200)
[SendLetter (Q35)]
A12a. Okay, I'll mail another letter and will call back in a few days. To what address should we
mail the letter?
__________________________________________________
HOUSE NUMBER / STREET NAME
APT. #
__________________
CITY
_______ ____________
STATE
ZIP CODE
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
Thanks (Q36) Status 831
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GATEKEEPER AND LETTER
A13.
The letter was from the U.S. Department of Labor, and addressed to [fill SAMPLE
MEMBER NAME]. The letter explained that this study is sponsored by the U.S.
Department of Labor and the study’s purpose is to help the government provide better
services to jobseekers in the future and be more responsive to the needs of the
unemployed. It also mentioned that we would be mailing [fill SM FirstName LastName]
a check for [$40/$30] when the survey is completed.
May I speak to [fill SAMPLE MEMBER NAME]?
IF NECESSARY: The letter was sent from the U.S. Department of Labor, and was
printed on letterhead with the U.S. Department of Labor’s name on the top.
BEGIN INTERVIEW ..................................................... 01 (A4)
NOT A GOOD TIME, SCHEDULE CALLBACK ............ 02 (CALLBACK)
HUNG UP DURING INTRODUCTION ......................... 03 (STATUS 640)
SUPERVISOR REVIEW .............................................. 04 (STATUS 380)
REFUSED.................................................................... r
(STATUS 200)
CALLBACK SCREENS
Hello (Q101)
Hello, my name is [fill InterviewerName]. I am calling from Mathematica on behalf of the
U.S. Department of Labor. May I please speak to [fill FullName]?
SPEAKING TO [FILL FIRSTNAME] ............................. 01
[FILL FIRSTNAME] COMES TO THE PHONE............. 02
PERSON ASKS WHAT CALL IS ABOUT .................... 03 (WHATABOUT Q102)
NEED TO CALLBACK ................................................. 04 (CALLBACK)
NEVER HEARD OF [FILL FULLNAME]/
WRONG NUMBER ...................................................... 05 (PHONECHECK Q106)
REFUSED.................................................................... r
IF SAMPLE MEMBER THEN GO TO SAMPMEMB (Q103)]
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(STATUS 200)
IF NOT SAMPLE MEMBER
WhatAbout (Q102)
[if SampleMember then]
I’m calling to finish the interview we are conducting with [fill SM FirstName].
When is a good time to reach [fill FirstName]?
[FILL FIRSTNAME] COMES TO THE PHONE............. 01
NEED TO CALLBACK ................................................. 02 (CALLBACK)
SUPERVISOR REVIEW .............................................. 03 (STATUS 380)
REFUSED.................................................................... r
(STATUS 200)
IF NOT SAMPLE MEMBER]
[IF SAMPLE MEMBER THEN GO TO SAMPMEMB (Q103)]
SampMemb (Q103)
[if Hello eq 2 or WhatAbout = 1 then]
Hello, my name is [fill InterviewerName].
[endif]
I’m calling to finish the interview we are conducting about improving services to people
who are eligible to collect unemployment insurance benefits. Is now a good time?
CONTINUE INTERVIEW ............................................. 01 (A4)
NOT A GOOD TIME .................................................... 02 (CALLBACK)
SUPERVISOR REVIEW .............................................. 03 (STATUS 380)
REFUSED.................................................................... r
(STATUS 200)
PhoneCheck (Q106)
I’m sorry. I thought I dialed [fill Phone]. Can you tell me what number I’ve reached to see
what kind of mistake I made?
RIGHT NUMBER, NO SUCH PERSON ....................... 01 (WRONGNUMBER Q107)
WRONG CONNECTION/MISDIAL ............................... 02 (THANKS Q108)
SUPERVISOR REVIEW REQUIRED ........................... 03 (STATUS 380)
REFUSED TO CONFIRM NUMBER ............................ 04 (THANKS Q108)
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WrongNumber (Q107)
I’m [fill InterviewerName] from Mathematica Policy Research. I thought we’d recently
spoken to someone there and according to the information I have, we were supposed to
call back to interview [fill FullName]. There must have been some mistake. Thank you for
your help. I’ll turn this over to my supervisor.
ENTER 1 TO CONTINUE ............................................ 1
(STATUS 380)
Thanks (Q108)
Thank you for your time.
ENTER 1 TO CONTINUE ............................................ 1
Backup (Q109)
BACKUP AND REDIAL PHONE NUMBER.
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(BACKUP Q109)
FREQUENTLY ASKED QUESTIONS (FAQs)
PROGRAMMER: ALLOW INTERVIEWER TO VIEW FAQS AT ANY TIME.
WHO/WHICH AGENCY IS SPONSORING THE STUDY?
This study is being sponsored by the U.S. Department of Labor.
WHO IS CONDUCTING THE STUDY?
Mathematica, an independent research company is conducting the study on behalf of the
U.S. Department of Labor. Mathematica has more than 40 years of policy research and program
evaluation experience. You can learn more about Mathematica by visiting our website at
www.mathematica-mpr.com.
WHAT IS THE PURPOSE OF THE STUDY?
Our goal is to learn about how effectively unemployment insurance benefits met the needs of
unemployed workers during the recent recession. This study is very important for improving
services to jobseekers in the future. It will allow us to understand what works well and what
doesn’t.
I DON’T COLLECT UNEMPLOYMENT BENEFITS ANY MORE/I COLLECTED FOR A VERY
SHORT TIME.
We are calling people who filed for unemployment benefits. Even if you no longer receive
benefits or if you collected for a short time only, your experience and input is very important to
the study. Hearing from people with different experiences helps us learn more about how the
unemployment insurance system is working.
I’M DISSATISFIED WITH MY UNEMPLOYMENT BENEFITS/LOCAL AGENCIES.
I understand. Your comments will be especially important to the research. The U.S. Department
of Labor needs to hear from people who were satisfied and people who were dissatisfied with
their experiences.
HOW DID YOU GET MY NAME?
Your name was scientifically selected from among persons in your state who filed for
unemployment insurance compensation in the last several years.
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FAQs – continued
IS THE SURVEY CONFIDENTIAL?
Yes. Your responses are protected from disclosure by federal statue [P.L. 107-347, Title V
Confidential Information Protection and Statistical Efficiency Act of 2002 (CIPSEA)].
Your answers will be combined with those of others and your name will never be used in
reporting the results of the study. Your answers to questions will not affect your eligibility for any
public program.
I DON’T HAVE THE TIME.
We can schedule a call to do the survey at your convenience. Our interviewers are available to
speak with you seven days a week as follows: on Mondays through Thursdays from 9:00 A.M. to
12:00 midnight, on Fridays from 9:00 A.M. to 8:00 P.M., Saturdays from 9:00 A.M.-5:00 P.M. and
Sundays from 1:00 P.M. to 9:00 P.M. Eastern Standard Time. We can also complete the survey
in more than one call, if necessary.
WHAT HAPPENS IF I DON’T PARTICIPATE IN THE SURVEY?
Your participation is voluntary and will not affect your eligibility to receive any services or
benefits. Your selection for the survey was done scientifically. You were chosen to represent
other people who received unemployment insurance benefits in your area. Your answers will
help the U.S. Department of Labor improve services to people who become unemployed. There
are no right or wrong answers. We’re interested in your experiences and opinions.
I’M NOT INTERESTED.
Let me reassure you that we are not selling anything. The questions we ask are designed to
help the U.S. Department of Labor improve services to people who are unemployed and
seeking jobs. There are no right or wrong answers. We’re interested in your experiences and
opinions. Your answers will be combined with those of others and your name will never be
included in any report. If you complete the survey we will pay you [$40/$30] as a token of
appreciation.
HOW LONG WILL THIS TAKE?
The length of the interview varies, but it usually takes about 30 minutes.
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FAQs – continued
WHO GAVE YOU THE AUTHORITY TO CONDUCT THE STUDY?
This study is being sponsored by the U.S. Department of Labor and has been approved by the
U.S. Office of Management and Budget under OMB control number 1225-0089. Without this
approval we would not be able to conduct this survey. Questions regarding any aspect of this
survey may be directed by mail to Mr. Jonathan A. Simonetta, U.S. Department of Labor, Office
of the Assistant Secretary for Administration and Management, 200 Constitution Avenue, NW,
Room S-2312, Frances Perkins Bldg., Washington, DC 20210, or by email:
[email protected].
WILL I BE PAID?
Yes, we will mail you a check in the amount of [$40/$30] within 2 weeks of completing the
survey.
WILL THERE BE ANOTHER FOLLOW-UP TO THIS STUDY?
No. Only one survey will be conducted for this study.
CAN SOMEONE ELSE RESPOND TO THIS QUESTIONNAIRE ON MY BEHALF?
Because of the types of questions we ask, it is important that we talk directly to you. If, however,
you need a family member or friend to translate our questions or your answers, that is okay.
WILL THERE BE A REPORT ON THE FINDINGS THAT I CAN READ? WHERE/WHEN CAN I
SEE A PUBLISHED REPORT ABOUT THE NATIONAL EVALUATION?
Survey results will be reported in several reports prepared by Mathematica for the
U.S. Department of Labor. Once these reports are cleared by the U.S. Department of Labor for
public release, they will be available on Mathematica’s website—www.mathematica-mpr.com.
WHAT ARE YOU GOING TO DO FOR ME NOW? ARE YOU GOING TO HELP ME FIND A
JOB? ARE YOU GOING TO SEND ME FOR MORE TRAINING?
Mathematica is a private, independent research firm. Our firm is conducting this evaluation for
the U.S. Department of Labor, and this survey is part of this evaluation. We cannot provide
assistance finding jobs or training. You will, however, receive [$40/$30] for completing the
survey.
I’M ON THE NATIONAL “DO NOT CALL LIST/REGISTRY.” WHY ARE YOU CALLING ME?
The do not call list or registry applies to telemarketing calls, not to calls like this one that are
approved by the government. Lawmakers recognize the need for the public to participate in
studies like this to learn how government programs are working and how to improve them. We
will not sell you anything, nor will we ask for money. Your privacy will be respected, and your
cooperation is appreciated. For more information on who is included and excluded on the do not
call list, you can visit the website at www.donotcall.gov.
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FAQs – continued
DOES THE MONEY I RECEIVE FOR COMPLETING THIS SURVEY COUNT TOWARDS MY
INCOME FOR THIS YEAR?
No, the money received for completing this survey is not considered employment income.
Employment income is generated from an employment contract. This is a one-time payment for
volunteering to take part in the survey.
WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the study, you can visit the U.S. Department of Labor (DOL) website
at http://www.dol.gov/. You can also email study’s project officer, Jonathan A. Simonetta of DOL
at [email protected]. or Mathematica’s Project Director, Dr. Karen Needels at
541-753-0201. For questions about the survey you can call Mathematica’s Survey Director,
Ms. Pat Nemeth at 609-275-2294.
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SECTION B – UI COLLECTION HISTORY
B1.
The first few questions I have are about the dates of your unemployment insurance
benefits. According to [fill STATE’s] Unemployment Insurance Agency records, you filed
for unemployment insurance benefits on or about [fill INITIAL UI CLAIM DATE]. Is that
correct?
YES ............................................................................. 01 (B3)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(B1 NE 01)
B2.
When around [fill INITIAL UI CLAIM DATE], did you file for or start collecting
unemployment benefits?
PROBE: If you filed more than once during that period, please tell me about the first of
those times that you filed for benefits.
PROBE, IF NECESSARY: Did you file for or start collecting unemployment benefits
around [fill UI CLAIM YEAR]?
RECORD MONTH AND YEAR
[PROGRAMMER:
REPLACE SAMPLE DATA UI CLAIM DATE WITH THIS DATE
FOR SUBSEQUENT QUESTIONS.]
| | |/| | |
MONTH
YEAR
(01-12)
|
|
(B3)
(2006-2010)
DID NOT FILE/COLLECT ............................................ n
(THANKS AND END,
Status 380, SUPERVISOR
REVIEW)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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(THANKS AND END,
Status 380, SUPERVISOR
REVIEW)
CATI: IF EXTRACT DATA HAS AN END DATE, ASK B3. IF THE EXTRACT DATE IS
MISSING, GO TO B4.
B3.
And, according to [fill STATE’s] unemployment insurance records, you stopped receiving
benefits on or about [fill UI END DATE]. Is that correct?
YES ............................................................................. 01 (B5)
NO ............................................................................... 00 (B4)
CURRENTLY RECEIVING/DID NOT STOP ................ 02 (C1)
DON’T KNOW .............................................................. d
(B4)
REFUSED.................................................................... r
(B4)
(EXTRACT DATE IS MISSING OR B3= 00, d OR r)
B4.
When around [fill UI END DATE], did you stop receiving unemployment insurance
benefits?
PROBE: When did your unemployment insurance benefits run out?
INTERVIEWER: IF SAMPLE MEMBER FILED MORE THAN ONCE DURING THAT
PERIOD, ASK THEM THE DATE UI BENEFITS RAN OUT FOR THE
TIME THEY FILED ON [fill UI CLAIM DATE].
RECORD MONTH AND YEAR.
RECORD: | | | / |
MONTH
|
| |
YEAR
|
(B5)
CURRENTLY RECEIVING/DID NOT STOP ................ 02 (C1)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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(B5)
(B5)
(B3=01 OR B4 NE 02)
B5.
Why did you stop collecting unemployment insurance benefits from your initial claim filed
in [fill INITIAL UI CLAIM DATE]?
CODE ONE ONLY
NEW INCOME SOURCE
RE-EMPLOYED/FOUND A JOB .................................. 01
STARTED OWN BUSINESS........................................ 02
BENEFIT RESTRICTION ISSUES
BENEFITS RAN OUT/EXHAUSTED ............................ 03
DISQUALIFIED ............................................................ 04
COMPLETED OR STOPPED PARTICIPATING
IN TRAINING PROGRAM THAT MADE ME
ELIGIBLE FOR BENEFITS .......................................... 05
RECEIVED WORKMEN’S COMPENSATION/
HAD CASE PENDING ................................................. 06
NOT AVAILABLE TO WORK
ENROLLED IN SCHOOL ............................................. 07
ILLNESS OR DISABILITY; PREGNANCY ................... 08
MOVED ....................................................................... 09
WENT INTO MILITARY ............................................... 10
RETIRED/RECEIVING SOCIAL SECURITY ................ 11
DID NOT WANT TO WORK ......................................... 12
LOST IMMIGRATION PAPERS/OTHER
IMMIGRATION ISSUE ................................................. 13
OTHER
DID NOT WANT UNEMPLOYMENT
INSURANCE BENEFITS ANY MORE.......................... 14
OTHER (SPECIFY) [specify] ........................................ 15
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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SECTION C – PRE-UI EMPLOYMENT
INFORMATION ON THE JOB THAT LED TO THE UI CLAIM
C1.
My next questions are about the job you had just before you filed for benefits in
[fill INITIAL CLAIM DATE]. My computer indicates that you worked at [fill NAME OF
COMPANY FROM PRELOADS] at that time. Is this correct?
YES ............................................................................. 01 (C3)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C2.
What was the name of the employer you worked for just before you filed for
unemployment benefits in [fill INITIAL UI CLAIM DATE]?
NOTE: PROBE FOR SPECIFIC DIVISION OR BRANCH OF OPERATION FOR THIS
EMPLOYER. For example, the manufacturing, retail or wholesale part of a
company.
(SPECIFY) [specify] ..................................................... 01
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C3.
What kind of company was it—what did they make, do, or sell?
PROBE, IF NECESSARY: What was the major product or service of [IF C1 = 1, THEN
FILL CL_CompanyName FROM SAMPLE LOAD, ELSE
FILL C2]?
(SPECIFY) [specify] ..................................................... 01
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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C4.
What kind of work did you do at [IF C1 = 1, THEN FILL CL_CompanyName FROM
SAMPLE LOAD, ELSE FILL C2]?
PROBE: That is, what was your occupation?
PROBE: What were your duties?
NOTE: PROBE FOR VERBS, E.G., I INSTALLED DOORS; I OPERATE A FORK
LIFT, I DROVE A TRACTOR TRAILER, I STOCKED SHELVES IN A
DISCOUNT STORE.
(SPECIFY) [specify] ..................................................... 01
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C5.
Were you represented by a union at your job with [fill EMPLOYER]?
PROBE FOR NON-YES RESPONSES: In some jobs you might be represented by a
union even if you are not a member.
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C6.
In what month and year did you first start working at [IF C1 = 1, THEN FILL
CL_CompanyName FROM SAMPLE LOAD, ELSE FILL C2]?
ADJUST DATE IF NECESSARY.
PROBE: Your best estimate would be fine.
CATI: DATE MUST BE BEFORE CLAIM DATE.
| | |/|
MONTH
(01-12)
| | |
YEAR
| (C8)
(1962-2012)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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C7.
How many years and/or months ago did you first start working for [IF C1 = 1, THEN FILL
CL_CompanyName FROM SAMPLE LOAD, ELSE FILL C2]?
PROBE: Your best estimate would be fine.
|
|
| YEARS AND/OR MONTHS |
YEARS
(01-50)
|
|
MONTHS
(01-12)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C8.
According to our records, [fill JOB SEPARATION DATE] was the last date that you
worked at [IF C1 = 1, THEN FILL CL CompanyName FROM SAMPLE LOAD, ELSE
FILL C2] before you applied for unemployment insurance benefits in [fill INITIAL CLAIM
DATE]? Is that correct?
YES ............................................................................. 01 (C9)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(C8=00, d OR r)
C8a.
In what month and year did your job at [IF C1 = 1, THEN FILL CL_CompanyName
FROM SAMPLE LOAD, ELSE FILL C2] end?
INTERVIEWER: DATE SHOULD USUALLY BE BEFORE INITIAL CLAIM DATE, BUT MAY
NOT BE IF STATE ALLOWS BENEFITS FOR PART-TIME WORKERS.
INTERVIEWER: IF RESPONDENT SAYS HOURS WERE REDUCED, SAY: Please tell me
the date your reduced hours started.
| | |/|
MONTH
(01-12)
| | |
YEAR
|
(2005-2010)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
CATI: NEED SOFT EDIT IF C8a MONTH AND YEAR IS AFTER INITIAL UI CLAIM DATE IN
B1, OR AFTER RESPONDENT PROVIDED UI CLAIM DATE IN B2.
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C9.
Did you work continuously at [fill COMPANY NAME] from the time you began working
there or were there periods when you were not working for [fill COMPANY NAME]
because you were laid off without pay?
INTERVIEWER: CONSIDER UNPAID ABSENCES OF TWO WEEKS OR MORE AS
NONCONTINUOUS EMPLOYMENT. PAID VACATIONS, SICK TIME,
DISABILITY, AND STRIKES ARE NOT BREAKS IN EMPLOYMENT.
YES, CONTINUOUSLY ............................................... 01 (C11)
NO, NOT CONTINUOUSLY ......................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C10.
In general, were you laid off from [fill COMPANY NAME FROM PRELOADS OR C2]
on a regular basis—for example, for a few weeks at about the same time each year?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C11.
How many hours per week, including regular overtime hours, did you usually work on
that job?
|
| | HOURS PER WEEK (C12)
(1-80)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(C11= d OR r)
C11a. Would you say you worked less than 20 hours per week, between 20 and 29 hours per
week, between 30 and 39 hours per week, or 40 or more hours per week?
LESS THAN 20 HOURS PER WEEK........................... 01
BETWEEN 20 AND 29 HOURS PER WEEK ............... 02
BETWEEN 30 AND 39 HOURS PER WEEK ............... 03
40 OR MORE HOURS PER WEEK ............................. 04
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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C12. What (was/is) your usual pay, including tips, bonuses and commissions at this job before
taxes or other deductions (were/are) taken?
PROBE: Your best estimate is fine.
INTERVIEWER: ACCEPT MOST CONVENIENT PAY PERIOD. IF NECESSARY,
CONFIRM PAY PERIOD.
PROBE IF BACK TO WORK AT SEPARATING JOB: What was your rate of pay when
you lost the job just before you filed for unemployment benefits?
$|
|
|
|,|
|
|
|.|
|
|
PER HOUR .................................................................. 01
PER WEEK .................................................................. 02
ONCE EVERY TWO WEEKS ...................................... 03
TWICE A MONTH ........................................................ 04
PER MONTH ............................................................... 05
PER YEAR................................................................... 06
IN-KIND ONLY............................................................. 07
PER DAY ..................................................................... 08
PER JOB ..................................................................... 09
COMMISSION ............................................................. 10
OTHER (SPECIFY) [specify] ........................................ 11
GO TO C13
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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(C12a)
(C12a)
(C12= d OR r)
C12a. Please try to estimate your annual pay at [fill EMPLOYER FROM PRELOADS OR C2].
Would you say your annual earnings (are/were) less than $30,000 or $30,000 or more?
LESS THAN $30,000 ................................................... 01 GO TO C12c
$30,000 OR MORE ...................................................... 02 GO TO C12b
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(C12a= 02)
C12b. Would you say it was…
$30,000 to under $45,000, ........................................... 01
$45,000 to under $60,000, ........................................... 02
$60,000 to under $75,000, ........................................... 03
$75,000 to under $90,000, ........................................... 04
$90,000 to under $105,000, or ..................................... 05
$105,000 or more?....................................................... 06
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO C13
(C12a= 01)
C12c. Would you say it was…
Less than $5,000, ........................................................ 01
$5,000 to under $10,000, ............................................. 02
$10,000 to under $15,000, ........................................... 03
$15,000 to under $20,000, ........................................... 04
$20,000 to under $25,000, or ....................................... 05
$25,000 to under $30,000? .......................................... 06
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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GO TO C13
GO TO C13
C13.
Was [fill a-c] available to you through your job at [fill EMPLOYER FROM PRELOADS
OR C2]?
INTERVIEWER: CODE “YES” IF AVAILABLE, BUT NOT USED.
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. Health insurance or membership in an HMO or
PPO plan? ...............................................................
01
00
d
r
b. Paid vacation? .........................................................
01
00
d
r
c. Retirement or pension benefits? ..............................
01
00
d
r
IF C13a NE 01, GO TO C15
(C13a=01)
C14.
Did you have health insurance through your job with [fill EMPLOYER FROM
PRELOADS OR C2] when that job ended in [fill JOB SEPARATION DATE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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C15.
What was the main reason your job at [fill EMPLOYER FROM PRELOADS OR C2]
ended? Was it because…
CODE ONE ONLY
you were laid off, .......................................................... 01 (C16)
(INCLUDE / REORGANIZATION/ DOWNSIZING/
COMPANY SOLD/ COMPANY MOVED/ COMPANY
WENT OUT OF BUSINESS / PLANT OR FACILITY
MOVED OR CLOSED/ END OF TERM IN SERVICE/
ENLISTMENT UP/ REDUCTION IN FORCE OR RIF’ED/
JOB/POSITION ELIMINATED)
you retired, ................................................................... 02 (C20)
you were discharged or fired, ....................................... 03 (D1)
you quit, ....................................................................... 04 (C19)
Or was there some other reason? (SPECIFY) ............. 05 (D1)
YOU GOT A BETTER JOB .......................................... 06 (D1)
YOU MOVED ............................................................... 07 (C19)
YOU HAD HEALTH PROBLEMS ................................. 08 (D1)
YOU RETURNED TO SCHOOL .................................. 09 (D1)
YOU NEEDED TO TAKE CARE OF A FAMILY
MEMBER ..................................................................... 10 (D1)
JOB COMPLETED/TEMP WORK/SEASONAL
WORK/WORK PERIOD ENDED .................................. 11 (C16)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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(C15=01)
C16.
What was the main reason that you were laid off in [fill JOB SEPARATION DATE]?
CODE ONE ONLY
THE COMPANY MOVED OR CLOSED ....................... 01
THE PLANT OR FACILITY MOVED OR CLOSED....... 02
THERE WAS A LACK OF WORK ................................ 03
YOUR JOB OR SHIFT WAS ELIMINATED .................. 04
THERE WAS A STRIKE .............................................. 05
COMPANY DOWNSIZING........................................... 06
COMPANY BOUGHT/SOLD/MERGED OR
REORGANIZED/ RESTRUCTURED ........................... 07
OUTSOURCED/JOB SENT OVERSEAS ..................... 08
THE RECESSION........................................................ 09
WEATHER ................................................................... 10
TEMPORARILY CLOSED/CLOSED FOR
INVENTORY ................................................................ 11
POOR WORK PERFORMANCE .................................. 12
DISPUTE WITH MANAGEMENT ................................. 13
COMPANY FINANCES/BUDGET CUTS/
BANKRUPT ................................................................. 14
TEMPORARY WORKER ............................................. 15
EMPLOYER SAID RESPONDENT COULD NOT
DO JOB ANYMORE, OR ............................................. 16
SOME OTHER REASON? (SPECIFY) [specify] .......... 17
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
C17.
At the time that you were laid off from [fill EMPLOYER FROM PRELOADS OR C2], did
you expect the layoff to be temporary – that is did you think you would be recalled?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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C18.
Did you actually go back to your job at [fill EMPLOYER FROM PRELOADS OR C2]
(IF C17 = 00, d, or r SAY: anyway)?
PROBE: Since [fill INITIAL UI CLAIM DATE].
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO D1
C19.
What was the main reason that you [fill quit/moved FROM C15]?
CODE ONLY ONE
YOUR ILL HEALTH OR DISABILITY ........................... 01
THE ILLNESS OR INJURY OF AN IMMEDIATE
FAMILY MEMBER ....................................................... 02
CHILD CARE RESPONSIBILITIES .............................. 03
OTHER FAMILY RESPONSIBILITIES ......................... 04
TO ACCOMPANY SPOUSE OR PARTNER TO A
NEW JOB .................................................................... 05
OTHER PERSONAL REASONS.................................. 06
YOU MOVED AWAY FOR ANOTHER REASON ......... 07
UNSATISFACTORY WORKING
ARRANGEMENTS OR YOU DISLIKED THE JOB ....... 08
YOU KNEW THE PLANT OR COMPANY WAS
GOING TO CLOSE OR MOVE .................................... 09
COMMUTING BECAME TOO DIFFICULT OR
EXPENSIVE ................................................................ 10
YOU WENT BACK TO SCHOOL ................................. 11
SOME OTHER REASON? (SPECIFY) [specify] .......... 12
DID NOT GET ALONG WITH SUPERVISOR .............. 13
DANGEROUS WORKING CONDITIONS .................... 14
FOUND BETTER JOB ................................................. 15
DID NOT MAKE ENOUGH MONEY............................. 16
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO D1
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C20.
What was the main reason you retired?
CODE ONE ONLY
YOU REACHED RETIREMENT AGE OR YEARS
ON JOB REQUIREMENT ............................................ 01
YOUR ILL HEALTH OR DISABILITY ........................... 02
THE ILLNESS OR INJURY OF AN IMMEDIATE
FAMILY MEMBER ....................................................... 03
CHILD CARE RESPONSIBILITIES .............................. 04
OTHER FAMILY RESPONSIBILITIES ......................... 05
TO ACCOMPANY SPOUSE OR PARTNER TO A
NEW JOB .................................................................... 06
OTHER PERSONAL REASONS.................................. 07
YOU MOVED AWAY FOR OTHER REASONS ........... 08
UNSATISFACTORY WORKING
ARRANGEMENTS OR YOU DISLIKED THE JOB ....... 09
YOU KNEW THE PLANT OR COMPANY WAS
GOING TO CLOSE OR MOVE .................................... 10
COMMUTING BECAME TOO DIFFICULT OR
EXPENSIVE ................................................................ 11
YOU WENT BACK TO SCHOOL, ................................ 12
SOME OTHER REASON (SPECIFY) [specify] ............ 13
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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SECTION D – POST CLAIM WORK SEARCH ACTIVITIES
D1.
Now, please think about what you may have done to look for work shortly after you first
began receiving unemployment benefits in [fill INITIAL UI CLAIM DATE]. Did you begin
to look for work within the first three months after your job ended?
YES ............................................................................. 01
NO ............................................................................... 00 (D4)
DON’T KNOW .............................................................. d (D4)
REFUSED.................................................................... r
D2.
(D4)
And during those first three months after your job ended, about how many hours did you
spend each week, on average, looking for work?
PROBE: Your best estimate is fine.
| | | HOURS PER WEEK (D3)
(1-80)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(D2=d OR r)
D2a.
Would you say you spent between…
CODE ONE ONLY
1 and 5 hours per week,............................................... 01
6 and 10 hours per week,............................................. 02
11 and 20 hours per week,........................................... 03
21 and 30 hours per week,........................................... 04
31 and 40 hours per week, or....................................... 05
more than 40 hours per week?..................................... 06
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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D3.
I’m going to read a list of things people sometimes do when looking for work. Please tell
me whether you did any of these things during the first three months after your job with
[fill EMPLOYER FROM PRELOADS OR C2] ended. Did you…
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. contact a private employment or placement
agency? ....................................................................
01
00
d
r
b. contact [fill STATE ONE-STOP CENTER NAME]?....
01
00
d
r
c. contact another state employment or unemployment
center? ......................................................................
01
00
d
r
d. contact another government agency? .......................
01
00
d
r
e. contact a school, training provider, college or
university? .................................................................
01
00
d
r
f.
01
00
d
r
g. contact your union? ...................................................
01
00
d
r
h. register online for job matching, job placement, or
networking services? .................................................
01
00
d
r
i.
contact personal or professional associates? ............
01
00
d
r
j.
use some other source? (SPECIFY) [specify] ...........
01
00
d
r
contact your former employer? ..................................
(C5 = 01)
_________________________________________
PROGRAMMER: IF D3a THROUGH D3i = 00, d, OR r, OR IF THERE IS ONLY ONE YES AT
D3, GO TO D5.
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D3a.
Of the things you did to look for work during the first three months after your job ended,
which one did you do most often in your job search?
PROGRAMMER: SHOW ONLY THE CATEGORIES CHECKED AT D3.
CODE ONE ONLY
CONTACTED A PRIVATE EMPLOYMENT OR
PLACEMENT AGENCY .............................................. 01
CONTACTED [FILL STATE ONE-STOP
CENTER NAME] .......................................................... 02
CONTACTED ANOTHER STATE EMPLOYMENT
OR UNEMPLOYMENT CENTER ................................. 03
CONTACTED ANOTHER GOVERNMENT
AGENCY ..................................................................... 04
CONTACTED A SCHOOL, TRAINING
PROVIDER, COLLEGE OR UNIVERSITY ................... 05
CONTACTED YOUR FORMER EMPLOYER .............. 06
CONTACTED YOUR UNION ....................................... 07
REGISTERED ONLINE FOR JOB MATCHING, JOB
PLACEMENT, OR NETWORKING SERVICE .............. 08
CONTACTED PERSONAL OR PROFESSIONAL
ASSOCIATES .............................................................. 09
USED SOME OTHER SOURCE
(SPECIFY) [specify] ..................................................... 10
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO D5
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D4.
What is the main reason you did not look for work in the first three months after your job
with [fill EMPLOYER FROM PRELOADS OR C2] ended?
CODE ONE ONLY
EXPECTED NEW JOB TO START .............................. 01
DID NOT WANT TO WORK/DID NOT WANT TO
LOOK FOR WORK ...................................................... 02
BELIEVES NO WORK AVAILABLE IN LINE OF
WORK OR AREA......................................................... 03
COULDN’T FIND ANY WORK ..................................... 04
EXPECTED TO BE CALLED BACK TO JOB (NO
SPECIFIC DATE)......................................................... 05
ON STANDBY WITH EMPLOYER—HAS A
SPECIFIC CALLBACK DATE ...................................... 06
EXPECTED UNION TO PROVIDE JOB ...................... 07
MOVED OR MOVING .................................................. 08
STARTED OWN BUSINESS/SELF-EMPLOYED ......... 09
LACKS NECESSARY SCHOOLING, TRAINING,
SKILLS OR EXPERIENCE .......................................... 10
RETIRED ..................................................................... 11
EMPLOYERS THINK TOO YOUNG OR TOO OLD ..... 12
OTHER TYPES OF DISCRIMINATION ....................... 13
CAN’T ARRANGE CHILD CARE ................................. 14
FAMILY RESPONSIBILITIES ...................................... 15
IN SCHOOL OR OTHER TRAINING............................ 16
ILL HEALTH OR PHYSICAL DISABILITY .................... 17
PREGNANCY .............................................................. 18
TRANSPORTATION PROBLEMS ............................... 19
STILL WORKING PART-TIME/WORKING PARTTIME WHILE COLLECTING UI BENEFITS.................. 20
OTHER (SPECIFY) [specify] ........................................ 21
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO E1
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D5.
Did any of the things you did to look for work during the first three months after your job
ended lead to specific referrals for job openings that matched your skills?
YES ............................................................................. 01
NO ............................................................................... 00 (E1)
D6.
DON’T KNOW .............................................................. d
(E1)
REFUSED.................................................................... r
(E1)
Did you follow up on any of these referrals?
YES ............................................................................. 01
NO ............................................................................... 00 (E1)
D7.
DON’T KNOW .............................................................. d
(E1)
REFUSED.................................................................... r
(E1)
Did you actually start work for any of those employers?
YES ............................................................................. 01
NO, BUT HAS A START DATE.................................... 02
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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SECTION E – EDUCATION AND TRAINING PROGRAMS
E1.
Now I’d like to ask you about school, education, and job training programs and courses
in which you may have participated.
First, what was the highest level of school you had completed or the highest degree you
had received at the time your job at [fill NAME OF COMPANY FROM PRELOADS OR
C2] ended?
PROBE: How far did you go in school?
CODE ONE ONLY
LESS THAN 1ST GRADE ............................................ 01
1ST, 2ND, 3RD OR 4TH GRADE ................................ 02
5TH OR 6TH GRADE .................................................. 03
7TH OR 8TH GRADE .................................................. 04
9TH GRADE ................................................................ 05
10TH GRADE .............................................................. 06
11TH GRADE .............................................................. 07
12TH GRADE NO DIPLOMA ....................................... 08
HIGH SCHOOL GRADUATE, HIGH SCHOOL
DIPLOMA OR THE EQUIVALENT (FOR
EXAMPLE: GED) ......................................................... 09
SOME COLLEGE BUT NO DEGREE .......................... 10
ASSOCIATE DEGREE IN COLLEGE
OCCUPATIONAL/VOCATIONAL PROGRAM.............. 11
ASSOCIATE DEGREE IN COLLEGE ACADEMIC
PROGRAM .................................................................. 12
BACHELOR'S DEGREE (FOR EXAMPLE:
BA, AB, BS) ................................................................. 13
MASTER'S DEGREE (FOR EXAMPLE: MA, MS,
MENG, MED, MSW, MBA) ........................................... 14
PROFESSIONAL SCHOOL DEGREE (FOR
EXAMPLE: MD, DDS, DVM, LLB, JD) ......................... 15
DOCTORATE DEGREE (FOR EXAMPLE:
PhD, EDD) ................................................................... 16
OTHER (SPECIFY) [specify] ........................................ 17
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
36
E1a.
Since your job at [IF C1 = 1, THEN FILL CL_CompanyName FROM SAMPLE LOAD,
ELSE FILL C2] ended, have you participated in any education and training programs
and courses? Please include training programs that helped you learn job skills or
prepare for an occupation, as well as general educational programs, such as college,
regular high school, or GED courses.
YES ............................................................................. 01
NO ............................................................................... 00 (F1)
DON’T KNOW .............................................................. d
(F1)
REFUSED.................................................................... r
(F1)
(E1a=01)
E2.
How many different education and training programs have you participated in since
[fill INITIAL UI CLAIM DATE]?
IF MORE THAN ONE, PROBE: Were these separate programs or different courses for
the same program?
| | |
(01-99)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(E1a=01)
E2a.
Are you currently participating in (this/any of these) program(s)?
YES ............................................................................. 01
NO ............................................................................... 00 (E3a)
DON’T KNOW .............................................................. d
(E3a)
REFUSED.................................................................... r
(E3a)
(E2a=01 AND E2>01)
E2b.
In how many training and education programs are you currently participating?
| | |
(01-99)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
37
ASK E3, E3a, AND E4 ACROSS
FIRST, THEN ASK E5-E18 FOR
EACH SELECTED PROGRAM
ONLY.
#1
TRAINING PROGRAM
#2
TRAINING PROGRAM
#3
TRAINING PROGRAM
(E2a=01)
E3.
What (is/are) the name(s)
of (the program(s) in which
you are currently
participating?
ENTER UP TO 3
CURRENT PROGRAMS,
MATCHING NUMBER AT
E2b.
(E2a=00, d or r OR E2> 1
PROGRAMS ENTERED AT E3)
E3a. (In addition to the
program(s) in which you
are currently participating)
What (is/are) the name(s)
of the (other) program(s) in
which have participated
since [fill INITIAL UI CLAIM
DATE]?
ENTER UP TO 3 NONCURRENT PROGRAMS,
MATCHING NUMBER AT
E2 MINUS E2b.
E4.
What is the length of
[fill PROGRAM NAME];
that is, how long would you
have to participate in
[fill PROGRAM NAME] to
get through the full
program?
PROBE: Please tell me the
full program length even if
you (did/have) not
participate(d) for the full
time.
E4ck.
|
|
|.|
|
|
CODE ONE ONLY
|
|.|
|
CODE ONE ONLY
|
|
|.|
|
CODE ONE ONLY
DAYS………………………….01
DAYS………………………….01
DAYS………………………….01
WEEKS ............................... 02
WEEKS ................................ 02
WEEKS ............................... 02
MONTHS ............................. 03
MONTHS ............................. 03
MONTHS ............................. 03
YEARS ................................ 04
YEARS ................................. 04
YEARS ................................ 04
DON’T KNOW ....................... d
DON’T KNOW ........................ d
DON’T KNOW ....................... d
REFUSED .............................. r
REFUSED ...............................r
REFUSED .............................. r
CATI: SELECT (1) THE LONGEST CURRENT PROGRAM AND (2) THE LONGEST PROGRAM,
CURRENT OR NON-CURRENT, WHICH WE HAVEN’T ALREADY ASKED ABOUT. WE SHOULD
ASK ABOUT A MAXIMUM OF TWO PROGRAMS. IF THERE ARE NO CURRENT PROGRAMS,
THEN WE WILL WANT TO ASK ONLY ABOUT THE LONGEST NON-CURRENT PROGRAM
(I.E., ONE PROGRAM), EVEN IF THERE ARE 2 OR MORE NON-CURRENT PROGRAMS.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
38
ASK E3, E3a, AND E4 ACROSS
FIRST, THEN ASK E5-E18 FOR
EACH SELECTED PROGRAM
ONLY.
#4
TRAINING PROGRAM
#5
TRAINING PROGRAM
#6
TRAINING PROGRAM
(E2a=01)
E3.
What (is/are) the name(s)
of (the program(s) in which
you are currently
participating?
ENTER UP TO 3
CURRENT PROGRAMS,
MATCHING NUMBER AT
E2b.
(E2a=00, d or r OR E2> 1
PROGRAMS ENTERED AT E3)
E3a. (In addition to the
program(s) in which you
are currently participating)
What (is/are) the name(s)
of the (other) program(s) in
which you have
participated since [fill
INITIAL UI CLAIM DATE]?
ENTER UP TO 3 NONCURRENT PROGRAMS,
MATCHING NUMBER AT
E2 MINUS E2b.
E4.
What is the length of
[fill PROGRAM NAME];
that is, how long would you
have to participate in
[fill PROGRAM NAME] to
get through the full
program?
PROBE: Please tell me the
full program length even if
you (did/have) not
participate(d) for the full
time.
E4ck.
|
|
|.|
|
|
CODE ONE ONLY
|
|.|
|
CODE ONE ONLY
|
|
|.|
|
CODE ONE ONLY
DAYS………………………….01
DAYS………………………….01
DAYS………………………….01
WEEKS ............................... 02
WEEKS ................................ 02
WEEKS ............................... 02
MONTHS ............................. 03
MONTHS ............................. 03
MONTHS ............................. 03
YEARS ................................ 04
YEARS ................................. 04
YEARS ................................ 04
DON’T KNOW ....................... d
DON’T KNOW ........................ d
DON’T KNOW ....................... d
REFUSED .............................. r
REFUSED ...............................r
REFUSED .............................. r
CATI: SELECT (1) THE LONGEST CURRENT PROGRAM AND (2) THE LONGEST PROGRAM,
CURRENT OR NON-CURRENT, WHICH WE HAVEN’T ALREADY ASKED ABOUT. WE SHOULD
ASK ABOUT A MAXIMUM OF TWO PROGRAMS. IF THERE ARE NO CURRENT PROGRAMS,
THEN WE WILL WANT TO ASK ONLY ABOUT THE LONGEST NON-CURRENT PROGRAM
(I.E., ONE PROGRAM), EVEN IF THERE ARE 2 OR MORE NON-CURRENT PROGRAMS.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
39
ASK E3, E3a, AND E4 ACROSS
FIRST, THEN ASK E5-E18 FOR
EACH SELECTED PROGRAM
ONLY.
#7
TRAINING PROGRAM
#8
TRAINING PROGRAM
#9
TRAINING PROGRAM
(E2a=01)
E3.
What (is/are) the name(s)
of (the program(s) in which
you are currently
participating?
ENTER UP TO 3
CURRENT PROGRAMS,
MATCHING NUMBER AT
E2b.
(E2a=00, d or r OR E2> 1
PROGRAMS ENTERED AT E3)
E3a. (In addition to the
program(s) in which you
are currently participating)
What (is/are) the name(s)
of the (other) program(s) in
which you have
participated since [fill
INITIAL UI CLAIM DATE]?
ENTER UP TO 3 NONCURRENT PROGRAMS,
MATCHING NUMBER AT
E2 MINUS E2b.
E4.
What is the length of
[fill PROGRAM NAME];
that is, how long would you
have to participate in
[fill PROGRAM NAME] to
get through the full
program?
PROBE: Please tell me the
full program length even if
you (did/have) not
participate(d) for the full
time.
E4ck.
|
|
|.|
|
|
CODE ONE ONLY
|
|.|
|
CODE ONE ONLY
|
|
|.|
|
CODE ONE ONLY
DAYS………………………….01
DAYS………………………….01
DAYS………………………….01
WEEKS ............................... 02
WEEKS ................................ 02
WEEKS ............................... 02
MONTHS ............................. 03
MONTHS ............................. 03
MONTHS ............................. 03
YEARS ................................ 04
YEARS ................................. 04
YEARS ................................ 04
DON’T KNOW ....................... d
DON’T KNOW ........................ d
DON’T KNOW ....................... d
REFUSED .............................. r
REFUSED ...............................r
REFUSED .............................. r
CATI: SELECT (1) THE LONGEST CURRENT PROGRAM AND (2) THE LONGEST PROGRAM,
CURRENT OR NON-CURRENT, WHICH WE HAVEN’T ALREADY ASKED ABOUT. WE SHOULD
ASK ABOUT A MAXIMUM OF TWO PROGRAMS. IF THERE ARE NO CURRENT PROGRAMS,
THEN WE WILL WANT TO ASK ONLY ABOUT THE LONGEST NON-CURRENT PROGRAM (I.E.
ONE PROGRAM), EVEN IF THERE ARE 2 OR MORE NON-CURRENT PROGRAMS.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
40
ASK E5-E18 FOR EACH SELECTED PROGRAM.
E5.
In what month and year did you start attending
[fill PROGRAM]?
FOR PROGRAM 2, SAY: Now I’m going to ask
you about [fill SELECTED PROGRAM 2
NAME].
(E5=d OR r)
E6. Do you recall what year you started attending
[fill PROGRAM] program after [fill INITIAL UI
CLAIM DATE]?
E6a. Are you still attending [fill PROGRAM NAME]?
E7.
And when did you stop attending (the/that)
program?
PROBE: In what month and year?
|
#1
SELECTED TRAINING PROGRAM
#2
SELECTED TRAINING PROGRAM
NAME:_________________________
NAME:_________________________
|
|/ |
E9.
How many hours per week (did/do) you
participate in [fill PROGRAM NAME]?
PROBE: Do not include time spent outside
of class studying or doing homework, only
time attending class should be included.
|
|
| [GO TO E6a]
|
YEAR
|
|/ |
|
MONTH
|
|
| [GO TO E6a]
YEAR
DON’T KNOW ....................................... d
DON’T KNOW ...................................... d
REFUSED.............................................. r
REFUSED ............................................. r
|
| | | | YEAR
(2005-2013)
DON’T KNOW ....................................... d
REFUSED.............................................. r
| | | | YEAR
(2005-2013)
DON’T KNOW ...................................... d
REFUSED ............................................. r
YES ................... [GO TO E8a] ............... 01
YES ...................[GO TO E8a]................ 01
NO .......................................................... 00
|
NO .......................................................... 00
DON’T KNOW .......................................... d
DON’T KNOW .......................................... d
REFUSED.............................................. r
REFUSED ............................................. r
|
|
|
|/|
|
MONTH
|
|
| [GO TO E9]
YEAR
|
|
|/|
|
MONTH
DON’T KNOW ....................................... d
REFUSED.............................................. r
(E7= d OR r)
E8. Do you recall what year you stopped attending
(the/that) program?
(E2a=01 OR E7=02)
E8a. When do you expect to complete this program?
|
MONTH
|
|
| [GO TO E9]
YEAR
DON’T KNOW ...................................... d
REFUSED ............................................. r
| | | | YEAR
(2006-2013)
|
| | | | YEAR
(2006-2013)
DON’T KNOW ....................................... d
REFUSED.............................................. r
[GO TO E9]
DON’T KNOW ...................................... d
REFUSED ............................................. r
[GO TO E9]
|
|
|
|/|
MONTH
|
|
|
YEAR
|
|
|/|
MONTH
|
|
|
YEAR
|
DON’T KNOW .......................................... d
DON’T KNOW .......................................... d
REFUSED ................................................. r
REFUSED ................................................. r
|
|
| HOURS PER WEEK
|
|
| HOURS PER WEEK
DON’T KNOW .......................................... d
DON’T KNOW .......................................... d
REFUSED ................................................. r
REFUSED ................................................. r
YES, ALL OF THE TIME......................... 01
YES, ALL OF THE TIME ......................... 01
YES, SOME OF THE TIME .................... 02
YES, SOME OF THE TIME..................... 02
NO .......................................................... 00
NO .......................................................... 00
DON’T KNOW .......................................... d
DON’T KNOW .......................................... d
REFUSED.............................................. r
REFUSED ............................................. r
IF RESPONDENT SAYS THEY TOOK
ONLINE CLASSES, PROBE: Please include
only the time you spent online actually
taking classes. Do not include time you
spent studying or doing homework.
E9a. (Are/Were) you employed while participating in
[fill PROGRAM NAME]?
PROBE IF YES: Was that for all of the time or
some of the time?
E9b. What kind of job (are/were) you being trained
for or what (are/were) you learning to do or
studying in that program?
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
41
#1
#2
TRAINING PROGRAM
TRAINING PROGRAM
ASK E5-E18 FOR EACH SELECTED PROGRAM.
E10. At what type of place (do/did) you go to get
that training?
(READ CHOICES IF NECESSARY)
E11. (Are/Were) you collecting unemployment
insurance benefits while participating in
[fill PROGRAM]?
PROBE IF YES: Was that for all of the time or
some of the time?
CODE ONE ONLY
COMMUNITY COLLEGE/ 2 YEAR
COLLEGE ................................................01
4 YEAR COLLEGE OR UNIVERSITY...... 02
4 YEAR COLLEGE OR UNIVERSITY ......02
STATE UNEMPLOYMENT OR
EMPLOYMENT OFFICE.......................... 03
STATE UNEMPLOYMENT OR
EMPLOYMENT OFFICE ..........................03
STATE/LOCAL ONE-STOP CENTER ..... 04
STATE/LOCAL ONE-STOP CENTER ......04
VOCATIONAL TRAINING CENTER ........ 05
VOCATIONAL TRAINING CENTER.........05
ADULT ED/COMMUNITY
SCHOOL/ADULT HS/NIGHT SCHOOL ... 06
ADULT ED/COMMUNITY
SCHOOL/ADULT HS/NIGHT SCHOOL ...06
PRIVATE COMPANY THAT PROVIDES
TRAINING (SPECIFY) [specify] ............... 07
PRIVATE COMPANY THAT PROVIDES
TRAINING (SPECIFY) [specify] ...............07
COMMUNITY BASED ORGANIZATION
OR OTHER NON-PROFIT PRIVATE
AGENCY ................................................. 08
COMMUNITY BASED ORGANIZATION
OR OTHER NON-PROFIT PRIVATE
AGENCY .................................................08
THE COMPANY WHERE YOU
WORK(ED) .............................................. 09
THE COMPANY WHERE YOU
WORK(ED) ..............................................09
ONLINE ................................................... 10
ONLINE ...................................................10
GOVERNMENT AGENCY/MILITARY ...... 11
GOVERNMENT AGENCY/MILITARY ......11
SOME PLACE ELSE (SPECIFY)
[specify] ................................................... 12
SOME PLACE ELSE (SPECIFY)
[specify] ...................................................12
DON’T KNOW ........................................... d
DON’T KNOW ............................................d
REFUSED .................................................. r
REFUSED ................................................. r
YES, ALL OF THE TIME.......................... 01
YES, ALL OF THE TIME ..........................01
YES, SOME OF THE TIME ..................... 02
YES, SOME OF THE TIME ......................02
NO ........................................................... 00
NO ...........................................................00
DON’T KNOW ........................................... d
DON’T KNOW ............................................d
REFUSED .................................................. r
REFUSED ................................................. r
CODE ALL THAT APPLY
E12. Who (pays/paid) for this training?
PROBE: Anyone else?
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
CODE ONE ONLY
COMMUNITY COLLEGE/ 2 YEAR
COLLEGE ............................................... 01
CODE ALL THAT APPLY
SAMPLE MEMBER/SAMPLE
MEMBER’S FAMILY ................................ 01
SAMPLE MEMBER/SAMPLE
MEMBER’S FAMILY ................................01
STATE UNEMPLOYMENT/
EMPLOYMENT OFFICE/ ONE STOP
CAREER CENTER/ WIA/INDIVIDUAL
TRAINING ACCOUNT (ITA) VOUCHER.. 02
STATE UNEMPLOYMENT/
EMPLOYMENT OFFICE/ ONE STOP
CAREER CENTER/ WIA/INDIVIDUAL
TRAINING ACCOUNT (ITA) VOUCHER ..02
OTHER GOVERNMENT/STATE
AGENCY ................................................. 03
OTHER GOVERNMENT/STATE
AGENCY .................................................03
TRADE ADJUSTMENT ASSISTANCE
(TAA) OR TRADE READJUSTMENT
ALLOWANCE (TRA) BENEFITS ............. 04
TRADE ADJUSTMENT ASSISTANCE
(TAA) OR TRADE READJUSTMENT
ALLOWANCE (TRA) BENEFITS ..............04
CURRENT OR FORMER EMPLOYER .... 05
CURRENT OR FORMER EMPLOYER ....05
PELL GRANT .......................................... 06
PELL GRANT ..........................................06
UNION..................................................... 07
UNION .....................................................07
PRIVATE ORGANIZATION OR
SCHOLARSHIP FUND ............................ 08
PRIVATE ORGANIZATION OR
SCHOLARSHIP FUND ............................08
DEPARTMENT OF VETERANS
DEPARTMENT OF VETERANS
AFFAIRS (VA) ......................................... 09
AFFAIRS (VA) .........................................09
FREE....................................................... 10
FREE .......................................................10
OTHER? (SPECIFY) [specify].................. 11
OTHER? (SPECIFY) [specify] ..................11
DON’T KNOW ........................................... d
DON’T KNOW ............................................d
REFUSED .................................................. r
REFUSED ................................................. r
42
#1
#2
TRAINING PROGRAM
TRAINING PROGRAM
ASK E5-E18 FOR EACH SELECTED PROGRAM.
(E6a=00, d or r)
E13. Did you complete [fill PROGRAM NAME]?
E14. (Was/Is) [fill PROGRAM NAME] supposed to
lead to a license, degree, or certificate?
(E14=01, 02, or 03)
E15. Did you receive the [fill LICENSE, DEGREE,
CERTIFICATE FROM E14] for participating in
[fill PROGRAM NAME]?
(E13 NE 01)
E16. What was the main reason that you stopped
attending [fill PROGRAM NAME]?
CODE ONE ONLY
E17. Did you get a job as a direct result of
participating in [fill PROGRAM NAME] either
through a direct referral from the program or
because of the skills you learned?
E18. PROGRAMMER: WAS ANOTHER
PROGRAM SELECTED?
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
YES......................................................... 01
YES......................................................... 01
NO .......................................................... 00
NO .......................................................... 00
NO SPECIFIC COMPLETION ................. 02
NO SPECIFIC COMPLETION ................. 02
DON’T KNOW ........................................... d
DON’T KNOW ........................................... d
REFUSED .................................................. r
YES, LICENSE........................................ 01
REFUSED .................................................. r
YES, LICENSE........................................ 01
YES. DEGREE ........................................ 02
YES. DEGREE ........................................ 02
YES, CERTIFICATE................................ 03
YES, CERTIFICATE................................ 03
NO ...........................[GO TO E16].......... 00
NO ...........................[GO TO E16].......... 00
DON’T KNOW .......... [GO TO E16]............ d
DON’T KNOW .......... [GO TO E16]............ d
REFUSED ................ [GO TO E16]............. r
REFUSED ................ [GO TO E16]............. r
YES......................................................... 01
YES......................................................... 01
NO .......................................................... 00
NO .......................................................... 00
DON’T KNOW ........................................... d
DON’T KNOW ........................................... d
REFUSED .................................................. r
FOUND JOB/RE-EMPLOYED ................. 01
REFUSED .................................................. r
FOUND JOB/RE-EMPLOYED ................. 01
COULDN’T AFFORD TO CONTINUE ..... 02
COULDN’T AFFORD TO CONTINUE ..... 02
NOT INTERESTED/DIDN’T LIKE
PROGRAM ............................................. 03
NOT INTERESTED/DIDN’T LIKE
PROGRAM ............................................. 03
ILLNESS ................................................. 04
ILLNESS ................................................. 04
PREGNANCY ......................................... 05
PREGNANCY ......................................... 05
CHILD CARE ISSUES ............................ 06
CHILD CARE ISSUES ............................ 06
OTHER FAMILY REASONS.................... 07
OTHER FAMILY REASONS.................... 07
TRANSPORTATION/LOGISTICAL
PROBLEMS ............................................ 08
TRANSPORTATION/LOGISTICAL
PROBLEMS ............................................ 08
PERSONAL PROBLEMS ........................ 09
PERSONAL PROBLEMS ........................ 09
POOR GRADES ..................................... 10
POOR GRADES ..................................... 10
COURSES OR PROGRAM POORLY
TAUGHT ................................................. 11
COURSES OR PROGRAM POORLY
TAUGHT ................................................. 11
DIDN’T THINK IT WOULD HELP ME
FIND A JOB ............................................ 12
DIDN’T THINK IT WOULD HELP ME
FIND A JOB ............................................ 12
STARTED OTHER SCHOOL/
TRAINING ............................................... 13
STARTED OTHER SCHOOL/
TRAINING ............................................... 13
DECIDED DIDN’T WANT JOB ................ 14
DECIDED DIDN’T WANT JOB ................ 14
STILL ATTENDING ................................. 15
STILL ATTENDING ................................. 15
OTHER (SPECIFY) [specify] ................... 16
OTHER (SPECIFY) [specify] ................... 16
DON’T KNOW ........................................... d
DON’T KNOW ........................................... d
REFUSED .................................................. r
REFUSED .................................................. r
YES......................................................... 01
YES......................................................... 01
NO .......................................................... 00
NO .......................................................... 00
STILL IN PROGRAM................................. n
STILL IN PROGRAM................................. n
DON’T KNOW ........................................... d
DON’T KNOW ........................................... d
REFUSED .................................................. r
REFUSED .................................................. r
YES........... [GO TO E5, PROGRAM 2] ... 01
GO TO E19
NO ............ [GO TO E19] ........................ 00
43
E19.
Did you collect any extra weeks of unemployment insurance benefits because you
participated in a training program?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
44
SECTION F – JOBS SINCE PRE-UI CLAIM JOB,
INCLUDING CURRENT EMPLOYMENT
F1.
The next questions are about the jobs you’ve held since working at [fill COMPANY
NAME FROM PRELOADS OR C2]. First, which of the following best describes your
work-related activities last week? Were you…
CODE ONE ONLY
working at a job for pay, ............................................... 01 (F2)
employed, but on vacation, on leave,
or not at work for other reasons, .................................. 02 (F2)
retired, ......................................................................... 03 (F5)
unable to work because of a disability, ......................... 04 (F5)
attending school or long-term training program, ........... 05 (F5)
unemployed, on a layoff, .............................................. 06 (F1a)
unemployed, looking for work ...................................... 07 (F5)
without a job and not looking for work, or ..................... 08 (F1b)
doing something else? (SPECIFY) [specify] ................. 09 (F1a)
DON’T KNOW .............................................................. d
(F1a)
REFUSED.................................................................... r
(F1a)
(F1=06, 09, d OR r)
F1a.
Were you looking for work last week?
YES ............................................................................. 01 (F5)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
(F5)
REFUSED.................................................................... r
(F5)
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
45
(F1=08 OR F1a = 00, d OR r)
F1b.
What is the main reason that you were not looking for work last week?
CODE ONE ONLY
EXPECTS NEW JOB TO START ................................ 01
DOES NOT WANT TO WORK/DOES NOT
WANT TO LOOK FOR WORK ..................................... 02
BELIEVES NO WORK AVAILABLE IN LINE OF
WORK OR AREA......................................................... 03
CAN’T FIND ANY WORK............................................. 04
EXPECTS TO BE CALLED BACK TO JOB ................. 05 (F1c)
EXPECTS UNION TO PROVIDE JOB ......................... 06
MOVED OR MOVING .................................................. 07
STARTED OWN BUSINESS/SELF-EMPLOYED ......... 08
LACKS NECESSARY SCHOOLING, TRAINING,
SKILLS OR EXPERIENCE .......................................... 09
RETIRED ..................................................................... 10
EMPLOYERS THINK TOO YOUNG OR TOO OLD ..... 11
OTHER TYPES OF DISCRIMINATION ....................... 12
CAN’T ARRANGE CHILD CARE ................................. 13
FAMILY RESPONSIBILITIES ...................................... 14
IN SCHOOL OR OTHER TRAINING............................ 15
ILL HEALTH, PHYSICAL DISABILITY ......................... 16
PREGNANCY .............................................................. 17
TRANSPORTATION PROBLEMS ............................... 18
STILL WORKING PART-TIME/WORKING PARTTIME WHILE COLLECTING UI BENEFITS.................. 19
OTHER (SPECIFY) [specify] ........................................ 20
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO F5
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
Prepared by Mathematica Policy Research
46
(F1b=05)
F1c.
Do you have a definite recall date to return to work?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
GO TO F5
(F1=01 OR 02)
F2.
How many jobs do you currently have?
| | |
(01-10)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(F1=01 OR 02)
F3.
Do you usually work 35 hours or more per week [IF F2 = 1, FILL “at your job,” IF F2 = 2
OR MORE, d, r, FILL “across all of your jobs”]?
YES ............................................................................. 01 (F5)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
F4.
Do you want to work a full-time workweek of 35 hours or more per week?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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47
F5.
(Including your current job(s)), how many different jobs have you had since [fill INITIAL
UI CLAIM DATE FROM PRELOADS IF VERIFIED (B1 =01). IF NOT VERIFIED, FILL
C8a – JOB END DATE OR B2]?
PROBE: How many different jobs have you had since you filed for unemployment
benefits?
INTERVIEWER: TREAT A JOB INTERRUPTED BY TWO OR MORE UNPAID WEEKS
AS SEPARATE JOBS, EVEN IF IT IS WITH THE SAME EMPLOYER.
IF SEPARATION IS LESS THAN TWO WEEKS, TREAT AS ONE
JOB.
| | |
(01-10)
ZERO........................................................................... 00 (G1)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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48
CATI: ALLOW FOR 10 JOBS.
ASK F6 ACROSS FIRST,
THEN ASK F8-F11 FOR
ALL JOBS.
F6.
Please tell me the name of
the companies,
organizations, or people
you’ve worked for since
your job with [fill
COMPANY NAME FROM
SAMPLE IF C1=1, ELSE
fill C2 COMPANY NAME]
ended around [fill INITIAL
UI CLAIM DATE]. Start
with your current job (or
jobs), then the most recent
jobs that you had.
CURRENT JOB - JOB 1
JOB 2
JOB 3
(SPECIFY) [specify] .............. 01
(SPECIFY) [specify] ............. 01
(SPECIFY) [specify] .............. 01
_________________________
_________________________
_________________________
DON’T KNOW ........................ d
DON’T KNOW ........................ d
DON’T KNOW .........................d
REFUSED .............................. r
REFUSED .............................. r
REFUSED...............................r
PROBE: What was the job
before that?
F7.
Let me verify that since [fill
INITIAL UI CLAIM DATE]
you worked at [fill F6
NAMES]. Is this correct, or
are there any other jobs
you may have had?
IF CORRECT, ENTER “1” AND
CONTINUE.
IF IT IS NOT CORRECT, ENTER
“0”; GO BACK TO F5 AND F6
TO ENTER CORRECT
NUMBER AND NAMES OF
JOBS HELD.
F8.
In what month and year did
you start working for
[fill F6_JOB_1 –
F6_JOB_10]?
RECORD MONTH AND YEAR.
INTERVIEWER: DATE
USUALLY WILL BE AFTER
PRE UI CLAIM JOB, BUT IT
MAY NOT BE.
| | |/|
MONTH
Do you recall what year
you started working for
[fill JOB NAME]?
F10. When did that job end?
RECORD MONTH AND YEAR.
| | |/|
MONTH
| | |
YEAR
| [GO TO F10]
| | |/|
MONTH
| | |
YEAR
| [GO TO F10]
DON’T KNOW ...................... d
DON’T KNOW ....................... d
REFUSED ............................ r
REFUSED ............................ r
REFUSED............................. r
|
|
| |
YEAR
|
DON’T KNOW ...................... d
REFUSED ............................ r
|
| |/|
MONTH
|
| |
YEAR
|]
STILL AT JOB ...................... 02
|
|
| |
YEAR
|
DON’T KNOW ...................... d
REFUSED ............................ r
|
| |/|
MONTH
|
| |
YEAR
|]
STILL AT JOB ...................... 02
[GO TO F8, JOB 2 OR F12ck1]
[GO TO F8, JOB 3 OR F12ck1]
DON’T KNOW ...................... d
REFUSED ............................ r
DON’T KNOW ...................... d
REFUSED ............................ r
(F10= d OR r)
F11. Do you recall what year
that job ended?
| [GO TO F10]
DON’T KNOW ...................... d
(F8= d OR r)
F9.
| | |
YEAR
|
|
| |
YEAR
|
DON’T KNOW ...................... d
REFUSED ............................ r
|
|
| |
YEAR
|
DON’T KNOW ...................... d
REFUSED ............................ r
|
|
| |
YEAR
|
DON’T KNOW ....................... d
REFUSED............................. r
|
| |/|
MONTH
|
| |
YEAR
|]
STILL AT JOB....................... 02
[GO TO F8 FOR NEXT JOB,
UP TO 10 JOBS]
DON’T KNOW ....................... d
REFUSED............................. r
|
|
| |
YEAR
|
DON’T KNOW ....................... d
REFUSED............................. r
CATI SOFT EDIT: IF F10 MONTH AND YEAR IS BEFORE INITIAL UI CLAIM DATE, OR F11 YEAR IS
BEFORE INITIAL CLAIM DATE.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
49
Prepared by Mathematica Policy Research
(All)
F12ck1.
PROGRAMMER:
CHECK F5. IS F5 >1—HAS SAMPLE MEMBER HAD MORE
THAN ONE JOB SINCE INITIAL CLAIM?
YES ............................................................................. 01 (F12ck2)
NO ............................................................................... 00 (F13)
(NOTE: THIS IS FOCAL JOB 1)
(F12ck1=01)
F12ck2.
PROGRAMMER:
CHECK F10 ACROSS ALL JOBS. DOES F10=02 FOR MORE
THAN ONE JOB—DOES THE SAMPLE MEMBER HAVE
MORE THAN ONE CURRENT JOB?
YES ............................................................................. 01 (F12a1)
NO ............................................................................... 00 (F12b)
(F12ck2=01)
F12a1.
Which of your [fill NUMBER OF CURRENT JOBS] current jobs is your main source of
income and benefits?
SPECIFY_______________________________
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
PROGRAMMER: SET FLAG FOR JOB LISTED ABOVE AS “FOCAL JOB 1.”
F12a2.
PROGRAMMER:
CHECK START DATES AT F8. IS FOCAL JOB 1 THE SAME
AS THE FIRST JOB HELD AFTER THE INITIAL UI CLAIM
DATE?
YES ............................................................................. 01
NO ............................................................................... 00
PROGRAMMER:
IF THE FIRST JOB HELD AFTER THE INITIAL UI CLAIM DATE
IS THE SAME AS FOCAL JOB 1 (F12a2 = 01), THEN LEAVE
FOCAL JOB 2 BLANK.
OTHERWISE (F12a2=00), THEN FLAG THE FIRST JOB HELD
AFTER THE INITIAL UI CLAIM DATE AS FOCAL JOB 2.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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50
F12ck3.
PROGRAMMER:
DID THE SAMPLE MEMBER HAVE ANY ADDITIONAL JOBS
SINCE INITIAL UI CLAIM DATE?
YES ............................................................................. 01
NO ............................................................................... 00 (F13)
(F12ck1OR F12ck3 =01)
F12b. Considering all of the jobs you have had since filing for unemployment benefits in
[fill INITIAL UI CLAIM DATE], which has been your main source of income and benefits?
SPECIFY
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
PROGRAMMER: SET FLAG FOR JOB LISTED ABOVE AS “FOCAL JOB 3, IF JOB HAS
NOT BEEN SELECTED AS EITHER FOCAL JOB 1 OR FOCAL JOB 2.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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51
CATI: ASK F13 TO F20 FOR UP
TO 3 SELECTED FOCAL JOBS.
F13. What kind of company is
[fill JOBS SELECTED BY
CATI]—what do they make,
do, or sell?
PROBE: What kind of
business or industry is
this?
INTERVIEWER: IF
RESPONDENT
RETURNED TO JOB, SAY:
You may have told me this
information about when
you worked for [fill
EMPLOYER] before.
F14. What (do/did) you do
there—what (is/was) your
job?
PROBE: What (are/were)
your most important duties
at (this/that) job?
NOTE: TRY TO GET A VERB
F15. (Are/Were) you
represented by a union at
your job with [fill
EMPLOYER]?
PROBE: On some jobs you
might be represented by a
union, even if you are not a
union member.
F16. Which of the following best
describes your employment
status at [fill EMPLOYER]?
(Are/Were) you…
F17. How many hours per week,
including regular overtime
hours (do/did) you usually
work at [fill EMPLOYER
NAME]?
(F17=d OR r)
F17a. Would you say you
work(ed) less than 20
hours per week, between
20 and 29 hours per week,
between 30 and 39 hours
per week, or 40 or more
hours per week?
FOCAL JOB 1
FOCAL JOB 2
FOCAL JOB 3
(SPECIFY) [specify] ................01
(SPECIFY) [specify] ............... 01
(SPECIFY) [specify] ............... 01
DON’T KNOW ........................d
DON’T KNOW ........................ d
DON’T KNOW ........................ d
REFUSED ..............................r
REFUSED .............................. r
REFUSED.............................. r
(SPECIFY) [specify] ................01
(SPECIFY) [specify] ............... 01
(SPECIFY) [specify] ............... 01
DON’T KNOW ........................d
DON’T KNOW ........................ d
DON’T KNOW ........................ d
REFUSED ..............................r
REFUSED .............................. r
REFUSED.............................. r
YES ........................................01
YES ........................................ 01
YES ....................................... 01
NO ..........................................00
NO ......................................... 00
NO ......................................... 00
DON’T KNOW ........................d
DON’T KNOW ........................ d
DON’T KNOW ........................ d
REFUSED ..............................r
a regular part-time or
full-time employee, .................01
REFUSED .............................. r
a regular part-time or
full-time employee, ................. 01
REFUSED.............................. r
a regular part-time or
full-time employee, ................. 01
a leased or contract
employee, ...............................02
a leased or contract
employee, .............................. 02
a leased or contract
employee, .............................. 02
an independent contractor,
consultant, or self-employed, ..03
an independent contractor,
consultant, or self-employed, . 03
an independent contractor,
consultant, or self-employed, . 03
a casual or day laborer, or ......04
an on-call or temporary
employee? ..............................05
a casual or day laborer, or ...... 04
an on-call or temporary
employee? ............................. 05
a casual or day laborer, or ..... 04
an on-call or temporary
employee? ............................. 05
DON’T KNOW ........................d
REFUSED ..............................r
DON’T KNOW ........................ d
REFUSED .............................. r
DON’T KNOW ........................ d
REFUSED.............................. r
|
|
|
| |
(1-120)
| # HOURS PER WEEK
| |
(1-120)
| # HOURS PER WEEK
| |
(1-120)
| # HOURS PER WEEK
GO TO F18
DON’T KNOW ........................d
REFUSED ..............................r
LESS THAN 20 HOURS
PER WEEK ............................01
BETWEEN 20 AND
29 HOURS PER WEEK ..........02
GO TO F18
DON’T KNOW ........................ d
REFUSED .............................. r
LESS THAN 20 HOURS
PER WEEK ............................ 01
BETWEEN 20 AND
29 HOURS PER WEEK ......... 02
GO TO F18
DON’T KNOW ........................ d
REFUSED.............................. r
LESS THAN 20 HOURS
PER WEEK ............................ 01
BETWEEN 20 AND
29 HOURS PER WEEK ......... 02
BETWEEN 30 AND
39 HOURS PER WEEK ..........03
BETWEEN 30 AND
39 HOURS PER WEEK ......... 03
BETWEEN 30 AND
39 HOURS PER WEEK ......... 03
40 OR MORE HOURS
PER WEEK ............................04
40 OR MORE HOURS
PER WEEK ............................ 04
40 OR MORE HOURS
PER WEEK ............................ 04
DON’T KNOW ........................d
REFUSED ..............................r
DON’T KNOW ........................ d
REFUSED .............................. r
DON’T KNOW ........................ d
REFUSED.............................. r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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52
FOCAL JOB 1
F18. What (are/were) your
earnings before taxes and
other deductions at your
job with [fill EMPLOYER]
(when your job ended)?
Please include tips,
commissions, bonuses,
and regular overtime.
PROBE: Before taxes were
taken out.
INTERVIEWER: ACCEPT
MOST CONVENIENT PAY
PERIOD. IF NECESSARY,
CONFIRM PAY PERIOD.
WHEN ENTERING AN
AMOUNT IN DOLLARS
AND CENTS, BE SURE
TO INCLUDE THE
DECIMAL POINT.
F19. (Are/Were) any of the
following benefits available
to you at [fill EMPLOYER]?
INTERVIEWER: IF
BENEFITS WILL BE
AVAILABLE AFTER A
STANDARD
PROBATIONARY
PERIOD, CODE YES
EVEN IF NOT
CURRENTLY
AVAILABLE.
F20. PROGRAMMER: CHECK
FOCAL JOBS FLAGS. IS
THERE ANOTHER
FOCAL JOB TO ASK
ABOUT?
$|
|
|
|,|
|
|
|.|
FOCAL JOB 2
|
|
CODE ONE TIME PERIOD
$|
|
|
|,|
|
|
|.|
FOCAL JOB 3
|
|
CODE ONE TIME PERIOD
$|
|
|
|,|
|
|
|.|
|
|
CODE ONE TIME PERIOD
PER HOUR ............................01
PER HOUR ............................ 01
PER HOUR ............................ 01
PER WEEK ............................02
PER WEEK ............................ 02
PER WEEK ............................ 02
PER YEAR .............................03
PER YEAR ............................. 03
PER YEAR............................. 03
ONCE EVERY
TWO WEEKS .........................04
ONCE EVERY
TWO WEEKS ......................... 04
ONCE EVERY
TWO WEEKS ........................ 04
TWICE A MONTH ..................05
TWICE A MONTH .................. 05
TWICE A MONTH .................. 05
PER MONTH ..........................06
PER MONTH.......................... 06
PER MONTH ......................... 06
IN-KIND ONLY .......................07
IN-KIND ONLY ....................... 07
IN-KIND ONLY....................... 07
PER DAY ................................08
PER DAY ............................... 08
PER DAY ............................... 08
NOT YET PAID.......................09
NOT YET PAID ...................... 09
NOT YET PAID ...................... 09
PER JOB ................................10
PER JOB................................ 10
PER JOB ............................... 10
COMMISSION ........................11
COMMISSION........................ 11
COMMISSION ....................... 11
OTHER (SPECIFY) [specify] ..12
OTHER (SPECIFY) [specify] .. 12
OTHER (SPECIFY) [specify].. 12
DON’T KNOW ........................d
DON’T KNOW ........................ d
DON’T KNOW ........................ d
REFUSED ..............................r
REFUSED .............................. r
REFUSED.............................. r
YES NO DK RF
a. Health
insurance or
membership
in an HMO or
PPO plan? ....... 01 00
d
b. Paid vacation? . 01 00
d
r
a. Health
insurance or
membership
in an HMO or
PPO plan? .......01 00
d
r
b. Paid vacation? .01 00
d
c. Retirement
or pension
benefits?.......... 01 00
YES NO DK RF
r
a. Health
insurance or
membership
in an HMO or
PPO plan? ....... 01 00
d
r
r
b. Paid vacation? . 01 00
d
r
d
r
c. Retirement
or pension
d
r
benefits? ..........01 00
c. Retirement
or pension
d
r
YES ...... [GO TO F13,
FOCAL JOB 2] .........01
YES ...... [GO TO F13,
FOCAL JOB 3] ........ 01
NO ........ [GO TO G1] ..............00
NO ....... [GO TO G1] ............. 00
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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53
YES NO DK RF
benefits? .......... 01 00
GO TO G1
SECTION G – MARITAL STATUS AND FINANCIAL WELL-BEING
CURRENT
Now I have some general questions about you.
G1.
What is your current marital status—are you now married, living with a partner,
separated, divorced, widowed, or have you never been married?
CODE ONE ONLY
MARRIED .................................................................... 01
LIVING WITH A PARTNER .......................................... 02
SEPARATED ............................................................... 03
DIVORCED .................................................................. 04
WIDOWED................................................................... 05
NEVER MARRIED ....................................................... 06
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
G2.
Is your current marital status different from when you worked at [fill NAME OF
COMPANY FROM PRELOADS OR C2] in [fill JOB SEPARATION DATE]?
YES ............................................................................. 01
NO ............................................................................... 00 (G4)
DON’T KNOW .............................................................. d (G4)
REFUSED.................................................................... r
(G4)
PRE-CLAIM
G3.
What was your marital status when you lost your job in [fill JOB SEPARATION DATE]?
Were you then married, living with a partner, separated, divorced, widowed, or had you
never been married?
CODE ONE ONLY
MARRIED .................................................................... 01
LIVING WITH A PARTNER .......................................... 02
SEPARATED ............................................................... 03
DIVORCED .................................................................. 04
WIDOWED................................................................... 05
NEVER MARRIED ....................................................... 06
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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54
G4.
In [fill INITIAL UI CLAIM DATE], did you have any savings in bank accounts?
YES ............................................................................. 01
NO ............................................................................... 00 (G7)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
G5.
(G7)
(G7)
Did you have enough savings to cover all of your living expenses for three months?
YES ............................................................................. 01
NO ............................................................................... 00 (G7)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
G6.
(G7)
(G7)
Did you have enough savings to cover all of your living expenses for six months?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
G7.
When your job ended in [fill JOB SEPARATION DATE] did you have any of the following
types of investments or savings? [READ a-e]
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. 401(k) or 403(b) accounts? .....................................
01
00
d
r
b. Individual Retirement Accounts or IRAs? ................
01
00
d
r
c. Certificates of Deposit or money market
accounts?................................................................
01
00
d
r
d. Other stocks and bonds? ........................................
01
00
d
r
e. Rental properties? ...................................................
01
00
d
r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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55
SECTION H – PRE- AND POST-CLAIM INCOME (OTHER THAN UI BENEFITS)
H1/H2. The next questions are about other types of payments besides unemployment insurance
benefits that you and other members of your household may be receiving now or may
have received in [fill UI CLAIM YEAR MINUS ONE]. By household we mean people who
live together and share finances.
For each type of payment first tell me if you or anyone in your household are currently
receiving the payment and then if you received it in [fill UI CLAIM YEAR MINUS ONE].
[READ a-j]…
PROBE:
Are you or anyone in your household currently receiving [FILL PAYMENT
TYPE}?/How about in [fill UI CLAIM YEAR MINUS ONE]?
PROGRAMMER: RANDOMIZE “START” PHRASE KEEP “j” AS ALWAYS LAST.
H1. CURRENTLY
a.
Social Security Retirement or
Railroad Retirement payments?
b.
Payments from a 401(k) or IRA
account?
c.
Pension benefits from a private or
government employer?
d.
Workers Compensation or private
disability insurance payments?
e.
Social Security Disability Insurance
(SSDI) payments or Supplemental
Security Income (SSI) payments for a
disability?
f.
Temporary Assistance for Needy
Families or TANF payments?
g.
General Assistance or other welfare
payments?
h.
Food stamp or SNAP benefits?
i.
An earned income tax credit or
EITC?
j.
Any other payments, such as child
support, alimony, rental income,
dividends, interest, or something
else? (SPECIFY)
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
H2. UI CLAIM YEAR MINUS ONE
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
YES .................................................. 01
NO .................................................... 00
DON’T KNOW .................................. d
REFUSED ........................................ r
CATI: ASK H3 ONLY IF BOTH H1 AND H2 CORRESPONDING ITEMS = 01.
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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56
(H1a and H2a=01)
H3a.
Did you or another member of your household receive Social Security Retirement or
Railroad Retirement payments continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1b and H2b=01)
H3b.
Did you or another member of your household receive payments from a 401(k) or IRA
account continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1c and H2c=01)
H3c.
Did you or another member of your household receive pension benefits from a private or
government employer continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1d and H2d=01)
H3d.
Did you or another member of your household receive Workers Compensation or private
disability insurance payments since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1e and H2e=01)
H3e.
Did you or another member of your household receive Social Security Disability
Insurance (SSDI) payments or Supplemental Security Income (SSI) for a disability
continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
APPENDIX A-UCP Recipient Survey OMB (10-9-12).docx
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57
(H1f and H2f=01)
H3f.
Did you or another member of your household receive Temporary Assistance for Needy
Families or TANF payments continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1g and H2g=01)
H3g.
Did you or another member of your household receive General Assistance or other
welfare payments continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1h and H2h=01)
H3h.
Did you or another member of your household receive food stamp or SNAP benefits
continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1i and H2i=01)
H3i.
Did you or another member of your household receive an earned income tax credit or
EITC continuously since [fill UI CLAIM YEAR MINUS ONE]?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
(H1j and H2j=01)
H3j.
Did you or another member of your household receive these other payments
continuously since [fill UI CLAIM YEAR MINUS ONE]?
PROBE: Other payments such as child support, alimony, rental income, dividends,
interest, or something else.
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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CATI: ASK H4 TO H7 ABOUT 2012 AND
THE PRE-CLAIM YEAR
H4.
What was the total income for you and
all the members of your household,
before taxes and other deductions, in
[fill 2012]? Please include all of the
sources of income we’ve talked about,
plus any others you may have had.
H4. 2012
$|
|
|
|,|
|
|
| [GO TO H4a]
H4a. UI CLAIM YEAR MINUS ONE
$|
|
|
|,|
|
|
| [GO TO H8]
DON’T KNOW ............................................d
DON’T KNOW ............................................ d
REFUSED ..................................................r
REFUSED .................................................. r
LESS THAN $30,000....... [GO TO H7] ......01
LESS THAN $30,000 ....... [GO TO H7] ...... 01
$30,000 OR MORE ....................................02
DON’T KNOW ............................................d
$30,000 OR MORE .................................... 02
DON’T KNOW ............................................ d
REFUSED ..................................................r
$30,000 to under $45,000, .........................01
REFUSED .................................................. r
$30,000 to under $45,000, ......................... 01
H4a. What was the total income for you and
all the members of your household,
before taxes and other deductions, in
[fill UI CLAIM YEAR MINUS ONE].
PROBE IF NEEDED: Please include income
from your spouse or partner, if applicable and
income from all possible sources such as
self-employment, regular jobs, and earnings
from odd jobs, side jobs, under-the-table jobs,
and other activities, social security, pensions,
rent, interest and dividends, unemployment
compensation, welfare, other public
assistance, food stamps, child support, and
money from any other sources. Your best
estimate is fine.
THIS ITEM SHOULD BE PROGRAMMED
LIKE AN INFO SCREEN.
CATI: IF TOTAL INCOME IS REFUSED,
SAY: Your answers to these questions will
help the researchers better understand the
problems people face when they are
unemployed. Neither your name nor any
other information that would identify you is
kept with your answers. Could you provide
your best estimate?
H5.
H6.
H7.
Would you say your household income
in [fill YEAR] was less than $30,000 or
$30,000 or more?
Would you say it was…
Would you say it was…
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$45,000 to under $60,000, .........................02
$45,000 to under $60,000, ......................... 02
$60,000 to under $75,000, .........................03
$60,000 to under $75,000, ......................... 03
$75,000 to under $90,000, .........................04
$75,000 to under $90,000, ......................... 04
$90,000 to under $105,000, or ...................05
$90,000 to under $105,000, or ................... 05
$105,000 or more? .....................................06
$105,000 or more?..................................... 06
DON’T KNOW ............................................d
DON’T KNOW ............................................ d
REFUSED ..................................................r
REFUSED .................................................. r
GO TO H8
GO TO H8
Less than $5,000, .......................................01
$5,000 to under $10,000, ...........................02
Less than $5,000, ...................................... 01
$5,000 to under $10,000, ........................... 02
$10,000 to under $15,000, .........................03
$15,000 to under $20,000, .........................04
$10,000 to under $15,000, ......................... 03
$15,000 to under $20,000, ......................... 04
$20,000 to under $25,000, or .....................05
$25,000 to under $30,000? ........................06
$20,000 to under $25,000, or ..................... 05
$25,000 to under $30,000? ........................ 06
DON’T KNOW ............................................d
REFUSED ..................................................r
DON’T KNOW ............................................ d
REFUSED .................................................. r
59
HOUSING
We understand that many people who become unemployed face difficulty paying their bills and
meeting their financial commitments. These next questions ask about some of the types of
situations that might be faced by people who are unemployed.
H8.
When your job ended in [fill JOB SEPARATION DATE], did you…
CODE ONE ONLY
Own your home, .......................................................... 01 (H9a)
Rent your home, .......................................................... 02 (H10)
Live with family or friends and pay part of the rent
or mortgage, ................................................................ 03 (H10)
Live with family or friends and not pay, or .................... 04 (H9d)
Live in some other housing arrangement? ................... 05 (H9d)
LIVE IN A GROUP SHELTER ...................................... 06 (H9d)
LIVE IN AN ASSISTED LIVING FACILITY ................... 07 (H9d)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
H9.
(H9d)
(H9d)
Since [fill INITIAL UI CLAIM DATE], have you…
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. missed or been late on a mortgage payment? ....
01
00 (H9d)
d
r
b. received a notice that your mortgage was in
default? ..............................................................
01
00
d
r
c. had your house foreclosed on? ..........................
01
00
d
r
H9d.
Since [fill INITIAL UI CLAIM DATE], have you rented a place to live?
YES ............................................................................. 01 (H10)
NO ............................................................................... 00 (H11)
DON’T KNOW .............................................................. d
(H11)
REFUSED.................................................................... r
(H11)
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H10.
Since [fill INITIAL UI CLAIM DATE], have you…
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. been charged a late fee or missed a rent
payment? .............................................................
01
00 (H11)
d
r
b. received a notice of eviction? ...............................
01
00 (H11)
d
r
c. been evicted? .......................................................
01
00
d
r
H11.
Since [fill INITIAL UI CLAIM DATE], have you…
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. had your utilities disconnected? ..............................
01
00
d
r
b. been charged a late fee on any monthly credit
payments? ..............................................................
01
00
d
r
c. declared personal bankruptcy? ...............................
01
00
d
r
d. postponed a major purchase that was planned or
needed such as a car or major appliance? ..............
01
00
d
r
e. received extra financial assistance from family
members? ...............................................................
01
00
d
r
01
00
d
r
f.
received any assistance from churches, food
banks, or other private community organizations?...
H12.
Since [fill INITIAL UI CLAIM DATE], did you or anyone in your household…
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. make an early withdrawal from a retirement
investment account such as a 401(k), 403(b),
or IRA?....................................................................
01
00
d
r
b. take early retirement to get benefits from a pension
plan? .......................................................................
01
00
d
r
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SECTION I – HEALTH STATUS AND HEALTH INSURANCE COVERAGE
I1ck.
PROGRAMMER: CHECK C14, DOES C14=01?
YES ............................................................................. 01
NO ............................................................................... 00 (I6)
I2.
We’re almost finished. Now I have some questions about health insurance coverage.
COBRA is a law that allows some workers and their families who lose their job and
health benefits the right to continue getting health benefits provided by their former
employer’s group plan for a limited period of time. Were you eligible to enroll in your
employer’s sponsored health plan through COBRA when your job ended in [fill JOB
SEPARATION DATE]?
YES ............................................................................. 01
NO ............................................................................... 00 (I6)
I2a.
DON’T KNOW .............................................................. d
(I6)
REFUSED.................................................................... r
(I6)
Did you enroll in your employer’s sponsored health plan through COBRA when your job
ended?
YES ............................................................................. 01
NO ............................................................................... 00 (I6)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
I3.
(I6)
(I6)
My next questions are about help with paying COBRA premium costs. ARRA, also
known as the Recovery Act or the stimulus plan, helped some groups of unemployed
workers pay the monthly premium for COBRA health insurance. Did you know about
this?
IF NEEDED: ARRA is the American Recovery and Reinvestment Act of 2009.
YES ............................................................................. 01
NO ............................................................................... 00 (I6)
DON’T KNOW .............................................................. d (I6)
REFUSED.................................................................... r
(I6)
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I4.
Were you eligible for this premium assistance?
YES ............................................................................. 01
NO ............................................................................... 00 (I6)
DON’T KNOW .............................................................. d (I6)
REFUSED.................................................................... r
(I6)
I5.
Did you use this premium assistance?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
I6.
(READ IF I1ck = 00. We’re almost finished. Now I have some questions about health
insurance coverage.) Were you eligible to participate in any of the following types of
group health insurance plans at the time your job ended in [fill JOB SEPARATION
DATE]? Please do not include health insurance provided by an employer from a new job
that began after [fill JOB SEPARATION DATE] or individual health plans here. Were you
eligible to participate in… [fill a-e]
INTERVIEWER: CODE “YES” IF ELIGIBLE, BUT NOT USED.
INTERVIEWER: IF NOT APPLICABLE, FOR EXAMPLE NO SPOUSE OR PARTNER,
CODE NO.
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
01
00
d
r
b. Your (spouse’s/partner’s) health insurance plan? ...........
01
00
d
r
c. A health insurance plan sponsored by a union? .............
01
00
d
r
A parent’s health insurance plan? ..................................
01
00
d
r
e. Another type of group health insurance plan? (SPECIFY)
01
00
d
r
a. Medicare? ......................................................................
(G1 NE 05 or 06)
d. PROGRAMMER: ASK “d” ONLY FOR
RESPONDENTS AGE 29 OR YOUNGER
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63
HEALTH INSURANCE COVERAGE
I7.
Between [fill JOB SEPARATION MONTH, YEAR] and now, for approximately how long
were you without health insurance coverage?
PROBE: Your best estimate is fine.
|
|
| MONTHS AND/OR |
(01-72)
|
| YEARS
(01-06)
ZERO/NONE ........................................................... 00
THE ENTIRE TIME .................................................. 99
DON’T KNOW ............................................................ d
REFUSED...................................................................r
I8.
Since [fill INITIAL UI CLAIM DATE], did you (or a household member)…
CODE ONE FOR EACH ROW
YES
NO
DON’T
KNOW
REFUSED
a. Put off getting important medical care?....................
01
00
d
r
b. Visit an emergency room? .......................................
01
00
d
r
c. Delay getting preventive medical care? ...................
01
00
d
r
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SECTION J – DEMOGRAPHICS
J1.
Do you consider yourself to be of Hispanic, Latino, or Spanish origin?
PROBE:
Are you of Cuban, Mexican, Puerto Rican, South or Central American, or
other Spanish culture or origin?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
J2.
What race do you consider yourself? Would you say you are…
CODE ALL THAT APPLY
White? ......................................................................... 01
Black or African American, ........................................... 02
American Indian or Alaska Native, ............................... 03
Asian,........................................................................... 04
Native Hawaiian or Other Pacific Islander, or ............... 05
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
J3.
INTERVIEWER: CODE RESPONDENT’S GENDER WITHOUT ASKING IF KNOWN.
MALE ........................................................................... 01
FEMALE ...................................................................... 02
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SECTION K – FAMILY SIZE AND NUMBER OF CHILDREN
Now please think back to [fill YEAR BEFORE UI CLAIM YEAR], before you began collecting
unemployment benefits.
K1.
How many people, including yourself, were part of your household in [fill YEAR BEFORE
UI CLAIM YEAR]?
PROBE: Please include people who were temporarily away, for example, at school or in
the hospital and people not related to you.
|
|
| # OF HOUSEHOLD MEMBERS AT UI CLAIM YEAR MINUS ONE
(01-20)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
K2.
(K4)
(K4)
How many children under 18 were financially dependent on you at that time?
PROBE: Please include people who were temporarily away, for example, at school or in
the hospital and people not related to you.
|
|
| # OF CHILDREN UNDER 18
(00-20)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
K3.
How many children or other dependents 18 years or older did you support in [fill YEAR
BEFORE UI CLAIM YEAR]?
PROBE: Please include people who were temporarily away, for example, at school or in
the hospital and people not related to you.
|
|
| # OF CHILDREN/DEPENDENTS 18 OR OLDER
(00-20)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
K4.
Have there been any changes in your household size and dependents since then?
YES ............................................................................. 01
NO ............................................................................... 00 (K8)
DON’T KNOW .............................................................. d
(K8)
REFUSED.................................................................... r
(K8)
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K5.
How many people, including yourself, are currently part of your household?
PROBE: Please include people who were temporarily away, for example, at school or in
the hospital and people not related to you.
|
|
| # OF CURRENT HOUSEHOLD MEMBERS
(01-20)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
K6.
How many children under 18 are financially dependent on you?
PROBE: Please include people who were temporarily away, for example, at school or in
the hospital and people not related to you.
|
|
| # OF CHILDREN UNDER 18
(00-20)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
K7.
How many children or other dependents 18 years of age or older do you currently
support?
PROBE: Please include people who were temporarily away, for example, at school or in
the hospital and people not related to you.
|
|
| # OF CHILDREN/DEPENDENTS 18 OR OLDER
(00-20)
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
CATI: ONLY ASK K8 IF THERE ARE OTHER HOUSEHOLD MEMBERS WHO ARE AGE 18
OR OLDER (K3>0).
(K1 NE 01 AND K4=00)
K8.
Since your job ended in [fill INITIAL UI CLAIM DATE], besides you did anyone else in
your household begin working or begin working more hours?
YES ............................................................................. 01
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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SECTION L – WORK MOBILITY
L1.
Now I would like you to think back to [fill INITIAL UI CLAIM DATE]. According to my
information, you worked in [fill STATE] just before you started receiving benefits. Is that
correct?
YES ............................................................................. 01 (L3)
NO ............................................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
L2.
In what state did you work at that time?
STATE NAME:
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
L3.
Since then, have you worked in a state different from [fill UI CLAIM STATE] or in another
country?
YES ............................................................................. 01
NO ............................................................................... 00 (M1)
L4.
DON’T KNOW .............................................................. d
(M1)
REFUSED.................................................................... r
(M1)
In what other states or countries have you worked since [fill INITIAL UI CLAIM DATE]?
PROBE: Do not include vacations or short visits.
OTHER (SPECIFY) [specify]
STATE/COUNTRY 1:__________________________________
STATE/COUNTRY 2:__________________________________
STATE/COUNTRY 3:__________________________________
STATE/COUNTRY 4:__________________________________
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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L5.
FOR EACH STATE/COUNTRY, ASK: When did you work in [fill STATE/COUNTRY1]?
RECORD FROM: | | | / |
MONTH
|
| |
YEAR
| TO | | | / |
MONTH
|
| |
YEAR
|
01
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
L6.
FOR EACH STATE/COUNTRY, ASK: When did you work in [fill STATE/COUNTRY2]?
RECORD FROM: | | | / |
MONTH
|
| |
YEAR
| TO | | | / |
MONTH
|
| |
YEAR
|
02
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
L7.
FOR EACH STATE/COUNTRY, ASK: When did you work in [fill STATE/COUNTRY3]?
RECORD FROM: | | | / |
MONTH
|
| |
YEAR
| TO | | | / |
MONTH
|
| |
YEAR
|
03
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
L7.
FOR EACH STATE/COUNTRY, ASK: When did you work in [fill STATE/COUNTRY4]?
RECORD FROM: | | | / |
MONTH
|
| |
YEAR
| TO | | | / |
MONTH
|
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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| |
YEAR
|
04
SECTION M – TRACKING INFORMATION
M1.
Thank you for participating in the survey. In case we have to contact you again to clarify
anything, I need to know how to get in touch with you. (What is/Is TELEPHONE
NUMBER) your telephone number?
TELEPHONE NUMBER SAME AS SAMPLE
INFORMATION ............................................................ 01
NEW TELEPHONE NUMBER:
|
|
|
|-|
|
|
|-|
|
|
|
|
AREA CODE
NO TELEPHONE ......................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
M2.
Please give me another telephone number where you can be reached, perhaps a cell
phone number, starting with the area code.
SECOND TELEPHONE NUMBER:
|
|
|
|-|
|
|
|-|
|
|
|
|
AREA CODE
NO TELEPHONE ......................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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M3.
The U.S. Department of Labor may want us to follow up with you in the future to see how
things are going for you. In case you move, we would like to have the name, address,
and phone number of one person who does not live with you who will know how to reach
you. We would only contact this person if we have trouble getting in touch with you
directly. What is the name, address, and telephone number of the person who would
always know how to get in touch with you?
PROBE FOR FULL NAMES, INCLUDING MIDDLE INITIALS.
_____________________ ______
FIRST
MI
___________________________
LAST
_________________________________________________________
HOUSE NUMBER / STREET NAME
APT. #
__________________
_______ ____________
CITY
|
|
STATE
|
|-|
|
|
|-|
ZIP CODE
|
|
|
|
AREA CODE
NO TELEPHONE ......................................................... 00
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
M4.
What is their relationship to you?
SPOUSE/PARTNER .................................................... 01
MOTHER ..................................................................... 02
FATHER ...................................................................... 03
SISTER........................................................................ 04
BROTHER ................................................................... 05
GRANDMOTHER ........................................................ 06
GRANDFATHER.......................................................... 07
AUNT ........................................................................... 08
UNCLE ........................................................................ 09
FRIEND ....................................................................... 10
DAUGHTER................................................................. 11
SON ............................................................................. 12
OTHER (SPECIFY) [specify] ........................................ 13
___________________________________________
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
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M5.
We will be mailing you a check in a couple of weeks and I would like to confirm the name
and address where we should send the payment. Is it…?
INTERVIEWER: VERIFY SPELLING OF NAME.
CATI: ALLOW FOR NAME CHANGES
_____________________ ______
FIRST
MI
___________________________
LAST
_________________________________________________________
HOUSE NUMBER / STREET NAME
APT. #
__________________
CITY
_______ ____________
STATE
ZIP CODE
DON’T KNOW .............................................................. d
REFUSED.................................................................... r
Thank you for your cooperation. This completes the survey! Best wishes.
M6.
SPECIFY LANGUAGE INTERVIEW COMPLETED IN:
CODE ONE ONLY
ARABIC ....................................................................... 01
BOSNIAN .................................................................... 02
CAMBODIAN ............................................................... 03
CHINESE ..................................................................... 04
CREOLE ...................................................................... 05
HINDI ........................................................................... 06
HMONG ....................................................................... 07
ITALIAN ....................................................................... 08
LAOTIAN ..................................................................... 09
POLISH ....................................................................... 10
PORTUGUESE ............................................................ 11
RUSSIAN ..................................................................... 12
SPANISH ..................................................................... 13
TAGALOG ................................................................... 14
VIETNAMESE .............................................................. 15
OTHER (SPECIFY) [specify] ........................................ 16
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| File Type | application/pdf |
| File Title | EVALUATION OF THE UNEMPLOYMENT COMPENSATION PROVISIONS OF THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 UCP RECIPIENT SURVE |
| Subject | Questionnaire |
| Author | Pat Nemeth |
| File Modified | 2012-12-03 |
| File Created | 2012-10-10 |