Combined Survey

OMB No. 1205-0498 Approval Expires 6/30/2015

CJ to Create the following variables to upload for the survey.

• Date1 – will now equal start of target period;

• Date1MY – only month and year of start of target period;

• Date2 – will now equal end of target period;

• Date2MY – only month and year of end of target period;

• RECRUITDate – will now equal date of recruitment into program

• Group – 1 or 2 (group 1 will be the group without a previous survey and group 2 with a previous survey)

• LastMonth – Date one month before Date2

• LastYear – Date one month prior to Date2

• Last6Month-Date six months prior to Date2

RExO SURVEY

[PRELOAD RAD, GENDER, TREATMENT/CONTROL STATUS, PROGRAM NAME, EDUCATION, SSN LAST 4, DOB]

PROGRAMMER DISPLAY: [Date1] and [Date2] on every screen; also display: (if group=1, display [1^st Interview]) (if group=2, display [2^nd Interview]

B1. INTERVIEWER: ARE YOU INTERVIEWING THE RESPONDENT WHILE HE/SHE IS IN PRISON OR JAIL?

YES 1

NO 2

On [RecruitDate], you voluntarily agreed to participate in a study of programs serving ex-offenders. This study of programs is called the Reintegration of Ex-Offenders (RExO) Study. At that time, you agreed to be contacted in the future for an interview about your experiences. The RExO Study is conducted on behalf of the U.S. Department of Labor, and the goal of the study is to learn whether such programs are successful in helping ex-offenders re-enter their communities, find work and avoid returning to prison or jail.

[ (if group=2, add) You previously participated in the first round survey – covering the 1^st two years since recruitment in the study]

Whether you directly received services from [program name] or not, your information is of great importance to us. During the interview, you will be asked questions about employment, earnings, and other support you have received, and about activities you might have engaged in, including illegal activities or substance use, in the [if group=1, 36 months] [if group=2, third year following your agreement to be part of the study. [If group=2,These questions should take approximately 20 minutes to answer.] [If group=1, These questions should take approximately 30 minutes to answer. This project has a Federal Certificate of Confidentiality from the government.  The certificate protects the information you provide. This means no one has the right to your record, including your corrections officials, program staff, or police.  If you tell me about child neglect or abuse, I will need to report this.  I will also need to report if you plan to harm yourself or others. The information collected in the interview will only be used by members of the research team.

Your participation in the RExO Study is voluntary. Your decision to participate or not will not affect your parole or probation status, other terms of your release, or services received from any agency. The risk in participating is minimal and you may skip or refuse to answer any questions, or stop the interview if you feel uncomfortable, without penalty.

We will not provide the information you give us to any of these agencies. [IF the R is institutionalized: We have requested from institutional officials that all telephone calls and in person interviews be conducted without monitoring; however, we cannot assure you that your participation will not be monitored by institutional management.] If you agree to participate and complete the interview, you will receive a check for $40 for your time.

[IF the R is institutionalized and unable to receive an incentive: If you agree to participate and complete the interview, we thank you in advance for your time].

[IF the R is institutionalized and able to receive a reduced incentive: If you agree to participate and complete the interview, you will receive a check/money order/deposit in your inmate/trust account for APPROVED AMOUNT].

Your responses to this survey will help us better understand the value of employment-centered programs for assisting ex-offenders. Individual responses will not be attributed to specific individuals. Responses to this data collection will be used only for statistical purposes. The reports prepared from this survey will summarize findings across the sample and individual forms will not be available to anyone outside the study team.

If you have any questions about your rights as a study participant, you may call the NORC IRB Manager, toll-free at 1-866-309-0542. If you have questions about the research study, please call the RExO toll-free number at 866-774-1637.

May I proceed?

1 Yes

2 No

Public Burden Statement

According to the Paperwork Reduction Act of 1995, persons are not required to respond to this collection of information unless it displays a currently valid OMB control number and expiration date. Responding to this questionnaire is voluntary. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to the U.S. Department of Labor, Employment and Training Administration, Office of Policy Development and Research, Room N5641, Attention: Eileen Pederson 200 Constitution Avenue, NW, Washington, D.C. 20210.

Do NOT send the completed questionnaire to this address.

AFTER AGREEMENT OF INFORMED CONSENT.

Section A: Intro and current BACKGROUND questions

First, I will begin by asking some brief questions about your personal characteristics, your current living arrangements, and your employment. Following these questions, I will ask you separately about how things have changed for you throughout the year since you became part of this study.

A1. What is your date of birth?

A1a. Month ___ ___ (1-12, DK=97, REF=98)

A1b. Day ___ ___ (1-31, DK=97, REF=98)

A1c. Year ___ ___ ___ ___ (1910-1992, DK=9997, REF=9998)

A2. To help verify that I have the correct participant, what are the last four digits of your social security number?

___ ___ ___ ___ (0001-9999)

DON’T KNOW 99997

REFUSED 99998

A3a. (If group=1) Were you born in the U.S?

YES (Go to A4a) 1

NO 2

DON’T KNOW 97

REFUSED 98

A3b. [If group=1 and A3a NE 1] How long have you been living in the U.S.?

_______________Years (1-90)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

A4a. (If group=1) Is English your primary language?

YES (Go to A5) 1

NO 2

DON’T KNOW 97

REFUSED 98

A4b. (IF group=1 and A4a NE 1) How well do you understand a conversation in English? Would you say:

Very well, 1

Well, 2

Somewhat, 3

Little, or 4

Not at all? 5

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

A5. What is your current marital status? Are you:

Single, Never Married, 1

Married, 2

Separated, 3

Divorced, or 4

Widowed 5

DON’T KNOW 97

REFUSED 98

A6a. Do you now have, or did you ever have, any children, including, biological, adopted, step, or foster children?

YES 1

NO (Skip to B1) 2

DON’T KNOW 97

REFUSED 98

A6b. (IF A6a = 1) Do you currently have children or dependents who are under the age of 18? (A dependent is someone who relies on you for financial support)

YES 1

NO (Skip to B1) 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

A6c. (IF A6b=1 ) How many children or dependents under the age of 18 do you have?

_______NUMBER OF CHILDREN (1-15)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

SECTION B: CURRENT HOUSING SITUATION

B1. (PROGRAMMER: PULL RESPONSE FROM FIRST SCREEN AND SKIP TO B2.) INTERVIEWER: ARE YOU INTERVIEWING THE RESPONDENT WHILE HE/SHE IS IN PRISON OR JAIL?

YES 1

NO 2

B2. In what city, state and zip code do you currently reside? (INTERVIEWER- INCLUDE LOCATION IF INCARCERATED)

B1a. City___________________________________

DON’T KNOW 97

REFUSED 98

B1b. State__________________________________

DON’T KNOW 97

REFUSED 98

B1c. Zipcode________________________________

DON’T KNOW 97

REFUSED 98

B3a. (PROGRAMMER if B1 is 1 code B3a as 6, and skip this question) Where are you currently living?

Your own place, (house, apt. or room) (Go to B3c) 1

Someone else’s place, (house, apt. or room) (Go to B3c) 2

Homeless, (car, shelter, on the street), 3

A treatment facility, 4

Transitional housing or halfway house, or 5

Prison or jail (GO TO SECTION D) 6

Someplace else? (Go to B3b and Specify) 7

DON’T KNOW 97

REFUSED 98

B3b. (IF B3a=7) Please specify, _______________________________

B3c. (IF B3a=1 or 2) Is it public housing? (INTERVIEWER DEFINITION: Public housing is a form of housing in which the property is owned by a government authority).

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B3d. (IF B3c= 2, 97 or 98) Is it Section 8 housing? (INTERVIEWER DEFINITION: SECTION 8 is officially called the Housing Choice Voucher Program, where individuals or families with a voucher find and lease a unit (either in a specified complex or in the private sector) and pay a portion of the rent (based on income, but generally no more than 30% of the family's income.)

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B4. How long have you been living at your current location?

REPORT NUMBER AND TIME UNIT.

B4a. _______NUMBER (1-365)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

B4b. DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

B5. (IF B3a=1 or 2) Have you been contributing to the cost of the rent or mortgage?

YES, EACH MONTH 1

YES, WHEN I CAN 2

NO 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6a. (IF B3a= 1, 2, or 7) Are you currently living alone or with others?

ALONE 1

WITH OTHERS 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6b. (IF B6a=2) With whom do you live? Do you live with:

B6b1. FOR MALES – wife, girlfriend, or other partner

FOR FEMALES – husband, boyfriend, or other partner

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6b2. (IF B6a=2 and A6a=1) With one or more of your children?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6b3. With one or both of your parents?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6b4. With other family members, such as an aunt, uncle, grandparent, brother,

Sister, or cousin?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6b5. With a friend or friends?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

B6c. (IF B6b2=1) How many of your children or dependents under the age of 18 currently live with you?

_______NUMBER (0-15)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

SECTION C: CURRENT EMPLOYMENT (PROGRAMMER-Skip this section if B3a=6)

C1. Are you currently working for pay?

YES 1

YES CURRENTLY ON PAID LEAVE 2

NO (Skip to section D) 3

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C2. (IF C1= 1 or 2) How many jobs do you currently have?

_______NUMBER (1-10)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C3. (IF C1=1 or 2) I’d like to ask you some questions about your current job.

(IF C2>1) For whom do you usually work the most hours?

(IF C2=1, 97 or 98) Please tell me the name of your current employer. ____________________

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C4. (IF C1=1 or 2) In what state do you work?

______________ State Name

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C5a. (IF C1=1 or 2) Would you describe this job as:

FULL TIME, (30 or more hours per week) 1

PART-TIME WITH HOURS MOST WEEKS, 2

SEASONAL WORK, 3

TEMPORARY WORK THROUGH A TEMP AGENCY 4

TEMPORARY WORK SUCH AS ODD JOBS OR DAY LABOR, 5

WORK THAT IS ‘OFF THE BOOKS,’ OR 6

SOMETHING ELSE? (Go to C5b and SPECIFY) 7

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C5b. (IF C5=7) Please specify _______________________________

C6. (IF C1=1 or 2) What month and year did you start this job?

C6a. MM ______ (1-12)

C6b. YYYY____________ (1920-2015)

N/A SKIPPED 96, 9996

DON’T KNOW 97, 9997

REFUSED 98, 9998

C6c. (IF C6a and C6b = [Date2-MY]) Do you remember the day of the month that you started that job? (INTERVIEWER; If necessary, prompt to identify before or after follow-up period)

DD ______________ (1-31)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C7a. (IF (TREATMENT=1) and ((C1=1) or (C1=2)) and (C6a/b/c before [Date2)) Did staff from the [PROGRAM NAME] help you get this job?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C7b. ((IF TREATMENT=2) and ((C1=1) or (C1=2)) and (C6a/b/c after [RADate]))) Did staff from any agency or organization help you get this job?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C8. (IF C1=1 or 2, and C6a/b/c before [Date2]) What is your occupation on this job? What kind of work do you do?

_____________ OCCUPATION/JOB

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C9. (IF C1=1 or 2, and C6a/b/c before [Date2]) What kind of business or industry is that in? What do they make or what service do they provide? _________________________________

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C10. (IF C1=1 or 2, and C6a/b/c before [Date2]) Including overtime, how many hours per week do you usually work on this job? __________________ (0-140)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C11. (IF C1=1 or 2, and C6a/b/c before [Date2]) Does the number of hours you work change from week to week: a lot, 1

a fair amount, 2

a little, or 3

hardly at all? 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C12a. (IF C1=1 or 2, and C6a/b/c before [Date2]) What is your wage before taxes? Please include tips, commissions, and regular overtime pay.

$ ___ ___ ___ , ___ ___ ___ . ___ ___ (0-999999.99

AMOUNT

MINIMUM WAGE 9999999.94

N/A SKIPPED 9999999.96

DON’T KNOW 9999999.97

REFUSED 9999999.98

C12b. Is that:

PER HOUR, 1

PER WEEK, 2

EVERY 2 WEEKS, 3

TWICE A MONTH, 4

ONCE A MONTH, 5

PER DAY OR PER PIECE, OR 6

SOME OTHER WAY? (Go to C12c and Specify) 7

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C12c. (IF C12b=7) Please specify. __________________________

C12d. (IF C12b=6 or 7). What would you estimate you make in a week?

$___ , ___ ___ ___ . ___ ___

AMOUNT PER WEEK

N/A SKIPPED 99999.96

DON’T KNOW 99999.97

REFUSED 99999.98

C13. (IF C1=1 or 2, and C6a/b/c before [Date2]) Do you get any of the following benefits on your job? (Identify all that apply):

C13a. Sick days with full pay?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

C13b Paid vacation?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

C13c. Paid holidays other than Christmas and New Year’s Day?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

C13d. A retirement plan?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

C13e. Dental benefits, including any offered at a cost to you?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

C14a. (IF C1=1 or 2, and C6a/b/c before [Date2]) Do you participate in a health plan or receive medical insurance through your job, including any offered at a cost to you?

YES (Go to C15a) 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C14b. (IF C14a=2) Does your employer offer a health plan or medical insurance?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C14c. (IF C14b=1). What is the main reason you didn’t enroll in your employer’s health insurance plan? Was it that:

You were covered by a public insurance program such as

Medicaid, or a state-funded program, 1

You were covered by another insurance plan, 2

The cost was too expensive, 3

You hadn’t worked long enough, or 4

Some other reason? (Go to C14d and Specify) 95

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C14d. (IF C14c=95) Please specify ________________________________

C15a. (IF C1=1 or 2, and C6a/b/c before [Date2]) Have you received a promotion while working at this job, meaning that you moved to a higher position or job title?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C15b. (IF C15a=1) When did you receive this promotion?

C15b1. MM ______ (1-12)

C15b2. YYYY____________(1920-2015

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C15c (IF C15a NE 1). Is your current job one in which there is a possibility that you could move up or be promoted?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

C15d (IF C15c=1). Do you think you are likely to move up or be promoted?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

SECTION D: RANDOM ASSIGNMENT DATE (RAD) REFERENCE SECTION

Programmer: If group=2, skip to question D4a.

For the questions that follow, I will ask you to think back to the time when you agreed to participate in this study on [RADate]. We will focus on the period of time between that day and three years later, [RADate+2]. I’m going to ask you a few questions that may help you remember back to [RADate] and what you were doing back then. Try to remember as best you can.

D1. (If Group=1) On [Date1], you went to the [PROGRAM NAME] office, and you were told about the Re-entry of Ex-offenders study and watched a DVD about the study. Where was that office located? EXACT ADDRESS NOT REQUIRED

Place_______________________________________

DON’T KNOW 97

REFUSED 98

D2a. (If Group=1) Think back to [Date1], where were you living at that time?

Your own place, (house, apt. or room) 1

Someone else’s place, (house, apt. or room) 2

Homeless, (car, shelter, on the street), 3

A treatment facility, 4

Transitional housing or halfway house, 5

Prison or jail, or 6

Someplace else (Go to D2b and Specify)? 7

DON’T KNOW 97

REFUSED 98

D2b. (IF D2a=7) Please specify. _________________________

D3a. (IF Group=1 and D2a=1,2, or 95) Were you living alone or with others at that time?

ALONE 1

WITH OTHERS 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3b. (IF group=1 and D3a=2) With whom did you live? Did you live with

D3b1. FOR MALES – wife, girlfriend, or other partner

FOR FEMALES – husband, boyfriend, or other partner

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3b2. (IF A6a=1 and D3a=2) With your children?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3b3. With one or both of your parents?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3b4. With other family members, such as an aunt, uncle, grandparent, brother,

Sister, or cousin?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3b5. With a friend or friends?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3c. (IF Group=1 and D3b2=1) On [Date1], how many of your children were living in your household?

_______NUMBER (1-15)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

D3d. (IF Group=1 and D3b2=1) On [Date1], how old was the youngest of those children?

_______Age of Youngest (0-50)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

Use this intro if Group=1

For the remaining questions, I will be referring to the period of time between [Date1] and [Date2].

Use this intro for Group 2

For these questions about your living arrangements, I will refer to the period of time between Date1 and Date2.

D4a. (IF B3a NE 6) Did you live at the same residence from [Date1] to [Date2]?

YES (Go to D6a) 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D4b. (IF D4a NE 1 or if B3a=6) [Between Date1MY and Date2MY], how many different places have you lived in? Please don’t count time in jail or prison, time on the street, or when homeless.

ONE 1

TWO 2

THREE 3

FOUR OR MORE 4

NONE, ONLY BEEN IN PRISON SINCE [RAD] 5

NONE, ONLY BEEN HOMELESS SINCE [RAD] 6

NONE, ONLY HOMELESS AND IN PRISON SINCE [RAD] 7

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D5a. (IF D4b = 1,2,3,4 ) Not considering any time that you were incarcerated, what was the main reason for your last move?

EVICTED 1

KICKED OUT BY HOUSEHOLD MEMBERS 2

UNABLE TO PAY FOR THE RENT AND OTHER EXPENSES 3

FOUND OWN PLACE TO LIVE 4

SAVED ENOUGH MONEY TO GET OWN PLACE TO LIVE 5

FOUND A NICER PLACE TO LIVE 6

MOVED IN WITH FAMILY 7

MOVED IN WITH FRIENDS 8

SOMETHING ELSE (GO TO D5b and SPECIFY) 9

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

D5b. (IF D5a=9) Please specify. _________________________

D6a. [Between Date1MY and Date2MY], did you get any assistance from an agency or organization that helps people find housing?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

D6b. (IF D6a=1) How helpful was this service? Would you say:

Very helpful, 1

Somewhat helpful, 2

A little helpful, or 3

Not at all helpful? 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

SECTION E: RECIDIVISM

These next questions are about any involvement in the criminal justice system that you may have had between [Date1] and [Date2]. Remember that you can refuse to answer any question that makes you uncomfortable.

E1. At any point between Date1MY and Date2MY, did you spend time in jail or prison?

YES 1

NO (GO TO E5a) 2

DON’T KNOW 97

REFUSED 98

E2. (IF E1=1) How many different times were you in jail or prison between [Date1MY and Date2MY]?

_______NUMBER (1-50)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

New E2b: (Group 2 Only):

E2b. Were you in jail or prison on [Date1MY]?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

E2c. (If E2b=1) What was the total amount of time that you spent in jail or prison during that stay SINCE DATE1MY? REPORT NUMBER AND TIME UNIT.

E3c. _______NUMBER

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E3d. DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

If E2=1 and E2b=1, skip to E5a.

E3. (IF (group=1) OR (E2b=2) When were you first placed in jail or prison since [Date1MY]?

(If E2>1 and E2b=1) After that placement, when were you next placed in jail or prison?

E3a MM ______ (1-12)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E3b YYYY____________ (2010-2015)

N/A SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

E3c/d. What was the total amount of time that you spent in jail or prison during that stay? REPORT NUMBER AND TIME UNIT.

E3c. _______NUMBER (1-365)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E3d. DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E4. (loops for each subsequent jail or prison stay up to E2#, unless E2b=1—then up to E2#minus1) ((IF E1=1) and (E2>1)) When were you next placed in jail or prison?

E4a (1-3) MM ______ (1-12)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E4b (1-3) YYYY____________ (2010-2016)

N/A SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

E4c/d. What was the total amount of time that you spent in jail or prison during that stay? REPORT NUMBER AND TIME UNIT.

E4c. _______NUMBER (1-365)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E4d. DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E4e./f (if E2> or =4) What was the total amount of time you spent in jail or prison between [Date1MY and Date2MY]?

E4e. _______NUMBER (1-365)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E4f. DAYS 1

WEEKS 2

MONTHS 3

YEARS 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E5a. At any point between [Date1MY] and [Date2MY],were you arrested?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E5b. (IF E5a=1) When did this happen? If it happened more than once, please tell me the date of your first arrest.

E5b1 MM ______ (1-12)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E5b2 YYYY____________ (2010-2015)

N/A SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

E5c. (IF B1 = 1 or B3a = 6 or E1 = 1 or E5a=1) Since [Date1MY], how many times have you been arrested? ____________ NUMBER OF TIMES (1-50)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E6a. Between [Date1MY] and [Date2MY] were you formally charged with a new crime (not including a probation or parole violation)?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

E6b. (IF E6a=1) When did this happen? If it happened more than once, please tell me the date of your first charge.

E6b1 MM ______ (1-12)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E6b2 YYYY____________ (2010-2015)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E6c. (IF E6a=1) Between [Date1MY] and [Date2MY] were you convicted of a new crime, not including probation or parole violations?

YES 1

NO 2

CURRENTLY ON TRIAL 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E6d. (IF E6c=1) From [Date1MY] to [Date2MY], how many times were you convicted of a new crime?

____________ NUMBER (0-50)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E7. Between [Date1MY] and [Date2MY], at any point were you on parole or probation?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

E8a. (IF E7=1) Between [Date1MY] and [Date2MY], were you charged with a violation of parole or probation? By violation, we mean that your parole or probation officer determined that you have violated the conditions of your supervision.

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E8b. (IF E8a=1) When did this happen? If it happened more than once, please tell me the date of your first violation.

E8b1 MM ______ (1-12)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

E8b2 YYYY____________ (2010-2015)

N/A SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

E8c. (IF E8a=1) What were the violations? (SPECIFY ALL VIOLATIONS)

E8c1. Specify 1^st violation ______________________________

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E8c2. Specify 2nd violation ______________________________

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E8c3. Specify 3rd violation ______________________________

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E8c4. Specify 4th violation ______________________________

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

E8d. (IF E8a=1) Was your parole or probation revoked, between [Date1MY] and [Date2MY]?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

SECTION F: EMPLOYMENT AND EDUCATION ACTIVITIES

Programmer: If group=2, skip to G2.

Now I will ask questions related to employment or education programs or activities in which you participated between [Date1] and [Date2].

F1a. From [Date1MY] to [Date2MY], did you participate in classes or group meetings that tried to teach you how to look for a job or prepare a resume? These programs are sometimes called “Job Club,” or “Job Readiness,” or “Life Skills Training”?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F1b and F1c. (IF F1a=1) (From [Date1MY] to [Date2MY]), About how many days/weeks did you go to these classes or group meetings?

F1b. _______NUMBER (1-365)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

F1c. DAYS 1

WEEKS 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F2a (From [Date1MY] to [Date2MY]), did you participate in an individual or independent job search activity in which you looked for a job on your own and reported back to an agency staff member with a list of employers that you contacted? Please don’t count reporting to your parole officer or job searches where you did not report back to someone who works at an agency.

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F2b. (IF F2a=1) (Between [Date1MY] and [Date2MY]), about how many weeks did you participate in an independent job search activity?

______ NUMBER OF WEEKS (1-52)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F3a. (From [Date1MY] to [Date2MY]), did you take part in any Adult Basic Education ( or ABE) classes, GED classes, or classes to prepare for a regular high school diploma?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F3b. (IF F3a=1) (From [Date1MY] to [Date2MY]), about how many weeks did you take Adult Basic Education (or ABE) classes, GED classes, or high school classes?

______ NUMBER OF WEEKS (1-52)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F4a. (From [Date1MY] to [Date2MY]), did you get vocational training for a specific job, trade, or occupation? Please don't include on-the-job training, unpaid work experience, or college courses (other than vocational).

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F4b. (IF F4a=1) (From [Date1MY] to [Date2MY]), about how many weeks did you take vocational training classes?

______ NUMBER OF WEEKS (1-52)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F4c. (IF F4a=1)What kind of occupation (what type of job) was this training for?

___________ TYPE OF OCCUPATION OR JOB

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F4d. (IF F4a=1) (From [Date1MY] to [Date2MY]), Did you receive any certificates or credentials as a result of this vocational training?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F5a. (From [Date1MY] to [Date2MY]), did you receive any employment services or assistance with finding a job designed to help former prisoners?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F5b. (IF F5a=1) How helpful was this service? Would you say:

Very helpful, 1

Somewhat helpful, 2

A little helpful, or 3

Not at all helpful? 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F6a. Are there any other employment-related programs or activities that you took part in (From [Date1MY] to [Date2MY]) that we did not talk about, such as workshops on career goals or how to keep a job?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F6b. (IF F6a=1) What kind of activity was it?

___________ TYPE OF ACTIVITIY

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F6c. (IF F6a=1) (From [Date1MY] to [Date2MY]), about how many weeks did you participate in this activity?

______ NUMBER OF WEEKS (1-52)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F7. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program refer you to a specific job opening?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F8. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program give you advice about job interviewing?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F9. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program give you advice about answering potential employers’ questions about your criminal history?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F10. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program give you advice about how to behave on the job?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F11. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program give you names of people to contact in the community about finding a job? YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F12. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program give you help in putting together a resume?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F13. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1) (From [Date1MY] to [Date2MY]), did any program give you help filling out job applications?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F14. (From [Date1MY] to [Date2MY]), did you take any college courses for credit?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F15a. (From [Date1MY] to [Date2MY]), did you receive a GED, High School, or other degree or diploma? YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F15b. (IF F15a=1) What type of degree or diploma have you earned from [Date1MY] to [Date2MY]?

GED, 1

HIGH SCHOOL DIPLOMA, 2

TECHNICAL SCHOOL/AA/

2-YEAR COLLEGE 3

4-YEAR (OR MORE) COLLEGE 4

NONE OF THE ABOVE 5

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

F16a. Did you participate in any formal mentoring program at any agency from [Date1MY] to [Date2MY]?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

F16b. (IF F16a=1) Was this with an individual mentor or in a group setting?

INDIVIDUAL 1

GROUP 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F17a. (IF TREATMENT=2 and F1a=2 and F2a=2 and F3a=2 and F4a=2 and F5a=2 and F6a=2 and F14 =2 and F15a=2 and F16a=2 ) Did you obtain assistance from any agency or organization, or participate in any programs from [Date1MY] to [Date2MY] to help you better deal with any problems or issues that you faced during that time, that you haven’t already indicated?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F17b. (IF 17a=1) (probe) What type of agency or program did you obtain assistance from? For what type of issue? _________________________________________________________

F18. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1 or F14 =1 or F15a=1 or F16a=1 or F17a=1) Thinking of the people you have worked with at agencies or organizations from [Date1MY] to [Date2MY], was there a person or persons to whom you could turn for advice or support with personal or family issues?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F19a. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1 or F14 =1 or F15a=1 or F16a=1 or F17a=1) Thinking of the people you have worked with at agencies or organizations from [Date1MY] to [Date2MY], was there a person or persons you view as your “mentor” or “guide”?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F19b. (IF F19a=1) How helpful was this person to your success in avoiding crime from [Date1MY] to [Date2MY]? Would you say s/he was:

Very helpful, 1

Somewhat helpful 2

A little helpful, or 3

Not at all helpful 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F19c. (IF F19a=1) How helpful was this person to your success in finding or keeping a job since [Date1MY]? Would you say s/he was:

Very helpful, 1

Somewhat helpful 2

A little helpful, or 3

Not at all helpful 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F20. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1 or F14 =1 or F15a=1 or F16a=1 or F17a=1) Thinking of the people you have worked with at agencies or organizations from [Date1MY] to [Date2MY], was there a person or persons who went out of their way to help you when you needed help?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F21a. (IF TREATMENT=1 or F1a=1 or F2a=1 or F3a=1 or F4a=1 or F5a=1 or F6a=1 or F14 =1 or F15a=1 or F16a=1 or F17a=1) From [Date1MY] to [Date2MY], did you participate in any sessions in which a single individual (or a few individuals) offered counseling or advice to a group of former offenders?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F21b. (IF F21a=1) How helpful was this session to your success since [Date1MY]? Would you say it was:

Very helpful, 1

Somewhat helpful 2

A little helpful, or 3

Not at all helpful 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F22a. While you were incarcerated immediately prior to [Date1MY], did staff from the prison or jail refer you to any organizations or agencies to get help finding a job or getting training?

YES 1

NO (GO TO F23) 2

DON’T KNOW (GO TO F23) 97

REFUSED (GO TO F23) 98

F22b. (IF F22a=1) Did they:

Give you a general list of agencies and organizations 1

Send you to a specific agency or organization 2

Both 3

Neither 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F23a. (IF E7=1) Since [Date1MY], did a parole or probation officer refer you to any organizations or agencies to get help finding a job or getting training?

YES 1

NO (GO TO F24) 2

NA/SKIPPED (GO TO F24) 96

DON’T KNOW (GO TO F24) 97

REFUSED (GO TO F24) 98

F23b. (IF F23a=1) Did they:

Give you a general list of agencies and organizations 1

Send you to a specific agency or organization 2

Both 3

Neither 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F24. (IF A6a=1 or B6c>0) From [Date1MY] to [Date2MY], has any program given you help dealing with the child support enforcement system?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

F25. (IF A6a=1 or B6c>0) From [Date1MY] to [Date2MY] did you have to quit a job, quit school, a job search, or a training activity because you had problems arranging childcare or keeping a childcare arrangement?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

SECTION G: EMPLOYMENT HISTORY

In this section, I will ask questions about your employment history.

G1. (If group=1) Since you turned 18, about how much of the time would you say you have been employed at a paying job? Would you say:

Most of the time, 1

About three-quarters of the time, 2

About half of the time, 3

About one-quarter of the time, 4

Hardly at all, or 5

None of the time? 6

DON’T KNOW 97

REFUSED 98

The following questions refer to any employment you may have had from Date1 to Date2.

G2. (IF C1 NE 1 or 2 or B3a=6) Since [Date1MY], have you worked for pay at all? Please think about any jobs you’ve had since [Date1MY], including self-employment, temporary work, work as a day laborer, and transitional or subsidized jobs.

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G3a. (IF C1 NE 1 or 2 or B3a=6) A lot of people have irregular, odd, or side jobs, or do extra work to make ends meet. Have you done any work like that for pay since [Date1MY]?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G3b. (IF C1 = 1 or 2) You have indicated that you are currently employed. A lot of people have irregular, odd, or side jobs, or do extra work to make ends meet. Have you done any work like that for pay since [Date1MY]?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G4. PROGRAMMER: Autocode G4 to 0 when C1 EQ 3 & G2 EQ 2 & G3a EQ 2 and skip to section H.

Autocode G4 to 0 when B3a EQ 6 & G2 EQ 2 & G3 EQ 2 and skip to section H.

How many jobs did you have between [Date1MY] and [Date2MY]? Please count all jobs including self-employment, temporary work, work as a day laborer, and transitional or subsidized jobs.

______ NUMBER (0-50)

DON’T KNOW 97

REFUSED 98

PROGRAMMER: IF G4=O, SKIP TO SECTION H.

G5. (IF G4=1 and C1=1) Is this the same job that you currently hold?

YES (Go to Section H) 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

PROGRAMMER: IF G5=1, PREFILL THE LAST JOB QUESTIONS (G8 THRU G22) AS THE SECTION C EQUIVALENTS, THEN SKIP TO SECTION H

G6. (If Group=1) Were you employed when you applied to participate in the employment program at [PROGRAM NAME] on [Date1]?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

If (group=2) ask the following version of G6:

Were you employed at the beginning of this followup period on Date1?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

		a. What was your job or occupation	b/c.What month and year did you start this job?	d/e.What month and year did you end this job?	f. Current job described	g. Check if LAST JOB
G7*_J1	(IF G6=1) What was this job? (IF G6 NE1 and NE 96) What was the first job obtained?		Month __ __ (1-12) Year __ __ __ __ ** (1920-20156)	Month __ __ (1-12)Year __ __ __ __ (19 20-2016)
G7*_J2	(IF G4>1) What was the second job you obtained?		Month __ __ Year __ __ __ __	Month __ __ Year __ __ __ __
G7*_J3	(IF G4>2) What is the next job you obtained?		Month __ __ Year __ __ __ __	Month __ __ Year __ __ __ __
G7*_J4	(IF G4>3) What is the next job you obtained?		Month __ __ Year __ __ __ __	Month __ __ Year __ __ __ __
G7*_J5	(IF G4>4) What is the next job you obtained?		Month __ __ Year __ __ __ __	Month __ __ Year __ __ __ __
G7*_J6	(IF G4>5) What is the next job you obtained?		Month __ __ Year __ __ __ __	Month __ __ Year __ __ __ __
G7*_J7	(IF G4>6) What was the last job you held between [Date1MY and Date2MY]?		Month __ __ Year __ __ __ __	Month __ __ Year __ __ __ __

** PROGRAMMER: IF THE FIRST JOB LISTED AT G7 STARTED AFTER Date2, SKIP TO SECTION H.

7-13 f. above. INTERVIEWER: CHECK THE JOB ON THE LIST ABOVE IF IT WAS DESCRIBED IN THE CURRENT SECTION (C1-15). IF YOU DON’T REMEMBER, PROMPT THE R WITH “WHICH OF THESE IS YOUR CURRENT JOB?”

7-13g. above. INTERVIEWER: IDENTIFY THE JOB THAT WAS HELD ON Date2 OR THE LAST ONE HELD BEFORE Date2. IF TWO WERE HELD ON THAT DATE, ASK THE R WHICH ONE HE/SHE WORKED THE MOST HOURS AT THAT MONTH. CHECK THE BOX OF THE ONE IDENTIFIED.

AT THIS STAGE, THE INTERVIEWER WILL ASK QUESTIONS ABOUT EACH OF THE JOBS LISTED UNDER J7a_J1 THROUGH J7.

• IF THE JOB IS THE LAST JOB, WE WILL COLLECT QUESTIONS G8 THRU G22.

• IF THE JOB IS NOT THE LAST JOB, WE WILL COLLECT QUESTIONS G7h THRU G7m.

• IF THE JOB IS THE SAME AS THE CURRENT JOB (I.E., INFORMATION COLLECTED IN SECTION C) THEN THE INFORMATION WILL BE BACK FILLED AND THE QUESTIONS SKIPPED.

NOT LAST JOB SECTION: G7*J1-J7 - QUESTIONS DEAL WITH ANY JOB EXCEPT THE JOB IDENTIFIED AS “LAST” UNDER G7g. .

PROGRAMMER: (G7h-l for job G7a, etc.) IF FOR ANY JOB FOR WHICH (g=no and f=yes) WHICH IS NOT THE LAST JOB, BUT IS THE CURRENT JOB, INFORMATION MAY BE PREFILLED FROM SECTION C:

G**h=C10; G**i,j,j2=C12a,b,c; G**k=C14a;G**l,m=NA

G7h. Including overtime, how many hours per week did you work on this job when you left? ________________Number of Hours (0-140)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G7i. What was your wage (just before you left), before taxes? Please include tips, commissions, and regular overtime pay.

$ ___ ___ ___ , ___ ___ ___ . ___ ___ (0-999999.99

AMOUNT

MINIMUM WAGE 9999999.94

N/A SKIPPED 9999999.96

DON’T KNOW 9999999.97

REFUSED 9999999.98

G7j. Was that:

Per hour 1

Per week 2

Every 2 weeks 3

Twice a month 4

Once a month 5

Per day or per piece 6

Something else (Go to G7k and specify) 7

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G7j2. (IF G7j=7) Specify: ____________________________

G7k. Did you receive any health or medical benefits from this job, including any offered at a cost to you?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G7l. Why did you leave this job?

INTERVIEWER: IF THE RESPODNENT IS STILL EMPLOYED, PLEASE SELECT NA/SKIPPED AT THIS QUESTION.

LAID OFF 1

QUIT 2

RETIRED 3

FIRED 4

REINCARCERATED/ARRESTED 5

ILLNESS/PREGNANCY/LEAVE OF ABSENCE 6

OTHER REASON (Go to G7m and Specify) 7

NA/SKIPPED 96

DK 97

REF 98

G7m. (IF G7l=7) Please Specify. ____________________

LAST JOB SECTION: G11_LJ THROUGH G22_LJ – QUESTIONS RELEVANT TO LAST JOB ONLY

PROGRAMMER: IF LAST JOB=CURRENT JOB (RESPONSES TO THESE QUESTIONS CAN BE FILLED FROM QUESTIONS C1 THROUGH C15d)

G11=C3; G12=C4; G13a,b=C5a,b; G14a,b=C7a,b; G15=C9; G16= C10; G17= C11; G18a,b,c,d=C12a,b,c,d;

G19a,b,c,d,e= C13a,b,c,d,e; G20a,b,c,d=C14a,b,c,d; G21a,b,c=C15a,b,c; G22a-G25c=NA

G8_LJ, G9a,b_LJ, G10a,b_LJ will be backfilled from either the table above or the current questions

G11_LJ. First, please tell me the name of the employer where you worked. _____________________________

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G12_LJ. What state was that in?

______________ State Name

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G13a_LJ. Would you describe that job as:

Full time, (30 or more hours per week) 1

Part-time with hours most weeks, 2

Seasonal work, 3

Temporary work through a temp agency, odd jobs or day labor, or 4

Something else? (Go to G13b and SPECIFY) 5

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G13b_LJ. (IF G13a=5) Please specify _______________________________

G14a_LJ . (IF TREATMENT = 1) Did staff from the [PROGRAM NAME] help you get that job?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G14b_LJ. (if TREATMENT=2) Did staff from any agency or organization help you get this job?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G15_LJ. What kind of business or industry was that in? What did they make or what service do they provide?

______________ TYPE OF BUSINESS

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G16_LJ. Including overtime, how many hours per week did you usually work on this job?

__________________ HOURS

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G17_LJ. Did the number of hours you worked change from week to week:

A lot, 1

A fair amount, 2

A little, or 3

Hardly at all? 4

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G18a_LJ. What was your wage before taxes? Please include tips, commissions, and regular overtime pay.

$ ___ ___ ___ , ___ ___ ___ . ___ ___ (0-999999.99

AMOUNT

MINIMUM WAGE 9999999.94

N/A SKIPPED 9999999.96

DON’T KNOW 9999999.97

REFUSED 9999999.98

G18b_LJ. Was that:

Per hour, 1

Per week, 2

Every 2 weeks, 3

Twice a month, 4

Once a month, 5

Per day or per piece, or 6

Some other way? (Go to G18c and Specify) 7

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G18c_LJ. (IF G18b_LJ=7) Please specify. __________________________

G18d_LJ. (IF G18b_LJ=6 or 7). What would you estimate you made in a week?

$___ , ___ ___ ___ . ___ ___

AMOUNT PER WEEK

N/A SKIPPED 99999.96

DON’T KNOW 99999.97

REFUSED 99999.98

G19_LJ. Did you get any of the following benefits on your job? (Identify all that apply):

G19a_LJ. Sick days with full pay?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G19b_LJ Paid vacation?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G19c_LJ. Paid holidays other than Christmas and New Year’s Day?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G19d_LJ. A retirement plan?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G19e_LJ. Dental benefits, including any offered at a cost to you?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

G20a_LJ. Did you participate in a health plan or receive medical insurance through your job, including any offered at a cost to you?

YES (Go to G21a_LJ) 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G20b_LJ. (IF G20a_LJ =2) Does your employer offer a health plan or medical insurance?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G20c_LJ. (IF G20b_LJ =1). What is the main reason you didn’t enroll in your employer’s health insurance plan? Was it that:

You were covered by a public insurance program such as

Medicaid, or a state-funded program, 1

You were covered by another insurance plan, 2

The cost was too expensive, 3

You hadn’t worked long enough, or 4

Some other reason? (Go to G20d_LJ and Specify) 5

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G20d_LJ. (IF G20c=5) Please specify ________________________________

G21a_LJ. Since [Date1MY], did you receive a promotion while working there, meaning that you moved to a higher position or job title?

YES (GO TO G21b _LJ) 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G21b_LJ. (IF G21a_LJ =1) When did you receive this promotion?

G21b1. MM ______ (1-12)

G21b2 YYYY____________ (1920-2015)

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G21c_LJ. (IF G21a_LJ =2) Was your job one in which there was a possibility that you could move up

or be promoted?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G22a_LJ. (if enddate NE 77/7777) Why did you leave this job?

LAID OFF, 1

QUIT, 2

RETIRED (GO TO SECTION H), 3

FIRED 4

REINCARCERATED 5

ILLNESS/PREGNANCY/LEAVE OF ABSENCE 6

ARRESTED 7

OTHER (SPECIFY—Go to G22b_LJ) 8

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G22b_LJ. (if G22a_LJ =8) Please specify.______________________________

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G22c_LJ. (if enddate NE 77/7777) Did you look for work after that job ended?

YES (GO TO SECTION H) 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

G22d_LJ. (IF G22C_LJ=2) Why did you not look for work after that job ended?

________________________________________________

SECTION H: HOUSEHOLD INCOME

I am shifting now to questions about income for both you alone and for the household where you lived from [Date1] to [Date2]. First we will ask questions about your income.

H1. Between [Date1MY] and [Date2MY], did you receive Food Stamps or Food Stamp benefits through the Supplemental Nutrition Assistance Program (SNAP)?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

H2. Between [Date1MY] and [Date2MY], did you receive TANF (Temporary Assistance for Needy Families), Family Assistance, Safety Net assistance, Rental/Housing assistance, or any cash assistance not including support money or childcare payments?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

H3. (IF A6a=1) (Between [Date1MY] and [Date2MY]), did you receive Child Support?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H4. (Between [Date1MY] and [Date2MY]), did you receive Supplemental Security Income or SSI?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

H5. (Between [Date1MY] and [Date2MY]), did you receive Social Security Disability Insurance, that is, SSDI or DI benefits?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

H6. What was your estimated total personal income for the year immediately prior to [Date2MY]? Please include all sources including your wages, public assistance, child support, food stamp benefits, etc.

$ ___ ___ ___ , ___ ___ ___ (GO TO H8a) (0-999,999)

DON’T KNOW 9999997

REFUSED 9999998 (GO TO H8a)

H7a. (IF H6=9999997) Would you say it was more or less than $1,500?

More than $1,500 1

Exactly $1,500 (GO TO H8a) 2

Less than $1,500 (GO TO H7c) 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H7b. (IF H7a=1) Would you say it was:

More than $1,500 but less than $2,000, (GO TO H8a) 1

At least $2000 but less than $2,500, or (GO TO H8a) 2

$2,500 or more (GO TO H8a) 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H7c. (IF H7a=3) Would you say it was:

At least $1,200 but less than $1,500 1

At least $800 but less than $1,200 2

At least $500 but less than $800, or 3

Less than $500? 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

For the next group of questions, please focus on the last month of our follow-up period, that is the month prior to [Date2MY], or from [LastMonth] to [Date2].

H8a. Where did you live the majority of time during that last month before [Date2]?

Your own place, (house, apt. or room) 1

Someone else’s place, (house, apt. or room) 2

Homeless, (car, shelter, on the street), 3

A treatment facility, 4

Transitional housing or halfway house, or 5

Prison or jail 6

Someplace else (Go to H8b and Specify)? 7

DON’T KNOW 97

REFUSED 98

H8b. (IF H8a=7) Please specify, _______________________________

H8c. (IF H8a=7) INTERVIEWER: DOES THE OTHER SPECIFY ENTERED INCLUDE A HOUSEHOLD WITH SHARED INCOME OR A FACILITY WITHOUT SHARED INCOME?

YES, SHARED INCOME 1

NO 2

H8d. (IF H8a=1 or 2 or If H8c=1) During that month, were you living alone or with others?

ALONE 1

WITH OTHERS 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

The following employment and income information relate to your entire household during that last month, from [LastMonth] to [Date2].Your household is considered anyone who lived with you or that you lived with, including relatives, friends or children.

H9. (IF H8d=2) During that month, did anyone else in your household work in a job for pay?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H10. (IF H8d=2) (From [LastMonth] to [Date2]), did anyone else in your household receive Food Stamp or Food Stamp benefits?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H11. (IF H8d=2) (From [LastMonth] to [Date2]), did anyone else in your household receive TANF (Temporary Assistance for Needy Families) or other cash assistance?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H12. (IF H8d=2) (From [LastMonth] to [Date2]), did anyone else in your household receive Child Support?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H13. (IF H8d=2) During that month, did anyone else in your household receive SSI?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H14. (IF H8d=2) (From [LastMonth] to [Date2]), did anyone else in your household receive SSDI or DI?

YES 1

NO 2

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

H15. (if H8d=2) During that month, what was the estimated total income before taxes of all members of your household including yourself from all sources, including all wages, public assistance, child support, food stamp benefits, etc.? $ ___ ___ ___ ,___ ___ ___ (GO TO H16) (0-999,999)

DON’T KNOW 9999997

REFUSED 9999998 (GO TO H16)

H15a. (IF H15=9999997) Would you say it was more or less than $1,500?

MORE THAN $1,500 1

EXACTLY $1,500 (GO TO H16) 2

LESS THAN $1,500 (GO TO H15c) 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H15b. (IF H15a=1) Would you say it was:

More than $1,500 but less than $2,000, (GO TO H16) 1

At least $2000 but less than $2,500, or (GO TO H16) 2

$2,500 or more (GO TO H16) 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H15c. (IF H15a=3) Would you say it was:

At least $1,200 but less than $1,500 1

At least $800 but less than $1,200 2

At least $500 but less than $800, or 3

Less than $500? 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H16. (IF H8a ne 6) In that month did you earn enough income to support yourself?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H17a. (IF H8a ne 6) (From [LastMonth] to [Date2]), did you receive money from someone else to help support you?

YES 1

NO (GO TO H18) 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H17b. (IF H17a=1) (From [LastMonth] to [Date2]), Who else provided you with money for your support? (Identify all that apply)

H17b1. Spouse/Girl/Boyfriend/Partner (YES 1,NO 2,NA 96,DK 97 REF 98)

H17b2. Parent(s) (YES 1,NO 2,NA 96,DK 97 REF 98)

H17b3. Other Family Members (YES 1,NO 2,NA 96,DK 97 REF 98)

H17b4. Child/children (YES 1,NO 2,NA 96,DK 97 REF 98)

H17b5. Roommate/Friend (YES 1,NO 2,NA 96,DK 97 REF 98)

H17b6. Other, GO TO H17b7. (YES 1,NO 2,NA 96,DK 97 REF 98)

H17b7.(IF H17b6=1) Please specify. ______________________

H18a. Between [LastYear] and [Date2-], did you file a federal tax return?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H18b. (IF H18a=1) For that tax return, did you receive the earned income tax credit (EITC)? (INTERVIEWER DEFINITION: The earned income credit (EITC) is a tax credit for certain people who work and have low wages. It reduces the amount of tax owed and may result in a refund.

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

H20. If you plan to file a federal tax return for the current year, do you plan on SEEKING the earned income tax credit (EITC)? (INTERVIEWER DEFINITION: The earned income credit (EITC) is a tax credit for certain people who work and have low wages. It reduces the amount of tax owed and may result in a refund.)

YES 1

NO 2

DO NOT PLAN ON FILING TAX RETURN 3

DON’T KNOW 97

REFUSED 98

SECTION J: HEALTH AND SUBSTANCE ABUSE

I will now ask questions about your health and any treatment you may have received in the (if group=1, insert three years) (if group=2, insert one year) between [Date1] and [Date2]. Remember that you can refuse to answer any question that makes you uncomfortable.

J1. Between [Date1MY] and [Date2MY], has there been a time when you needed to go to a doctor or the hospital but couldn’t because you didn’t have money or medical insurance?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J2. (Between [Date1MY] and [Date2MY],) has there been a time when you needed to see a dentist but couldn’t because you didn’t have money or medical insurance?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J3a. (Between [Date1MY] and [Date2MY],) did you make any visits to an emergency room or urgent care facility for any reason, either physical or emotional?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J3b. (IF J3a=1) How many visits to an emergency room or urgent care facility did you make during those [IF GROUP 1=12 months] [IF GROUP 2=36 months]?

________________ 1-52)

VISITS

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

J3c. (IF J3a=1) How many of those visits were for emergency care and not routine care?

________________ (0-52)

VISITS

N/A SKIPPED 96

DON’T KNOW 97

REFUSED 98

J4. Now I would like to ask you about your health. In general, would you say your health is:

Excellent, 1

Very Good, 2

Good, 3

Fair, or 4

Poor? 5

DON’T KNOW 97

REFUSED 98

J5a. Now I’d like you to only think about that last month between [LastMonth] and Date2]. Did your physical health limit you in the kind of work or other activities you could perform?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J5b. (IF J5a=1) How much did your physical health interfere with your normal work including both work outside the home and housework during that month? Would you say:

Not at all, 1

A little bit, 2

Moderately, 3

Quite a bit, or 4

Extremely? 5

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

J6a. Again thinking about that month, did any emotional problems limit you in the kind of work or other activities you could perform?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J6b. (IF J6a=1) How much did your emotional problems interfere with your normal work including both work outside the home and housework during that month? Would you say:

Not at all, 1

A little bit, 2

Moderately, 3

Quite a bit, or 4

Extremely? 5

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

J7. (IF J5a or J6a =1) During that month, how much of the time did your physical health or emotional problems interfere with your social activities (like visiting with friends, relatives, etc.)? Would you say:

All of the time, 1

Most of the time, 2

Some of the time, 3

A little of the time, or 4

None of the time? 5

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

J8a. Between [Date1] and [Date2], at any point were you in a treatment program for substance abuse?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J8b. (IF J8a=1) Was this treatment mandated or a condition of parole?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

J8c. (IF J8a=1) Were you in any treatment programs during the last month, between [LastMonth] and (Date2]?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

J8d. (IF J8c=1) Which programs were you in during that month? READ EACH, CIRCLE ALL THAT APPLY

J8d1. Detoxification? (YES 1,NO 2,NA 96,DK 97 REF 98)

J8d2. Out patient – drug free? (YES 1,NO 2,NA 96,DK 97 REF 98)

J8d3. Medicinal, such as

Methadone? (YES 1,NO 2,NA 96,DK 97 REF 98)

J8d4. Residential? (YES 1,NO 2,NA 96,DK 97 REF 98)

J8d5. Self-help groups, such as Alcoholics Anonymous or Narcotics Anonymous? (YES 1,NO 2,NA 96,DK 97 REF 98)

J8d6. Other type, not counting self help? (Go to J8d7)

(YES 1,NO 2,NA 96,DK 97 REF 98)

J8d7. (IF J8d6=1) Please specify. _____________________

J9a. During that month, did you use any illegal drugs or prescription drugs without an authorized prescription?

YES 1

NO 2

DON’T KNOW 97

REFUSED 98

J9b. (IF J9a=1) How frequently would you say you used such drugs during that time?

Every day, 1

A few days per week, but not daily 2

A few days per month, or 3

Once or twice? 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

J10. In that last month, on how many days did you have 5 or more drinks in a row, that is, within a couple of hours?

0 DAYS 1

1 TO 7 DAYS 2

8 TO 14 DAYS 3

15 OR MORE DAYS 4

DON’T KNOW 97

REFUSED 98

SECTION K: CHILD SUPPORT

(PROGRAMMER: SKIP THIS SECTION IF A6a NE 1)

This next section asks questions about support for your child(ren).

K1a. From [Date1] to [Date2], at any point were you required by a court to pay child support for any child or children living away from you?

YES 1

NO (GO TO SECTION L) 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K1b. (IF K1a=1) How many children were you required to pay child support for?

_______________ NUMBER OF CHILDREN (1-15)

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K1c1. (IF K1b=1) What amount were you required to pay?

(IF K1b>1) What is the total amount you were required to pay for all children?

$ ___ ___ ___ ___ (1-9994

AMOUNT

NA/SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

K1c2. Is that:

Per week 1

Every other week, 2

Per month, or 3

Some other time period? (Go to K1c3) 4

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K1c3. (IF K1c2=4) Specify. __________________________

K2. (IF K1a=1) Are you currently required to pay child support through the child support enforcement system?

YES 1

NO (GO TO K3a) 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K2a. (IF K2=1) Thinking of the last month before [Date2] did you pay child support through the child support enforcement system?

YES 1

SOME OF IT 2

NO 3

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K2b. (IF K2a=1 or 2) How much child support did you actually pay through the child support enforcement system in that month? ROUND TO WHOLE DOLLARS.

$ ___ ___ ___ ___ (0-9994)

AMOUNT

NA/SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

K3a. (IF K1a=1) During the six month period prior to [Date2], or between [Last6Month] and [Date2], did you directly give any money or other kind of child support to the custodial parent or guardian that was not paid through the child support enforcement system?

YES 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K3b. (IF K3a=1) During that six month period, did you provide:

K3b1. MONEY (YES 1,NO 2,NA 96,DK 97 REF 98)

K3b2. FOOD (YES 1,NO 2,NA 96,DK 97 REF 98)

K3b3. CLOTHING (YES 1,NO 2,NA 96,DK 97 REF 98)

K3b4. SOMETHING ELSE (YES 1,NO 2,NA 96,DK 97 REF 98)

K3c. (IF K3b1=1). Approximately how much money did you provide, not counting child support required by a court?

$ ___ ___ ___ ___ (0-9994)

AMOUNT

NA/SKIPPED 9996

DON’T KNOW 9997

REFUSED 9998

K3d. (IF K3b1=1) How many children did this cover?

___ ___ ___ ___ (1-15)

NUMBER

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

K4a. (IF K1a=1) From [Date1] to [Date2], did any concerns about owing child support affect your willingness to accept jobs that were offered to you?

YES 1

NO (GO TO SECTION L) 2

NA/SKIPPED (GO TO SECTION L) 96

DON’T KNOW (GO TO SECTION L) 97

REFUSED (GO TO SECTION L) 98

K4b. (IF K4a=1) Please explain: __________________________________________________

SECTION L: LOCATING

L5. This concludes the interview. Thank you very much for your willingness to answer our questions. We will send a check for {$40 } to you at [ADDRESS]. Is this address correct? ______________

YES (GO TO L7) 1

NO 2

L6. Please tell me the correct address. __________________________________________________

L7. INTERVIEWER: WOULD THE R LIKE A CHECK OR POSTAL MONEY ORDER?

CHECK 1

POSTAL MONEY ORDER 2

ALREADY PAID 3

ALTERNATE ARRANGEMENT 4

L8. Before sending the check or money order, my supervisor may contact you for feedback on our interview today and to verify your mailing information. Is this the best number to reach you _____________?

YES 1

NO (GO TO L9) 2

L9. Please tell me the best number to reach you. _________________________________________

L10a. Is there a better way to reach you?

YES (Go to L10b and specify) 1

NO 2

NA/SKIPPED 96

DON’T KNOW 97

REFUSED 98

L10b. (IF L10a=1) Please specify the best way to reach you? ____________

L11. If you have questions about this survey or this research study, please call the RExO toll-free number at 866-774-1637.Thank you.

L12: PLEASE ENTER ANY COMMENT YOU MAY HAVE

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