The American Community Survey

Attachment M

AMERICAN COMMUNITY SURVEY
Questions in Computer-assisted Telephone Interviewing (CATI) Failed Edit Follow Up (FEFU)
That Differ from Those in the Paper Questionnaire
Paper Questionnaire Item Number: Roster
FEFU Screen Name: USTATVER
On (RDATE), was there anyone living or staying at this address for more than two months?

***NOTE: RDATE stands for the Response Date, or the estimated date the respondent completed the
questionnaire.
FEFU Screen Name: CJIC2
On (RDATE) was this housing unit....?
Temporarily Occupied
acant
a Group Quarters
for Commercial Use Only

FEFU Screen Name: CJIC3
On (RDATE) was this housing unit....?
❍1. For rent
❍2. Rented, not occupied
❍3. For sale only
❍4. Sold, not occupied
❍5. For seasonal, recreational or occasional use
❍6. For migrant workers
❍7. Other vacant

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FEFU Screen Name: VACOTH
Why is this unit vacant?
❍1. Foreclosure
❍2. Personal/Family Reasons
❍3. Legal Proceedings
❍4. Preparing to Rent/Sell
❍5. Held for Storage of Household Furniture
❍6. Needs Repair
❍7. Currently Being Repaired/Renovated
❍8. Specific Use Housing
❍9. Extended Absence
❍10. Abandoned Possibly to be Demolished/Possibly Condemned
❍11. Other

FEFU Screen Name: CJIC4
How many months has this unit been vacant?
❍1. Less than 1 month
❍2. 1 up to 2 months
❍3. 2 up to 4 months
❍4. 4 up to 6 months
❍5. 6 up to 12 months
❍6. 12 up to 24 months
❍7. 24 or more months

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FEFU Screen Name: CoverageP
[I’d like to make sure that we’ve included everyone. I see that the household size ( / ) but we have data for
persons.]
I have listed: () How many people were here for more than two months on
()?
01 Sally

P

Smith

02 John

D

Smith

03 Brandon C

Smith

04
05
06
07
.
.
.
20

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FEFU Screen Name: LN_PG2, FN_PG2, MI_PG2
(Last/First) Name (MI)
(INCLUDE everyone living or staying here for more than two months.
INCLUDE anyone else staying here who does not have another place to stay even if they are
here for two months or less.
DO NOT INCLUDE anyone who is living somewhere else for more than two months, such as a
college student living away.)

Paper Questionnaire Item Number: Demographic 3
FEFU Screen Name: SEX

(Are you /Is ) male or female?

Paper Questionnaire Item Number: Demographic 4
FEFU Screen Name: P2DOB

What is (’s/your) date of birth?
♢ Enter the month/day/4-digit year

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FEFU Screen Name: AGEP
So that makes (/you) as of ?
Is that correct?
❍ 1. Yes
❍ 2. No

FEFU Screen Name: AGEVER
When I calculate {’s/your} age from the birth date provided, that makes
{/you} as of , but age given on the questionnaire was
. Which is correct as of ?
❍1.
❍2.
❍3. Neither

FEFU Screen Name: AGEASK
How old {was/were you} as of ?

Paper Questionnaire Item Number: Demographic 5
FEFU Screen Name: HISW
What is that origin?
(For example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so
on.)

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Paper Questionnaire Item Number: Demographic 6
FEFU Screen Name: RAC
What is (’s/your) race? You may choose one or more races. For this survey, Hispanic
origin is not a race.
♦ Enter all that apply, separate with commas.
21. Native Hawaiian
Black or African
American
Alaska Native

Guamanian or Chamorro
Samoan
(For
example, Hmong, Laotian,
Thai, Pakistani, Cambodian,
and so on.)

Other Pacific Islander
(For example, Fijian, Tongan,
and so on.)

FEFU Screen Name: RCW1
What is (his/her/your/’s) enrolled or principal tribe? You may list one or more tribes.

FEFU Screen Name: RCW2
If RAC is <20>:
What is that other Asian group?
(For example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.)
If RAC is <24>:
What is that other Pacific Islander group?
(For example, Fijian, Tongan, and so on.)
If RAC is <20> and <24>
What is that other Asian group and other Pacific Islander group?
(For example, Hmong, Laotian, Thai, Pakistani, Cambodian, Fijan, Tongan, and so on.)

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FEFU Screen Name: RCW3

What is {his/her/’s/your} other race group?

Paper Questionnaire Item Number: Housing 2
FEFU Screen Name: YBL
About when was this first built?
(If you do not know exact year, give your best estimate.)

-1999
-1989
-1979
-1969
-1959
-1949

FEFU Screen Name: YBLW
(What year was this built?)

Paper Questionnaire Item Number: Housing 3
FEFU Screen Name: MVM
When did (you/) move into this ?
♢ Select month

FEFU Screen Name: MVY
When did (you/) move into this ?
♢ Enter the year the household moved into this (mobile home/ house/ apartment/ unit).

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Paper Questionnaire Item Number: Housing 7b
FEFU Screen Name: BDS
How many of these rooms are bedrooms?
Count as bedrooms those rooms you would list if this were for sale or rent. If this is an efficiency/studio apartment, you would not count
any bedrooms.

Paper Questionnaire Item Number: Housing 8a
FEFU Screen Name: RWATPR (Puerto Rico Only)
Does this have running water?

Paper Questionnaire Item Number: Housing 8b
FEFU Screen Name: HOTWAT (Puerto Rico Only)
Does this have a water heater?

Paper Questionnaire Item Number: Housing 9a
FEFU Screen Name: LAPTOP
At this do you or any member of this household
own or use a desktop, laptop, netbook, or notebook computer? EXCLUDE GPS devices,
digital music players, and devices with only limited computing capabilities, for example:
household appliances.

Paper Questionnaire Item Number: Housing 9b
FEFU Screen Name: HANDHELD
At this do you or any member of this household
own or use a handheld computer, smart mobile phone, or other handheld wireless
computer? EXCLUDE GPS devices, digital music players, and devices with only limited
computing capabilities, for example: household appliances.

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Paper Questionnaire Item Number: Housing 9b
FEFU Screen Name: COMPOTH
At this do you or any member of this household
own or use some other type of computer?
EXCLUDE GPS devices, digital music players, and devices with only limited computing
capabilities, for example: household appliances.

FEFU Screen Name: COMPOTHW
What is this other type of computer?

Paper Questionnaire Item Number: Housing 10
FEFU Screen Name: WEB
At this do you or any member of this household
access the Internet?

FEFU Screen Name: ACCESS
At this do you or any member of this household
access the Internet with or without a subscription to an Internet service?
1) With a subscription to an Internet service
2) Without a subscription to an Internet service

Paper Questionnaire Item Number: Housing 11a
FEFU Screen Name: DIALUP
At this do you or any member of this household
subscribe to the Internet using dial-up service?

Paper Questionnaire Item Number: Housing 11b
FEFU Screen Name: DSL
At this do you or any member of this household
subscribe to the Internet using DSL service?

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Paper Questionnaire Item Number: Housing 11c
FEFU Screen Name: MODEM
At this do you or any member of this household
subscribe to the Internet using a cable modem service?

Paper Questionnaire Item Number: Housing 11d
FEFU Screen Name: FIBEROP
At this do you or any member of this household
subscribe to the Internet using a fiber-optic service?

Paper Questionnaire Item Number: Housing 11e
FEFU Screen Name: BROADBND
At this do you or any member of this household
subscribe to the Internet using a mobile broadband plan for a computer or a cell phone?

Paper Questionnaire Item Number: Housing 11f
FEFU Screen Name: SATELITE
At this do you or any member of this household
subscribe to the Internet using satellite Internet service?

Paper Questionnaire Item Number: Housing 11g
FEFU Screen Name: OTHSVCE
At this do you or any member of this household
subscribe to the Internet using some other service?

FEFU Screen Name: OTHSVCEW
What is this other type of Internet service?

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Paper Questionnaire Item Number: Housing 14a
FEFU Screen Name: ELE
LAST MONTH, what was the cost of electricity for this ?

FEFU Screen Name: ELEX
Was the electricity -- Included in rent or condominium fee, or No charge for electricity or
electricity not used?

Paper Questionnaire Item Number: Housing 14b
FEFU Screen Name: GAS
LAST MONTH, what was the cost of gas for this ?

FEFU Screen Name: GASX
Was the gas -- Included in rent or condominium fee, Included in electricity payment, or No
charge or gas not used?

Paper Questionnaire Item Number: Housing 14c
FEFU Screen Name: WAT
IN THE PAST 12 MONTHS, what was the cost of water and sewer for this ?

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FEFU Screen Name: WATX
Was the water and sewer -- Included in rent or condominium fee, or
No charge for water or sewer?

Paper Questionnaire Item Number: Housing 14d
FEFU Screen Name: FUL
IN THE PAST 12 MONTHS, what was the cost of oil, coal, kerosene, wood, etc., for this
?

FEFU Screen Name: FULX
Were the Other Fuel costs -- Included in the rent or condominium fee, or No charge or
these fuels are not used?

charge, or these fuels not used

Paper Questionnaire Item Number: Housing 16
FEFU Screen Name: CONX
Is this part of a condominium?

FEFU Screen Name: CON
What is the monthly condominium fee?

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Paper Questionnaire Item Number: Housing 18a
FEFU Screen Name: RenterRN
What is the monthly rent?
♢ Estimate monthly rent in dollars.

Paper Questionnaire Item Number: Person 7
FEFU Screen Name: PBX1
Where (was /were you) born?

FEFU Screen Name: PBW2 (if PBX1 = 1)
In what state was that?

FEFU Screen Name: PBW3 (if PBX1 = 2)
In what country (were you/was )born?

Paper Questionnaire Item Number: Person 8
FEFU Screen Name: CIT
(Is /Are you) a CITIZEN of the United States?
(How was the citizenship obtained?)
Yes, born in the United States
Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands or Northern Marianas
Yes, born abroad of U.S. citizen parent or parents
Yes, a U.S. citizen by naturalization
No, not a U.S. citizen

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FEFU Screen Name: CITW
In what year did (/you) become a naturalized citizen of the United States?

Paper Questionnaire Item Number: Person 13
FEFU Screen Name: SCHG
What grade or level (was / were you) attending?
Nursery school, preschool
Kindergarten
Grade 1 through 12
College undergraduate years (freshman to senior)
Graduate or professional school beyond a bachelor’s degree (for example: MA
or PhD program, or medical or law school)

FEFU Screen Name: SCHGW
(What grade (was / were you) attending?)

Paper Questionnaire Item Number: Person 13
FEFU Screen Name: SCHL
What is the highest degree or level of school ( has/you have) COMPLETED?
No schooling completed
Nursery school
Kindergarten
Grade 1 through 11
12th grade - NO DIPLOMA
Regular high school diploma
GED or alternative credential
Some college credit, but less than 1 year of college credit
1 or more years of college credit, no degree
Associate’s degree (for example: AA, AS)
Bachelor’s degree (for example: BA, BS)
Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA)

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Professional degree beyond a bachelor’s degree (for example: MD, DDS,
DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

FEFU Screen Name: SCHLW (if SCHG = 3)
(What is the highest grade ( has/you have) COMPLETED?)

Paper Questionnaire Item Number: Person 17
FEFU Screen Name: MIG
Did (/you) live in this 1 year ago?

Person is under 1 year old
Yes, this house
No, outside the United States and Puerto Rico
No, different house in the United States or Puerto Rico

FEFU Screen Name: MGW1 (if MIG = 3)
What was the foreign country?

FEFU Screen Name: MGW2 (if MIG = 4)
Where did (/you) live 1 year ago? What was the street address?

FEFU Screen Name: MGW3 (if MIG = 4)
What was the city, town, or post office?

FEFU Screen Name: MGW4 (if MIG = 4)
What was the U.S. county or municipio in Puerto Rico?

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FEFU Screen Name: MGW5 (if MIG = 4)
What was the U.S. state, or was that in Puerto Rico?

FEFU Screen Name: MGW6 (if MIG = 4)
What was the ZIP code?

Paper Questionnaire Item Number: Person 18
FEFU Screen Name: HINS1
(Are you/Is ) currently covered by health insurance through a current or former
employer or union of (yours/ or another family member)?

FEFU Screen Name: HINS2
(Are you/Is ) currently covered by health insurance purchased directly from an
insurance company by (you/you or another family member/ or another family
member)?

FEFU Screen Name: HINS3
(Are you/Is ) currently covered by Medicare, for people age 65 or older or people
with certain disabilities?

FEFU Screen Name: HINS4
(Are you/Is ) currently covered by Medicaid, Medical Assistance, or any kind of
government-assistance plan for those with low incomes or a disability?

FEFU Screen Name: HINS5
(Are you/Is ) currently covered by TRICARE or other military health care?

FEFU Screen Name: HINS6
(Are you/Is ) currently covered through the VA or have you ever used or enrolled
for VA health care?

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FEFU Screen Name: HINS7
(Are you/Is ) currently covered through the Indian Health Service?
FEFU Screen Name: HINS8
(Are you/Is ) currently covered by any other health insurance or health coverage
plan?

FEFU Screen Name: HINSW
What is the name of the health care plan?

Paper Questionnaire Item Number: Person 17a
FEFU Screen Name: HIEPREM
Previously you reported (you were/ was) covered by the following types of
insurance or health coverage: (list previously reported health insurance from original
interview).
Is there a monthly premium for this plan? A monthly premium is a fixed amount of money
people pay each month to have health coverage. It does not include copays or other expenses
such as prescription costs.
❍ 1. Yes
❍ 2. No

Paper Questionnaire Item Number: Person 17b
FEFU Screen Name: HIESUBSID
Previously you reported (you were/ was) covered by the following types of
insurance or health coverage: (list previously reported health insurance from original
interview).
Is the cost of the premium subsidized based on family income?
❍ 1. Yes
❍ 2. No

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Paper Questionnaire Item Number: Person 21
FEFU Screen Name: MAR
(Is /Are you) married, widowed, divorced, separated, or never married?
1. Now married
2. Widowed
3. Divorced
4. Separated
5. Never married

Paper Questionnaire Item Number: Person 22
FEFU Screen Name: MARHM
In the past 12 months, did (/you) get married?

FEFU Screen Name: MARHW
In the past 12 months, did (/you) become a ()?

FEFU Screen Name: MARHD
In the past 12 months, did (/you) get divorced?

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Paper Questionnaire Item Number: Person 23
FEFU Screen Name: MARHT
How many times (has /have you) been married? Is that -1. Once
2. Two times
3. Three or more times

Paper Questionnaire Item Number: Person 27
FEFU Screen Name: VET
(Has /Have you) ever served on ACTIVE DUTY in the U.S. Armed Forces, Reserves, or
National Guard?

FEFU Screen Name: TRAINING
{Was /Were you} on active duty ONLY FOR TRAINING in the Reserves or National
Guard?

FEFU Screen Name: ACTIVE
{Is /Are you} currently on active duty?

FEFU Screen Name: RESERVES
{Has / Have you} ever been in the Reserves or National Guard?

Paper Questionnaire Item Number: Person 30a
FEFU Screen Name: WRK
During the week of (), did (/you) do any work for pay at a job or
business?
(Include any work even if (/you) worked only 1 hour, or helped without pay in a
family business or farm for 15 hours or more, or (was/were) on active duty in the Armed
Forces.)

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Paper Questionnaire Item Number: Person 30b
FEFU Screen Name: WRKJ
During the week of (), did (/you) do ANY work for pay, even for as little
as one hour?

Paper Questionnaire Item Number: Person 31a
FEFU Screen Name: PWW1
During the week of (), at what location did (/you) work?
(What is the street number and street name of the location?)

Paper Questionnaire Item Number: Person 31b
FEFU Screen Name: PWW2
What is the city, town, or post office where {/you} worked during the week of
{} ?

Paper Questionnaire Item Number: Person 31d
FEFU Screen Name: PWW4
What is the name of the county where (/you) worked during the week of
()?

Paper Questionnaire Item Number: Person 31e
FEFU Screen Name: PWW5
What is the state or foreign country where (/you) worked during the week of
()?

Paper Questionnaire Item Number: Person 31f
FEFU Screen Name: PWW6
What is the ZIP Code where (/you) worked during the week of ()?

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Paper Questionnaire Item Number: Person 32
FEFU Screen Name: JWTR
During the week of () how did (/ you) USUALLY get to work?

trolley bus

. Ferryboat

Paper Questionnaire Item Number: Person 33
FEFU Screen Name: JWRI
During the week of (), how many people, including (/you) usually rode
to work in the car, truck, or van?

Paper Questionnaire Item Number: Person 34
FEFU Screen Name: JWLH
During the week of (), what time did (/you) usually leave for work?
(what hour?)

FEFU Screen Name: JWLM
(-- minutes past that hour?)

FEFU Screen Name: JWAM
(-- was that AM or PM?)
1. AM
2. PM

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Paper Questionnaire Item Number: Person 35
FEFU Screen Name: JWMN
During the week of (), how many minutes did it usually take (/you) to
get from home to work?

Paper Questionnaire Item Number: Person 36a
FEFU Screen Name: NWLA
During the week of (), (was /were you) on layoff from a job?

Paper Questionnaire Item Number: Person 36b
FEFU Screen Name: NWAB
During the week of (), (was /were you) TEMPORARILY absent from a
job or business?
on vacation, temporary illness, maternity leave, other family/personal reasons, bad
weather, etc.

Paper Questionnaire Item Number: Person 36c
FEFU Screen Name: NWRE
As of the week of (), had (/you) been informed that (/you)
would be recalled to work within the next six months OR been given a date to return to
work?

Paper Questionnaire Item Number: Person 37
FEFU Screen Name: NWLK
As of the week of (), during the LAST 4 WEEKS, had (/you) been
ACTIVELY looking for work?

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Paper Questionnaire Item Number: Person 38
FEFU Screen Name: NWAV
During the week of (), could (/you) have started a job if offered one, or
returned to work if recalled?
YES, could have gone to work
NO, because of temporary illness
NO, because of all other reasons (in school, etc.)

Paper Questionnaire Item Number: Person 43
FEFU Screen Name: INX1
((Was / Were you) working on Active Duty in the US Armed forces?)

Paper Questionnaire Item Number: Person 48
FEFU Screen Name: P8_INTRO
Next I’ll ask about income during the last 12 months—that is, from {} to {}.
❒ 1. Continue

Paper Questionnaire Item Number: Person 48a
*If respondent has provided a monetary response in 48a of the paper form, (s)he is asked WAGX.
FEFU Screen Name: WAGX
Did {/you} receive any wages, salary, commissions, bonuses or tips DURING THE
PAST 12 MONTHS?

*If respondent has not provided a monetary response in 48a of the paper form, (s)he is asked the
following four questions, in lieu of WAGX.
FEFU Screen Name: EARNX
Did receive any wages or salary DURING THE PAST 12 MONTHS?

FEFU Screen Name: EARN

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How much did {/you} receive in wages and salary from all jobs before taxes and
deductions DURING THE PAST 12 MONTHS?

FEFU Screen Name: TIPSX
Did {/you} receive any [if EARNX=yes, fill with "additional"] tips, bonuses or
commissions DURING THE PAST 12 MONTHS?

FEFU Screen Name: TIPS
How much did {/you} receive in tips, bonuses, or commissions from all jobs before
taxes and deductions DURING THE PAST 12 MONTHS?

Paper Questionnaire Item Number: Person 48b
FEFU Screen Name: SEMX
IN THE PAST 12 MONTHS, did (/you) receive any self-employment income from
own nonfarm businesses or farm businesses, including proprietorships and partnerships?

FEFU Screen Name: SEM
IN THE PAST 12 MONTHS, what was the amount of the self-employment income that
(/you) received?

FEFU Screen Name: SEML
Was that self-employment income a loss?

Paper Questionnaire Item Number: Person 48c
*If respondent has provided a monetary response in 48c of the paper form, (s)he is asked INTRESTX.
FEFU Screen Name: INTRESTX
IN THE PAST 12 MONTHS, did (/you) receive any interest, dividends, net rental
income, royalty income or income from estates and trusts?

*If respondent has not provided a monetary response in 48a of the paper form, (s)he is asked the
following six questions, in lieu of INTRESTX.

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FEFU Screen Name: INTRX
Did receive any interest or dividends [DURING THE PAST 12 MONTHS]?
Report even small amounts credited to an account.

FEFU Screen Name: INTR
What was the amount?

FEFU Screen Name: RENTX
Did receive any net rental income DURING THE PAST 12 MONTHS?
Net rental income is the total amount after expenses.

FEFU Screen Name: RENT
How much did {/you} receive in tips, bonuses, or commissions from all jobs before
taxes and deductions DURING THE PAST 12 MONTHS?

FEFU Screen Name: ROYALX
Did receive any royalty income or income from estates and trusts DURING
THE PAST 12 MONTHS?

FEFU Screen Name: ROYAL
Was that interest, dividends, net rental income, royalty income or income from estates
and trusts income a loss?

Paper Questionnaire Item Number: Person 48d
FEFU Screen Name: SS
IN THE PAST 12 MONTHS, did (/you) receive any Social Security or Railroad
Retirement income?

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FEFU Screen Name: SSX
IN THE PAST 12 MONTHS, what was the amount of the Social Security or Railroad
Retirement income that (/you) received?

Paper Questionnaire Item Number: Person 48e
FEFU Screen Name: SSIX
IN THE PAST 12 MONTHS, did (/you) receive any Supplemental Security Income
(SSI)?

FEFU Screen Name: SSI
IN THE PAST 12 MONTHS, what was the amount of the Supplemental Security Income (SSI)
that (/you) received?

Paper Questionnaire Item Number: Person 48f
FEFU Screen Name: PAX
IN THE PAST 12 MONTHS, did (/you) receive any public assistance or public
welfare income?

FEFU Screen Name: PA
IN THE PAST 12 MONTHS, what was the amount of the public assistance or public welfare
income that (/you) received?

Paper Questionnaire Item Number: Person 48g
FEFU Screen Name: RETX
IN THE PAST 12 MONTHS, did (/you) receive any retirement, survivor or disability
pensions?

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FEFU Screen Name: RET
IN THE PAST 12 MONTHS, what was the amount of the retirement, survivor or disability
pension that (/you) received?

Paper Questionnaire Item Number: Person 48h
FEFU Screen Name: OIX
IN THE PAST 12 MONTHS, did (/you) receive any other income on a REGULAR
basis, such as -- VA payments, unemployment compensation, child support or alimony?
(Include all reoccurring income. Do not include one-time lump sum payments such as
refunds, inheritances, withdrawals from savings or IRAs, etc.)

FEFU Screen Name: OI
IN THE PAST 12 MONTHS, what was the amount of the other income that (/you)
received?

Paper Questionnaire Item Number: Person 49
FEFU Screen Name: TI
What was the total income for (/you) for the PAST 12 MONTHS?

FEFU Screen Name: TIN
I have recorded that {/you} received no income IN THE PAST 12 MONTHS. Is that
correct?

FEFU Screen Name: TIL
Was that income a loss?

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