Form ASEC Questionnaire ASEC Questionnaire ASEC Questionnaire

Attachment A

2014 Annual Social and Economic Supplement

Items Booklet - Feb/March/April 2014

2014 ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT

CPS FIELD REPRESENTATIVE / CATI INTERVIEWER

ITEMS BOOKLET

This document does not contain any Title 13 data or other Personally Identifiable Information. All data are fictitious and any resemblance to actual data is coincidental. Consistent with Field Division Policy, any names referenced in practice interviews or other exercises are not meant to refer to any actual businesses, schools, group quarters, or persons, especially any current or former Census Bureau employees.

MOVER ITEMS

HH32b

Did (you/name of reference person) live at this address during the week of November 19, 2013?

1 Yes

2 No

HH32d

Did any of the following household members live here during the week of

November 19, 2013?

1. Yes

2. No

FAMILY INCOME

S_FAMINC

Which category represents the total combined income of all members of this FAMILY during the past 12 months?

This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, social security payments and any other money income received by members of this family who are 15 years of age or older?

1 Less than $5,000 9 30,000 to 34,999

2 5,000 to 7,499 10 35,000 to 39,999

3 7,500 to 9,999 11 40,000 to 49,999

4 10,000 to 12,499 12 50,000 to 59,999

5 12,500 to 14,999 13 60,000 to 74,999

6 15,000 to 19,999 14 75,000 to 99,999

7 20,000 to 24,999 15 100,000 to 149,000

8 25,000 to 29,999 16 150,000 to more

INCDKR

Is the combined income of all members of this FAMILY during the past 12 months above or below $75,000?

1. Above

2. Below

INTRODUCTION

Pr_incom

?[F1] Importance of responding

Wording of introduction is optional.

The questions you just answered were about your job and economic status last week. The next set of questions ask about your job and economic status last year.

1 Enter 1 to Continue

WORK EXPERIENCE

Q29a

Did (name/you) work at a job or business at any time during 2013?

1. Yes

2. No

Q29b

Did (you/he/she) do any temporary, part-time, or seasonal work even

for a few days during 2013?

1. Yes

2. No

Q30

Even though (name/you) did not work in 2013, did (you/he/she) spend any time trying to find a job or on layoff?

1. Yes

2. No

Q31

How many different weeks (was/were) (name/you) looking for work or on layoff from a job?

 (01-52) Number of weeks

________________

Q32

What was the main reason (you/he/she) did not work in 2013?

Read categories if necessary

1. Ill, or disabled and unable to work

2. Retired

3. Taking care of home or family

4. Going to school

5. Could not find work

6. Doing something else

Q33

During 2013 in how many weeks did (name/you) work even for a few hours?
Include paid vacation and sick leave as work.

(01-52) Number of weeks

Enter 97 if respondent can only answer in months

________________

Q33mon

 Enter number of months worked

(1-12)

________________

Q33ver

Then (name/you) worked about (number) weeks. Is that correct?

1. Yes

   0. 2 No – back to Q33 and obtain estimate

Q35

Did (name/you) lose any full weeks of work in 2013 because (you/he/she)

(were/was) on layoff from a job or lost a job?

Number of weeks worked in 2013: (number)

1. Yes

   0. 2 No

   1. 7 Mistake made in number of weeks worked last year - Specify in Q35SP

Q35SP

Specify mistake made in number of weeks worked last year

_________________________________________________

Q36

You said (name/you) worked about (number) (week/weeks).

How many OF THE REMAINING (number) WEEKS (was/were)
(you/he/she) looking for work or on layoff from a job?

Enter 0 for none

________________

Q37

Were the (number) weeks (name/you) (was/were) looking for work or on layoff all in one stretch?

1. Yes – one stretch

2. No – two stretches

3. No – 3 or more stretches

Q38

What was the main reason (name/you) (was/were) not working or looking for work in the remaining weeks of 2013?

Read list only if respondent is having difficulty answering the question

1. Ill, or disabled and unable to work

2. Taking care of home or family

3. Going to school

4. Retired

5. No work available

6. Other   (Specify - Q38sp)

Q38sp

 Enter verbatim response

_________________________________________________

Q39

For how many employers did (name/you) work in 2013?
If more than one at the same time, only count it as one employer.

1. One

2. Two

3. Three or more

Q41

In the (one week/weeks) that (name/you) worked, how many hours did (you/he/she) (work that week?/usually work per week?)

Enter number of hours

________________

Q43

During 2013, were there one or more weeks in which (name/you) worked less than 35 hours?

Exclude time off with pay because of holidays, vacation, days off, or sickness.

1. Yes

2. No

Q44

In the weeks that (name/you) worked, how many weeks did (name/you) work less than 35 hours in 2013?

 Number of weeks worked in 2013: (number)
(Number of weeks was reported in item Q33)

(1-52)

________________

Q45

What was the main reason (name/you) worked less than 35 hours per week?

 Read list only if respondent is having difficulty answering the question

1. Could not find a full time job

2. Wanted to work part time or only able to work part time

3. Slack work or material shortage

4. Other reason

Q46

What was (name's/your) longest job during 2013?

Was it:

(IO1NAM:) (name of employer)

(IO1IND:) (kind of business or industry)

(IO1OCC:) (occupation)

(IO1DT:) (duties)

CLASS OF WORKER: (PRIVATE/FEDERAL GOVERNMENT/STATE GOVERNMENT/LOCAL GOVERNMENT/WORKING WITHOUT PAY IN FAMILY BUS./SELF EMPLOYED--INCORPORATED/SELF EMPLOYED--UNINCORPORATED)

1. Same as listed

2. Different job

Q47a

For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job during 2013?))

Name of Company, business, organization or other employer

      

(blank/( IO1NAM:) (entry)

The current employer is pre-filled in the Form Pane below. Press ENTER if Same)

(blank/ If longest job last year is military job, enter Armed Forces)

(blank/ Enter N for no work done at all during 2013)

_________________________________________________

Q47b

What kind of business or industry is this?

For example: TV and radio manufacturing, retail shoe store, farm

(blank/( IO1IND:) (entry)

The current business or industry type is pre-filled in the Form Pane below. Press ENTER if Same)

(blank/ If longest job last year is military job, enter NA)

_________________________________________________

Q47b1

Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?

(blank/( IO1MFG:) (entry)

The current business or organization type is pre-filled in the Form Pane below. Press ENTER if Same)

(blank/ If longest job last year is military job, enter 4)

1. Manufacturing

2. Retail

3. Wholesale trade

4. Something else

Q47c

What kind of work (was/were) (you/he/she) doing?

For example: Electrical Engineer, Stock Clerk, Typist

(blank/( IO1OCC:) (entry)

The current occupation is pre-filled in the Form Pane below. Press ENTER if Same)

(blank/ If longest job last year is military job, enter Armed Forces)

_________________________________________________

Q47d1

What were (your/his/her) most important activities or duties?

For example: Types, keeps account books, files, sells cars, operates printing press, finishes concrete.

(blank/( IO1DT:) (entry)

The current job description is pre-filled in the Form Pane below. Press ENTER if Same)

(blank/ If longest job last year is military job, enter NA)

_________________________________________________

Q47d2

What were (your/his/her) most important activities or duties?

For example: Types, keeps account books, files, sells cars, operates printing press, finishes concrete.

(blank/( IO1DT:) (entry)

The current job description is pre-filled in the Form Pane below. Press ENTER if Same)

(blank/ If longest job last year is military job, enter NA)

_________________________________________________

Q47E1

 Ask Only If Necessary

(Were/Was) (you/he/she) employed by government, by a PRIVATE company, a nonprofit organization, or (was/were) ( you/he/she) self-employed or working in a family business?

1. Government

2. Private for profit company

3. Non profit organization including tax exempt and charitable organizations

4. Self employed

5. Working in family business

Q47E1a

Would that be the federal, state, or local government?

1. Federal

2. State

3. Local (county, city, township)

Q47E1b

Was this business incorporated?

1. Yes

2. No

Q47E1c

(Were/Was) (you/name) the owner of the business?

1. Yes

2. No

Q4788

Counting all locations where (this employer/(name/you)) (operates/operate), what is the total number of persons who work for ((name's/your) employer)/name/you))?

Read categories if necessary

1. under 10

2. 10-49

3. 50-99

4. 100-499

5. 500-999

6. 1,000+

EARNED INCOME

Q48aa

How much did (name/you) earn from this employer before taxes and other deductions during 2013?

Enter dollar amount

Enter 0 for none

________________

Q48aarn1 Ask only if the respondent “Doesn’t know” or refused Q48aa and is on redesigned income path.

Could you tell me if (name/you) earned less than $45,000, between $45,000 and $60,000, or over $60,000 for the TOTAL yearly amount from this employer before taxes and other deductions during 2013?

1. Less than $45,000

2. Between $45,000 and $60,000

3. $60,000 or more

Q48aarn2 Redesigned income path only.

Did (name/you) earn less than $15,000, between $15,000 and $30,000, or over $30,000 from this employer during 2013?

1. Less than $15,000

2. Between $15,000 and $30,000

3. Over $30,000 but less than $45,000

Q48aap

Read if necessary

Is this a weekly, every other week, twice a month, monthly, or yearly amount?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q48a1

For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q48aa) from this employer in 2013?

(1-12/1-24/1-26/1-52)

________________

Q48aC2

Do not read to the respondent.

The annual rate appears out of range. The total annual earnings entered is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48aV

According to my calculations (name/you) earned (total) altogether from this employer in 2013 before deductions. Does that sound about right?

1. Yes

2. No

Q48a2

What is your best estimate of (name's/your) correct total amount of earnings from this employer during 2013 before deductions?

PREVIOUS ENTRIES: Q48aa: (amount) 

Q48aap: (periodicity)

Q48a1: (number of pay periods)

Enter dollar amount

________________

Q48a3

Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this employer in 2013?

1. Yes

2. No

Q48aad

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from this employer in 2013?

Enter dollar amount

________________ 

Q48aadrn1 Ask only if the respondent “Doesn’t know” or refused Q48aad and is on redesigned income path.

Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in tips, bonuses, overtime pay, or commissions from this employer during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3,000 or more

Q48aadrn2 Redesigned income path only

Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses, overtime pay, or commissions from this employer during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q48b

What were (name's/your) net earnings from this business/farm after expenses during 2013?

If response is "Broke Even" then enter 1

Enter "0" for None

If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b_char

Enter “L” for Lost Money

________________

Q48BL

  Enter amount of money lost in 2013

  Enter annual amount only

________________

Q48brn1 Ask only if the respondent “Doesn’t know” or refused Q48b and is on redesigned income path.

Could you tell me if (name/you) earned less than $45,000, between $45,000 and $60,000, or over $60,000 for the TOTAL yearly amount from this business/farm after expenses during 2013?

1. Less than $45,000

2. Between $45,000 and $60,000

3. $60,000 or more

Q48brn2 Redesigned income path only

Did (name/you) earn less than $15,000, between $15,000 and $30,000, or over $30,000 from this business/farm after expenses during 2013?

1. Less than $15,000

2. Between $15,000 and $30,000

3. Over $30,000 but less than $45,000

Q48bp

Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

5. Quarterly

7. Yearly

Q48B1A

Do not read to the respondent.

The annual rate appears out of range. The total annual business loss entered is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48B1B

Do not read to the respondent.

The annual rate appears out of range. The total annual business income entered is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q48b2

What is your best estimate of (name's/your) ANNUAL net earnings from this business/farm after expenses in 2013?

PREVIOUS ENTRIES:  Q48b: (amount) 

Q48bp: (periodicity)

Enter dollar amount

________________

Q48b2L

What is your best estimate of (name's/your) ANNUAL net LOSS from this business/farm after expenses in 2013?

PREVIOUS ENTRIES:  Q48bL: (amount) 

Q48bp: (periodicity)

Enter dollar amount

________________

Q48b3

What were (name's/your) net earnings from this business/farm during the FIRST quarter of 2013?

If response is "Broke Even" then enter 1

Enter "0" for None

If response is “Lost Money” press enter

Enter dollar amount

________________

Q48b3_char

Enter "L" for Lost Money

________________

Q48B3L

Enter amount of money lost in the first quarter of 2013.

________________

Q48b4

What were (name's/your) net earnings from this business/farm during the SECOND quarter of 2013?

If response is "Broke Even" then enter 1

Enter "0" for None

If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b4_char

Enter "L" for Lost Money

________________

Q48B4L

Enter amount of money lost in the second quarter of 2013.

________________

Q48b5

What were (name's/your) net earnings from this business/farm during the THIRD quarter of 2013?

If response is "Broke Even" then enter 1

Enter "0" for None

If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b5_char

Enter "L" for Lost Money

________________

Q48B5L

Enter amount of money lost in the third quarter of 2013.

________________

Q48b6

What were (name's/your) net earnings from this business/farm during the FOURTH quarter of 2013?

If response is "Broke Even" then enter 1

Enter "0" for None

If response is "Lost Money" press enter

Enter dollar amount

________________

Q48b6_char

Enter "L" for Lost Money

________________

Q48B6L

Enter amount of money lost in the fourth quarter of 2013.

________________

Q48b7

Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this business in 2013?

1. Yes

2. No

Q48bad

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions

in 2013?

 Enter dollar amount

________________

Q48badrn1 Ask only if the respondent “Doesn’t know” or refused Q48bad and is on the redesigned income path.

Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in tips, bonuses, overtime pay, or commissions from this business during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q48badrn2 Redesigned income path only

Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses, overtime pay, or commissions during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q49a

Did (name/you) earn money from any other work (you/he/she) did during 2013?

1. Yes

2. No

Q49b1d

How much did (name/you) earn from all other employers before taxes and other deductions during 2013?

 Enter dollar amount

 Enter “0” for None

________________

Q49b1drn1 Ask only if the respondent “Doesn’t know” or refused Q48bld and is on the redesigned income path.

Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 from all other employers before taxes and other deductions during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q49b1drn2 Redesigned income path only

Did (name/you) earn less than $1,000, between $1,000 and $5,000, or over $5,000 from all other employers before taxes and other deductions during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q49b1p

Read if necessary

Is this a weekly, every other week, twice a month, monthly, or yearly amount?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q49B11

For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn (fill from Q49b1d) from all other employers in 2013?

(1-12/1-24/1-26/1-52)

________________

Q49B1C

Do not read to the respondent.

The total annual earnings entered from all other employers is (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q49B1V

According to my calculations (name/you) earned (total) altogether from all other employers in 2013.  Does that sound about right?

1. Yes

2. No

Q49B12

What is your best estimate of (name's/your) correct total amount of earnings from all other employers during 2013?

PREVIOUS ENTRIES:  Q49b1d: (amount)

Q49b1p: (periodicity)

Q49b11: (number of pay periods)

 

Enter dollar amount

________________

Q49b13

Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from all other employers in 2013?

1. Yes

2. No

Q49B1A

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from all other employers in 2013?

Enter dollar amount

________________

Q49B1arn1 Ask only if the respondent “Doesn’t know” or refused Q49B1A and is on the redesigned income path.

Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 in tips, bonuses, overtime pay, or commissions from all other employers in 2013?

1. Less than $10,000 (proceed to Q49B1arn2)

2. Between $10,000 and $20,000

3. $20,000 or more

Don’t know/ refused

Q49B1arn2 Redesigned income path only

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in tips, bonuses, overtime pay, or commissions from all other employers in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

DK/refused

Q49b2

How much did (name/you) earn from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

If response is "Broke Even" then enter 1

Enter "0" for None

If response is "Lost Money" press enter

Enter annual amount only

________________

Q49b2rn1 Ask only if the respondent “Doesn’t know” or refused Q49b2 and is on the redesigned income path.

Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

1. Less than $10,000 (proceed to Q49b2rn2)

2. Between $10,000 and $20,000

3. $20,000 or more

Don’t know/ refused

Q49b2rn2 Redesigned income path only

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

DK/refused

Q49b2_char

Enter "L" for Lost Money

________________

Q49b3

 Enter annual amount lost only

____________

Q49b4

How much did (name/you) earn from (your/his/her) farm after expenses?

If response is "Broke Even" then enter 1 

Enter "0" for None 

If response is "Lost money" press enter

Enter annual amount only

_______________

Q49b4rn1 Ask only if the respondent “Doesn’t know” or refused Q49b4 and is on the redesigned income path.

Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over $20,000 from (your/his/her) farm after expenses?

1. Less than $10,000 (proceed to Q49b4rn2)

2. Between $10,000 and $20,000

3. $20,000 or more

Don’t know/ refused

Q49b4rn2 Redesigned income path only

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 from (blank/any other businesses of) (your/his/her) (own/own business) after expenses?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

DK/refused

Q49b4_char

Enter "L" for Lost Money

________________

Q49b5

Enter annual amount lost only

________________

TRADITIONAL INCOME SECTION

UNEMPLOYMENT AND WORKERS COMPENSATION

Q51A1_T

At any time during 2013 did (name/you) receive any State or Federal unemployment compensation?

1. Yes

2. No

Q51A1p_T

What is the easiest way for you to tell us (name's/your) State or Federal unemployment compensation; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q51A11_T

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in State or Federal unemployment compensation during 2013?

Enter dollar amount 

________________

Q51A1C_T

Do not read to the respondent.

The annual rate appears out of range. The total State or Federal unemployment compensation received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A12_T

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive from State or Federal unemployment compensation during 2013?

 (1-12/1-24/1-26/1-52)

________________

Q51A13_T

According to my calculations (name/you) received (total) altogether from State or Federal unemployment compensation during 2013. Does that sound about right?

1. Yes

2. No

Q51A14_T

What is your best estimate of the correct total amount (name/you) received from State or Federal unemployment compensation during 2013?

PREVIOUS ENTRIES:  Q51A11: (amount)
  Q51A1p: (periodicity)
  Q51A12: (number of pay periods)

Enter dollar amount 

________________

 

Q51A2_T

At any time during 2013 did (name/you) receive any Supplemental Unemployment Benefits (SUB)?

1. Yes

2. No

Q51A2p_T

What is the easiest way for you to tell us (name's/your) Supplemental Unemployment Benefits; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q51A21_T

How much did (name/you) receive (weekly/every other week/twice a month/

monthly/ ) in Supplemental Unemployment Benefits during 2013?

Enter dollar amount 

_____________

Q51A2C_T

Do not read to the respondent.

The annual rate appears out of range. The total Supplemental Unemployment Benefits received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A22_T

How many (weekly/every other week/twice a month/ monthly) payments did (name/you) receive from Supplemental Unemployment Benefits during 2013?

(1-12/1-24/1-26/1-52)

________________

Q51A23_T

According to my calculations (name/you) received (total) altogether from Supplemental Unemployment Benefits during 2013. Does that sound about right?

1. Yes

2. No

Q51A24_T

What is your best estimate of the correct total amount (name/you) received from Supplemental Unemployment Benefits during 2013?

 PREVIOUS ENTRIES:  Q51A21: (amount)
Q51A2p: (periodicity)
Q51A22: (number of pay periods)

Enter dollar amount

________________

Q51A3_T

At any time during 2013 did (name/you) receive any Union Unemployment or Strike Benefits?

1. Yes

2. No

Q51A3p_T

What is the easiest way for you to tell us (name's/your) Union Unemployment or Strike Benefits; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q51A31_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in Union Unemployment or Strike Benefits during 2013?

 Enter dollar amount

________________

C251A3_T

Do not read to the respondent.

The annual rate appears out of range. The total Union Unemployment or Strike Benefits received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A32_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive from Union Unemployment or Strike Benefits during 2013?

(1-12/1-24/1-26/1-52)

________________

Q51A33_T

According to my calculations (name/you) received  (total) altogether from Union Unemployment or Strike Benefits during 2013. Does that sound about right?

1. Yes

2. No

Q51A34_T

What is your best estimate of the correct total amount (name/you) received from Union Unemployment or Strike Benefits during 2013?

 PREVIOUS ENTRIES:  Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)

Enter dollar amount

________________

Q52a_T

During 2013 did (name/you) receive any Worker’s Compensation payments or other payments as a result of a job related injury or illness?

Exclude sick pay and disability retirement.

1. Yes

2. No

Q52b_T

What was the source of these payments?

1. State Worker's Compensation

2. Employer or employer's insurance

3. Own insurance

4. Other

Q52cp_T

What is the easiest way for you to tell us (name's/your)Worker’s Compensation; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q52c1_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in Worker’s Compensation during 2013?

 Enter dollar amount

________________

Q52cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total worker's compensation received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q52c2_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive from Worker’s Compensation during 2013?

(1-12/1-24/1-26/1-52)

________________

Q52c3_T

Then (name/you) received (total) altogether from Worker’s Compensation

during 2013. Does that sound about right?

1. Yes

2. No

Q52c4_T

What is your best estimate of the correct total amount (name/you)
received from Worker’s Compensation during 2013?

PREVIOUS ENTRIES:  Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)
 Enter dollar amount

________________

SOCIAL SECURITY

Q56a_T

During 2013 did (you/ anyone in this household) receive any Social Security payments from the U.S. Government?

1. Yes

2. No

Q56b_T

 Read only if necessary

Who received Social Security payments either for themselves or as combined payments with other family members?

Enter Line Number Of Parent Or Guardian For Payments Made To
Children Under Age 15
Enter all that apply, separate using the space bar or a comma.

Enter persons line number (1-16)

Q56dp_T

What is the easiest way for you to tell us (name's/your) Social Security payment; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q56d_T

How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments in 2013?

 Enter dollar amount 

 If already included in amount reported for another household member, press Enter

________________

Q56d_Char_T

Enter <A> for Already included

________________

Q56d1_T

What is the amount of the Social Security payment (name/you) received last month?

Enter dollar amount 

________________

Q56d2_T

For how many (months/quarters) did (name/you) receive Social Security in 2013?

(1-4; 1-12)

________________

Q56d3_T

Is this $(amount from Q56d/amount from Q56d1) before or after the Medicare part B monthly deduction?

1. After Deduction

2. Before Deduction

Q56d4_T

Were there any changes since last year in your monthly payments?

1. Yes

2. No

Q56dC2_T

Do not read to the respondent.

The annual rate appears out of range. The total Social Security received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q56d5_T

According to my calculations (name/you) received $(total) altogether from Social Security in 2013. Does that sound about right?

1. Yes

2. No

Q56d6_T

What is your best estimate of the correct amount (name/you) received in Social Security during 2013?

PREVIOUS ENTRIES: (amount)
Q56dp: (periodicity)
  Q56d2: (number of pay periods)
  Q56d3: (amount added per month)
Q56d4: (cost of living subtracted per month)
Enter dollar amount 

________________

SSR_T

What were the reasons (name/you) (was/were) getting Social Security in 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

1. Retired

2. Disabled

3. Widowed

4. Spouse

5. Surviving child

6. Dependent child

7. On behalf of surviving, dependent, or disabled children

8. Other

SSRs_T

 Specify other reason

________________________________________________

SSC_T

Which children under age 15 were receiving Social Security in 2013?

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

SSCR_T

What were the reasons (Child's name/the children) (was/were) getting Social Security in 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

1. Disabled child/children

2. Surviving child/children

3. Dependent child/children

4 Other

SOCIAL SECURITY FOR CHILDREN

Q56f_T

Did anyone in this household receive any Social Security income in 2013 that we have not already counted on behalf of children in this household?

 Includes all children under 19 years of age

 Social Security Income previously reported will appear here

LN  Name  Amount reported in Q56d amount

1. Yes

2. No

Q56g_T

Read only if necessary

Who received these Social Security payments?

Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q56ip_T

What is the easiest way for you to tell us (name's/your) Social Security payment for children in this household; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q56i_T

How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments for children in this household in 2013?

Enter dollar amount 

If already included in amount reported for another household member, press Enter

________________

Q56i_Char_T

Enter A for Already included

________________

Q56i1_T

What is the amount of the Social Security payment (name/you) received for children in this household last month?

 Enter dollar amount 

________________

Q56i2_T

For how many (months/quarters) did (name/you) receive Social Security in 2013?

 (1-4; 1-12)

________________

Q56i3_T

Was the cost of living increase the only change which occurred in monthly payments for children in this household?

1. Yes

2. No

Q56iC2_T

Do not read to the respondent.

The annual rate appears out of range. The total Social Security received for children in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q56i4_T

According to my calculations (name/you) received $(total) altogether for children in this household from Social Security in 2013. Does that sound about right?

1. Yes

2. No

Q56i5_T

What is your best estimate of the correct amount (name/you) received in Social Security for children in this household during 2013?

 Previous entries: (amount)
  Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)

Enter dollar amount

________________

CSS_T

Which children under age 19 were receiving Social Security in 2013?

 Probe: Anyone Else?

 Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

CRSS_T

What were the reasons (Child’s name/the children) (was/were) getting Social Security in 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

1. Disabled child/children

2. Surviving child/children

3. Dependent child/children

4. Other

SUPPLEMENTAL SECURITY INCOME (SSI)

Q57a_T

During 2013 did (you/ anyone in this household) receive:

any SSI payments, that is, Supplemental Security Income?

Note: SSI are assistance payments to low-income aged, blind and disabled persons, and come from state or local welfare offices, the Federal government, or both.

1. Yes

2. No

Q57b_T

Read only if necessary

 Who received SSI?

Supplemental Security Income

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q57cp_T

What is the easiest way for you to tell us (name's/your) Supplemental Security Income payment; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q57c_T

How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income payments in 2013?

Enter dollar amount 

________________

Q57c1_T

What is the amount of the Supplemental Security Income payment (name/you) received last month?

Enter dollar amount

________________

Q57c2_T

For how many (months/quarters) did (name/you) receive Supplemental Security Income in 2013?

(1-4; 1-12)

________________

Q57c3_T

Was the cost of living increase the only change which occurred in monthly payments?

1. Yes

2. No

Q57cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total Supplemental Security Income received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q57c4_T

According to my calculations (name/you) received $(total) altogether from Supplemental Security Income in 2013. Does that sound about right?

1. Yes

2. No

Q57c5_T

What is your best estimate of the correct amount (name/you) received in Supplemental Security Income during 2013?

Previous entries: (amount)

Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)

Enter Dollar Amount

________________

SSIR_T

What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

1. Disabled

2. Blind

3. On behalf of a disabled child

4. On behalf of a blind child

5. Other

SSIC_T

Which children under age 15 were receiving Supplemental Security Income in 2013?

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed
Enter 96 for All persons

Enter persons line number (1-16)

SUPPLEMENTAL SECURITY INCOME FOR CHILDREN

Q57d _T

Did anyone in this household receive any Supplemental Security Income in 2013 that we have not already counted on behalf of children in this household?

Includes all children under 18 years of age 

SSI previously reported will appear here

LN  Name  Amount for Q57C amount

1. Yes

2. No

Q57e _T

Read only if necessary

 Who received these Supplemental Security Income payments?

Enter line number of parent or guardian

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q57ip_T

What is the easiest way for you to tell us the Supplemental Security
Income (name/you) received on behalf of children?

4 Monthly

5 Quarterly

7 Yearly

Q57i_T

How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security
Income on behalf of children in 2013?

Enter dollar amount

________________

Q57i1_T

What is the amount of the Supplemental Security Income payment (name/you)

received on behalf of children last month?

Enter dollar amount 

________________

Q57i2_T

For how many (months/quarters) did (name/you) receive Supplemental Security Income on behalf of children in 2013?

(1-4;1-12)

________________

Q57i3_T

Was the cost of living increase the only change which occurred in monthly payments?

1. Yes

2. No

Q57iC2_T

Do not read to the respondent.

The annual rate appears out of range. The total Supplemental Security Income received on behalf of children in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q57i4_T

According to my calculations (name/you) received $(total) altogether from Supplemental Security Income on behalf of children in 2013.

Does that sound about right?

1. Yes

2. No

Q57i5_T

What is your best estimate of the correct amount (name/you) received in Supplemental Security Income on behalf of children during 2013?

PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)

 Enter dollar amount 

________________

RSSI_T

What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2013?

 Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

1. On behalf of a disabled child/children

2. On behalf of a blind child/children

3. Other

CSSI_T

Which children under age 18 were receiving Supplemental Security Income

in 2013?

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

PUBLIC ASSISTANCE

Q59A88_T

At any time during 2013, even for one month, did (you/ anyone in this household) receive any CASH assistance from a state or county welfare program such as

(State Program Name)?

Include cash payments from:

welfare or welfare-to-work programs,

(State Program Name and/or acronyms),

Temporary Assistance for Needy Families program (TANF),

Aid to Families with Dependent Children (AFDC),

General Assistance/Emergency Assistance program,

Diversion Payments,

Refugee Cash and Medical Assistance program,

General Assistance from Bureau of Indian Affairs, or

Tribal Administered General Assistance.

Do not include food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits, SSI, energy assistance, WIC, School meals, or transportation, childcare, rental, or education assistance.

1. Yes

2. No

Q59A89_T

Just to be sure, in 2013, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?

1. Yes

2. No

Q59b_88 _T

Who received this CASH assistance?

Enter line number

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q59C8_T

From what type of program did (name/you) receive the CASH assistance? Was it a welfare or welfare-to-work program such as (State Program Name), General Assistance, Emergency Assistance, or some other program?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Program?

1. (State Program Name)/welfare/AFDC

2. General Assistance

3. Emergency Assistance/short-term cash assistance

4. Some other program (specify)

Q59C8s _T

What type of program?

_________________________________________________

Q59ep_T

What is the easiest way for you to tell us (name's/your) CASH assistance payments; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q59e_T

During 2013, how much CASH assistance did (name/you) receive (per week/every other week/twice a month/ monthly/ )?

 Enter dollar amount

___________

Q59e2_T

How many (weekly/every other week/ twice a month/ monthly) cash assistance payments did (name/you) receive in 2013?

(1-12; 1-52)

________________

Q57eC2_T

Do not read to the respondent.

The annual rate appears out of range. The total cash assistance received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q59e3_T

According to my calculations (name/you) received $(total) altogether in cash assistance from a state or county program in 2013. Does that sound about right?

1. Yes

2. No

Q59e4_T

What is your best estimate of the correct amount of cash assistance
(name/you) received during 2013?

PREVIOUS ENTRIES:  Q59e: (amount)

Q59ep: (periodicity)

Q59e2: (number of pay periods)

Enter dollar amount 

________________

Q59f_T

Was the cash assistance for adults AND children, or JUST children?

1. Both adults AND children

2. Children only

3. Adults only

Q59g_T

(Who/Which children) in your household was the cash assistance for?

 

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

VETERANS PAYMENTS

Q60A88_T

At any time during 2013 did (you/ anyone in this household) receive:

Any Veterans’ (VA) payments?

 Include assistance received by children of veterans

1. Yes

2. No

Q60b_88_T

 Read only if necessary

Who received Veterans’ (VA) payments either for themselves or as combined payments with other family members?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q60C8_T

What type of Veterans' payment did (name/you) receive?

 Read list only if respondent is having difficulty answering the question.

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Payments?

1. Service-connected disability compensation

2. Survivor Benefits

3. Veterans’ Pension

4. Educational assistance (including assistance received by children of veterans)

5. Other Veterans’ payments

Q60D88_T

(Are/Is) (name/you) required to fill out an annual income questionnaire for the Department of Veterans' Affairs?

1. Yes

2. No

Q60V1P_T

What is the easiest way for you to tell us (name's/your) (fill from first answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q60V1_T

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) before deductions in (fill from first answer in Q60c8) in 2013?

Enter dollar amount

________________

Q60V12_T

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q60c8) in 2013?

(1-52)

________________

Q60V1C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q60c8) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q60V13_T

According to my calculations (name/you) received (total) dollars altogether from (fill from first answer in Q60c8) in 2013. Does that sound about right?

1. Yes

2. No

Q60V14_T

What is your best estimate of the correct amount (name/you) received in Veteran's benefits during 2013?

PREVIOUS ENTRIES:  Q60V1:  (amount) 

Q60V1P: (periodicity)

Q60V12:  (number of pay periods)

 Enter dollar amount

________________

Q60V2P_T

What is the easiest way for you to tell us (name's/your) (fill from second answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly

2 Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q60V2_T

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) before deductions in (fill from second answer in Q60c8) in 2013?

Enter dollar amount

________________

Q60V22_T

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q60c8) in 2013?

(1-52)

________________

Q60V2C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q60c8) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q60V23_T

According to my calculations (name/you) received (total) dollars altogether from

(fill from second answer in Q60c8) in 2013. Does that sound about right?

1. Yes

2. No

Q60V24_T

What is your best estimate of the correct amount (name/you) received in

(fill from second answer in Q60c8) during 2013?

PREVIOUS ENTRIES:  Q60V2:  (amount)

Q60V2P: (periodicity)

Q60V22: (number of pay periods)

Enter dollar amount

________________

SURVIVOR BENEFITS

Q58A_T

Did (you/ anyone in this household) receive any survivor benefits in 2013 such as

widow’s pensions, estates, trusts, insurance annuities, or any other survivor benefits

(other than Social Security/ other than VA benefits/ other than Social Security or

VA benefits)?

1. Yes

2. No

Q58b_T

Read only if necessary

 

Who received this income?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q58C_T

What was the source of this income?

Asking About: (name/name- -CURRENT RESPONDENT) 

Read list if respondent is having difficulty answering the question

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Source?

2 Company or union survivor pension (INCLUDE PROFIT SHARING)

3. Federal Government survivor (CIVIL SERVICE) pension

4. U.S. Military retirement survivor pension

5. State or Local government survivor pension

6. U.S. Railroad retirement survivor pension

7. Worker's compensation survivor pension

8. Black Lung survivor pension

9. Regular payments from estates or trusts

10. Regular payments from annuities or paid-up insurance policies

11 Other or don't know (SPECIFY) - ENTER LAST

Q58Cs1_T

Specify other source of income as survivor or widow

Enter "Survivor Benefits" if the answer is "Don't Know"

________________________________________________

Q58E1P_T

What is the easiest way for you to tell us (name's/your) (fill from first answer

in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly,

or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q58E1_T

How much did (name/you) receive (weekly/every other week/twice a month/

monthly/ ) in (fill from first answer in Q58C or Q58Cs1) in 2013?

Enter dollar amount

________________

Q58E12_T

How many (weekly/every other week/twice a month/monthly) payments did

(name/you) receive in (fill from first answer in Q58C or Q58Cs1) in 2013?

 (1-52)

________________

Q58E1C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q58C or Q58Cs1) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E13_T

According to my calculations (name/you) received (total) altogether from
(fill from first answer in Q58C or Q58Cs1) in 2013. Does that sound about right?

1. Yes

2. No

Q58E14_T

What is your best estimate of the correct amount (name/you) received from (fill from first answer in Q58C or Q58Cs1) during 2013?

PREVIOUS ENTRIES:  Q58E1: (amount)
Q58E1P: (periodicity)
Q58E12: (number of pay periods)
 Enter dollar amount

________________

Q58E2P_T

What is the easiest way for you to tell us (name's/your) (fill from second answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q58E2_T

How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2013?

Enter dollar amount

________________

Q58E22_T

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q58C or Q58Cs1) in 2013?

 (1-52)

________________

Q58E2C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q58C or Q58Cs1) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E23_T

According to my calculations (name/you) received (total) altogether from

(fill from second answer in Q58C or Q58Cs1) in 2013.

Does that sound about right?

1. Yes

2. No

Q58E24_T

What is your best estimate of the correct amount (name/you) received from (fill from second answer in Q58C or Q58Cs1) during 2013?

 PREVIOUS ENTRIES: Q58E2: (amount)

Q58E2P: (periodicity)

Q58E22: (number of pay periods)

Enter dollar amount

________________

Q58E3P_T

What is the easiest way for you to tell us (name's/your) (fill from third answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q58E3_T

How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from third answer in Q58C or Q58Cs1) in 2013?

 Enter dollar amount

________________

Q58E32_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (fill from third answer in Q58C or Q58Cs1) in 2013?

 (1-52)

________________

Q58E3C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from third answer in Q58C or Q58Cs1) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E33_T

According to my calculations (name/you) received (total) altogether from (fill from third answer in Q58C or Q58Cs1) in 2013. Does that sound about right?

1. Yes

2. No

Q58E34_T

What is your best estimate of the correct amount (name/you) received from (fill from third answer in Q58C3 or Q58Cs1) during 2013?

PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)

Enter dollar amount

_______________

DISABILITY INCOME

Q59A_T

(Do you/Does anyone in the household) have a health problem or disability which prevents (you/them) from working or which limits the kind or amount of work (you/they) can do?

1. Yes

2. No

Q59b_T

 Read only if necessary

Who is that?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

 

Q60a_T

(Did you/Is there anyone in this household who) ever (retire or leave/ retired or left) a job for health reasons?

1. Yes

2. No

Q60b_T

 Read only if necessary

Who is that?

 Enter all that apply, separate using the space bar or a comma.

 Probe: Anyone Else?

Enter persons line number (1-16)

Q61b_T

Did (name/you) receive any income in 2013 as a result of (your/his/her) health problem (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits) ?

(blank/If amount was reported previously as compensation from a job related injury or illness, then enter precode 2)

(blank/Amount previously reported in (Q52CT) was $(amount))

1. Yes

2. No

Q61c_T

What was the source of this income?

Asking About: (name) (blank/- -CURRENT RESPONDENT)

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

2. Worker’s compensation

3. Company or union disability

4. Federal Government (CIVIL SERVICE) disability

5. U.S. Military retirement disability

6. State or Local government employee disability

7. U.S. Railroad retirement disability

8. Accident or disability insurance

9. Black Lung miner’s disability

10. State temporary sickness

11. Other or don’t know – Specify – Enter last

Q61Cs1_T

Specify other source from health problem or disability

Enter "Other Health Problem/Disability" if the answer is "Don't Know"

_____________________________________________

Q61E1P_T

What is the easiest way for you to tell us (name's/your) (first answer from Q61c or Q61cs1) payments; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q61E1_T

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) before deductions in (first answer from Q61c or Q61cs1) payments in 2013?

 Enter dollar amount

_______________

Q61E12_T

How many (weekly/ every other week/ twice a month/ monthly) payments did
(name/you) receive in (first answer from Q61c or Q61cs1) payments in 2013?

Disability income source #1 (1-12; 1-52)

_______________

Q61E1C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q61c or Q61cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q61E13_T

According to my calculations (name/you) received (total) dollars altogether from
(first answer from Q61c or Q61cs1) payments in 2013. Does that sound about right?

1. Yes

2. No

Q61E14_T

What is your best estimate of the correct amount (name/you) received from (first answer from Q61c or Q61cs1) payments during 2013?

PREVIOUS ENTRIES: Q61E1: (amount)
Q61E1P: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount

_______________

Q61E2P_T

What is the easiest way for you to tell us (name's/your) (second fill from Q61c or Q61cs1) payments; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q61E2_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) before deductions in (second answer from Q61c or Q61cs1)
payments in 2013?

Enter dollar amount

_______________

Q61E22_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer from Q61c or Q61cs1) payments in 2013?

 Disability income payment source #2 (1-12; 1-52)

_______________

Q61E2C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q61c or Q61cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q61E23_T

According to my calculations (name/you) received (total) dollars altogether

from (second answer from Q61c or Q61cs1) payments in 2013. Does that

sound about right?

1. Yes

2. No

Q61E24_T

What is your best estimate of the correct amount (name/you) received from (second fill from Q61c or Q61cs1) payments during 2013?

PREVIOUS ENTRIES:  Q61E2: (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)

 Enter dollar amount

_______________

RETIREMENT AND PENSIONS

Q62A_T

During 2013 did (you/ anyone in this household) receive any pension or retirement income from a previous employer or union, or any other type of retirement income (other than Social Security/ other than VA benefits/ other than Social Security or VA benefits) ?

1. Yes

2. No

Q62b_T

Read only if necessary

Who received pension or retirement income?

 Enter all that apply, separate using the space bar or a comma.

 Probe: Anyone Else?

Enter persons line number (1-16)

Q62C_T

What was the source of (name's/your) income?

 Enter all that apply, separate using the space bar or a comma.

 Probe: Any Other pension or retirement income?

1. Company or union pension (INCLUDE PROFIT SHARING)

2. Federal Government (CIVIL SERVICE) retirement

3. U.S. Military retirement

4. State or Local government pension

5. U.S. Railroad Retirement

6. Regular payments from annuities or paid up insurance policies

7. Regular payments from IRA, KEOGH, 401(k), 403(b), and 457(b) and (f) accounts

8. Other sources or don’t know – Specify – Enter last

Q62Cs1_T

 Enter other source of pension or retirement income

 Enter "Other Pension Or Retirement" if the answer is "Don't Know"

_____________________________________________

Q62E1P_T

What is the easiest way for you to tell us (name's/your) (first answer from Q62c or Q62cs1); weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q62E1_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in (first answer from Q62c or Q62cs1) in 2013?

 Enter dollar amount

_______________

Q62E12_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer from Q62c or Q62cs1) in 2013?

 Pension/Retirement #1 (1-12; 1-52)

_______________

Q62E1C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q62c or Q62cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E13_T

According to my calculations (name/you) received (total) dollars altogether from (first answer from Q62c or Q62cs1) in 2013. Does that sound about right?

1. Yes

2. No

Q62E14_T

What is your best estimate of the correct amount (name/you) received in (first answer from Q62c or Q62cs1) during 2013?

PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
  Q62E12: (number of pay periods)

Enter dollar amount

_______________

Q62E2P_T

What is the easiest way for you to tell us (name's/your) (second answer from Q62c or Q62cs1); weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q62E2_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in (second answer from Q62c or Q62cs1) in 2013?

Enter dollar amount

_______________

Q62E22_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer from Q62c or Q62cs1) in 2013?

 Pension/Retirement #2 (1-12; 1-52)

_______________

Q62E2C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q62c or Q62cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E23_T

According to my calculations (name/you) received (total) dollars altogether from (second answer from Q62c or Q62cs1) in 2013. Does that sound about right?

1. Yes

2. No

Q62E24_T

What is your best estimate of the correct amount (name/you) received in (second answer from Q62c or Q62cs1) during 2013?

PREVIOUS ENTRIES:  Q62E2: (amount)
Q62E2P: (periodicity)
Q62E22: (number of pay periods)

Enter dollar amount

_______________

Q62E3P_T

What is the easiest way for you to tell us (name's/your) (third answer from Q62c or Q62cs1); weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

Q62E3_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/) in (third answer from Q62c or Q62cs1) in 2013?

 Enter dollar amount

_______________

Q62E32_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (third answer from Q62c or Q62cs1) in 2013?

 Pension/Retirement #3 (1-12; 1-52)

_______________

Q62E3C_T

Do not read to the respondent.

The annual rate appears out of range. The total (fill from third answer in Q62c or Q62cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E33_T

According to my calculations (name/you) received (total) dollars altogether from
(third answer fromQ62c or Q62cs1) in 2013. Does that sound about right?

1. Yes

2. No

Q62E34_T

What is your best estimate of the correct amount (name/you) received in (third answer from Q62c or Q62cs1) during 2013?

 PREVIOUS ENTRIES:  Q62E3: (amount)
Q62E3P: (periodicity)
Q62E32: (number of pay periods)

Enter dollar amount

_______________

INTEREST

Q63A1_T

At anytime during 2013 did (you/ anyone in this household):

Have money in any kind of money market fund, interest earning checking account, or savings account?

1. Yes

2. No

Q63A2_T

At anytime during 2013 did (you/ anyone in this household):

Have any savings bonds?

1. Yes

2. No

Q63A3_T

At anytime during 2013 did (you/ anyone in this household):

Have any treasury notes, IRAs, certificates of deposit, or any other investments which pay interest?

1 Yes

2 No

Q63b_T

Ask only if necessary

Which members of this household ages 15 and over had (interest earning accounts or money market funds/savings bonds/treasury notes, IRAs, CDs, or any other investments which pay interest)?

Include each person in cases of joint accounts or ownership

 Enter all that apply, separate using the space bar or a comma.

 Probe: Anyone Else?

 

Enter persons line number (1-16)

Q63c_T

How much did (name/you) receive in interest from these sources during 2013, including even small amounts reinvested or credited to accounts?

 Only include interest received from U.S. Savings Bonds cashed during 2013

 Separate amounts for joint ownership

If already included in amount reported for another household member, press Enter

Enter dollar amount 

_______________

Q63c_Char_T

Enter A for "Already Included"

_______________

Q63cp_T

Read if necessary

Is this a weekly, every other week, twice a month, monthly, quarterly,
every 6 months, or yearly amount?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

5. Quarterly

6. Every 6 months

7. Yearly

Q63c2_T

How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name/you) receive in interest income in 2013?

 (1-2; 1-52)

_______________

Q63cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total interest income received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q63c3_T

According to my calculations (name/you) received (total) dollars altogether from
interest income in 2013. Does that sound about right?

1. Yes

2. No

Q63c4_T

What is your best estimate of the correct amount (name/you) received from interest payments during 2013?

PREVIOUS ENTRIES: Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)

 Enter dollar amount

_______________

DIVIDENDS

Q64A_T

At anytime during 2013 did (anyone in this household ages 15 and over/you) own any shares of stock in corporations (PAUSE) or any mutual fund shares?

1. Yes

2. No

Q64b_T

Ask only if necessary

Which members of this household?

Include each person in case of joint accounts or ownership

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else

Enter persons line number (1-16)

Q64c_T

How much did (name/you) receive in dividends from stocks (or mutual funds) during 2013, including dividends that were reinvested?

 

 Separate amounts for joint ownership

 If already included in amount reported for another household member, press Enter

   Enter "0" for None

   Enter dollar amount

_______________

Q64c_Char_T

Enter <A> for Already included

_______________

Q64cp_T

Read if necessary

Is this a weekly, every other week, twice a month, monthly, quarterly,
every 6 months, or yearly amount?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

5. Quarterly

6. Every 6 months

7. Yearly

Q64c2_T

How many (weekly/every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (name's/your) receive in dividends from stocks (or mutual funds) in 2013?

(1-2; 1-52)

_______________

Q64cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total dividend payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q64c3_T

According to my calculations (name/you) received (total) dollars altogether from
dividend payments in 2013. Does that sound about right?

1. Yes

2. No

Q64c4_T

What is your best estimate of the correct amount (name/you) received from dividend payments during 2013?

PREVIOUS ENTRIES: Q64c: (amount)
Q64cp: (periodicity)
Q64c2: (number of pay periods)

Enter dollar amount 

_______________

PROPERTY INCOME

Q65A1_T

During 2013 did (you/ anyone in this household):

Own any land, business property, apartments, or houses which were rented to others?

1. Yes

2. No

Q65A2_T

At anytime during 2013 did (you/ anyone in this household):

Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)

1. Yes

2. No

Q65A3_T

At anytime during 2013 did (you/ anyone in this household):

Receive income from estates or trusts? (exclude estates or trusts already reported)

1. Yes

2. No

Q65b_T

Ask only if necessary

Who received this (income/rent) ?

Include each in cases of joint ownership. For self-employed persons, determine if

income was already included

Enter all that apply, separate using the space bar or a comma.
 Probe: Anyone Else?

Enter persons line number (1-16)

Q65c_T

How much did (name/you) receive in income from rent (blank /, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES during 2013?

 Separate amounts for joint ownership if response is "Broke Even" then enter 1.
   Enter dollar amount

If already included in amount reported for another household member,

or if response is "None",

or if response is "Lost Money"

press <Enter> key

_______________

Q65c_Char_T

Enter "A" for Already included 

Enter "L" for Lost Money

Enter "X" for None

______________

Q65cL_T

 Enter amount of money lost in 2013.

_______________

Q65cp_T

Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

5. Quarterly

7 Yearly

Q65c2_T

What is your best estimate of (name's/your) ANNUAL net income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2013?

 PREVIOUS ENTRIES:  Q65c: (amount)
  Q65cp: (periodicity)

 Enter dollar amount

_______________

Q65cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total income received from rent ( /roomers or boarders, estates, trusts, or royalties) was (amount) in 2013. Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q65c2L_T

What is your best estimate of (name’s/your) ANNUAL LOSS from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2013?

 PREVIOUS ENTRIES:  Q65cL: (amount)
  Q65cp: (periodicity)

Enter dollar amount 

_______________

EDUCATION ASSISTANCE

Q66a_T

During 2013 did (you/ anyone in this household) attend school beyond the high school level including a college, university, or other schools? 

(include vocational, business, or trade schools)

1. Yes

2. No

Q66b_T

Did (you/ anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2013?

 Exclude loans, assistance from household members, and VA educational benefits

1. Yes

2. No

Q66c_T

 Ask only if necessary

Which member received assistance?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else? 

Enter persons line number (1-16)

Q66d_T

What type of assistance did (name/you) receive?

Exclude assistance from household members

Enter all that apply, separate using the space bar or a comma.

 Probe: Any other assistance?

2. Pell Grant

3. Assistance from a welfare or social service office

4. Some other government assistance

5. Scholarships, grants, etc.

6. Other assistance (employers, friends, etc.)

Q69F88_T

How much did (name/you) receive in Pell Grants during 2013?

Enter annual amount only

________________

Q66HP_T

What is the easiest way for you to tell us (name's/your) (other/blank ) educational assistance during 2013; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q66H_T

(blank/Aside from the Pell Grant assistance,) (How/how) much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in educational assistance during 2013? 

Enter dollar amount

________________

Q66H2_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in educational assistance in 2013?

(1-12/1-24/1-26/1-52)

________________

Q66hC2_T

Do not read to the respondent.

The annual rate appears out of range. The total educational assistance received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q66H3_T

According to my calculations (name/you) received (total) altogether from educational assistance in 2013. Does that sound about right?

1. Yes

2. No

Q66H4_T

What is your best estimate of the correct amount (name/you) received from educational assistance during 2013?

 Previous entries: Q66h: (amount)

Q66hp: (periodicity)
  Q66h2: (number of pay periods)

Enter dollar amount

________________

CHILD SUPPORT AND ALIMONY

Q70a_T

During 2013 did (you/ anyone in this household) receive:

Any child support payments?

1. Yes

2. No

Q70b_T

 Read only if necessary

Who received these payments?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else? 

Enter persons line number (1-16)

Q70cp_T

What is the easiest way for you to tell us (name's/your) child support payments;

weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q70c_T

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in child support payments in 2013?

Enter dollar amount 

________________

Q70c2_T

How many (weekly/every other week/ twice a month/ monthly) child support payments did (name/you) receive in 2013?

 (1-12/1-24/1-26/1-52)

________________

Q70cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total child support payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q70c3_T

According to my calculations (name/you) received (total) altogether from child support payments in 2013. Does that sound about right?

1. Yes

2. No

Q70c4_T

What is your best estimate of the correct amount (name/you) received from child support payments during 2013?

PREVIOUS ENTRIES: Q70c: (amount)
  Q70cp: (periodicity)
  Q70c2: (number of pay periods)

Enter dollar amount

________________

Q71a_T

During 2013 did (you/ anyone in this household) receive:

Any alimony payments?

1. Yes

2. No

Q71b_T

Read only if necessary

Who received these payments during 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q71cp_T

What is the easiest way for you to tell us (name's/your) alimony payments;

weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q71c_T

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in alimony payments in 2013?

Enter dollar amount 

________________

Q71c2_T

How many (weekly/every other week/ twice a month/ monthly) alimony payments did (name/you) receive in 2013?

(1-12/1-24/1-26/1-52)

________________

Q71cC_T

Do not read to the respondent.

The annual rate appears out of range. The total alimony payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q71c3_T

According to my calculations (name/you) received (total) altogether from alimony payments in 2013. Does that sound about right?

1. Yes

2. No

Q71c4_T

What is your best estimate of the correct amount (name/you) received from alimony payments during 2013?

PREVIOUS ENTRIES:  Q71c: (amount)
Q71cp: (periodicity)
Q71c2: (number of pay periods)

 Enter dollar amount

________________

REGULAR FINANCIAL ASSISTANCE

Q72a_T

During 2013 did (you/ anyone in this household) receive:

(Any other/Any) regular financial assistance from friends

or relatives not living in this household?

Do not include loans

1. Yes

2. No

Q72b_T

Read only if necessary

Who received this assistance?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q72cp_T

What is the easiest way for you to tell us (name's/your) regular financial assistance;

weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q72c_T

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in regular financial assistance in 2013?

 Enter dollar amount

________________

Q72c2_T

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2013?

(1-12/1-24/1-26/1-52)

_______________

Q72cC2_T

Do not read to the respondent.

The annual rate appears out of range. The total regular financial assistance payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q72c3_T

According to my calculations (name/you) received (total) altogether from regular financial assistance in 2013. Does that sound about right?

1. Yes

2. No

Q72c4_T

What is your best estimate of the correct amount (name/you) received from regular financial assistance during 2013?

PREVIOUS ENTRIES:  Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)

________________

OTHER MONEY INCOME

Q73A1_T

During 2013 did (you/ anyone in this household) receive income from:

Hobbies, home businesses, farms, or business interests not already covered?

1. Yes

2. No

Q73A1b_T

Ask only if necessary

Who received this income?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q73A1c_T

What was the source of this income?

 Asking about: (name/you) (name/name- -CURRENT RESPONDENT)

_________________________________________________

Q731P_T

What is the easiest way for you to tell us (name's/your) income from hobbies, home businesses, farms, or business interests not already covered during 2013;

weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q731_T

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income from hobbies, home businesses, farms, or business interests not already covered during 2013?

 Enter dollar amount

________________

Q7312_T

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in income from hobbies, home businesses, farms, or business interests not already covered in 2013?

 (1-12/1-24/1-26/1-52)

________________

Q731C2_T

Do not read to the respondent.

The annual rate appears out of range. The total income from hobbies, home businesses, farms, or business interests not already covered in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q7313_T

According to my calculations (name/you) received (total) altogether from hobbies, home businesses, farms, or business interests not already covered in 2013.

Does that sound about right?

1. Yes

2. No

Q7314_T

What is your best estimate of the correct amount (name/you) received in income from hobbies, home businesses, farms, or business interests not already covered during 2013?

PREVIOUS ENTRIES: Q731: (amount)
Q731P: (periodicity)
Q7312: (number of pay periods)

Enter dollar amount 

________________

Q73A2_T

During 2013 did (you/ anyone in this household) receive income from:

Any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered?

1. Yes

2. No

Q73A2b_T

Ask only if necessary

Who received this income?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q73A2c_T

What was the source of this income?

Asking about: (name/you) (name/name- -CURRENT RESPONDENT)

_________________________________________________

Q732P_T

What is the easiest way for you to tell us (name's/your) income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2013; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week (bi-weekly)

3. Twice a month

4. Monthly

7 Yearly

Q732_T

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income from any severance pay, welfare, emergency assistance,

other short-term cash assistance, foster child care payments, or any other money I income not already covered during 2013?

Enter dollar amount 

________________

Q7322_T

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2013?

 (1-12/1-24/1-26/1-52)

________________

Q732C2_T

Do not read to the respondent.

The annual rate appears out of range. The total income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money not already covered in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q7323_T

According to my calculations (name/you) received (total) altogether from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2013. Does that sound about right?

1. Yes

2. No

Q7324_T

What is your best estimate of the correct amount (name/you) received in income from any severance pay, welfare, emergency assistance, other short-term cash assistance, foster child care payments, or any other money income not already covered during 2013?

PREVIOUS ENTRIES:  Q732: (amount)
  Q732P: (periodicity)
  Q7322: (number of pay periods)

Enter dollar amount 

________________

REDESIGNED INCOME SECTION

This questionnaire order is the Default (under 62, not low income household). This pattern will differ for aged 62+ households and low-income households (see Table 1. Alternate Order of Income Questions).

Sources of Income:

UNEMPLOYMENT AND WORKERS COMPENSATION

Q51A1

At any time during 2013 did (you/anyone in the household) receive any State or Federal unemployment compensation?

1 Yes

2 No (skip to Q51A2)

Q51A1b

 Read only if necessary

Who received State or Federal unemployment compensation?

• Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q51A2

At any time during 2013 did (you/anyone in the household) receive any Supplemental Unemployment Benefits (SUB)?

1 Yes

2 No (skip to Q51A3)

Q51A2b

 Read only if necessary

Who received Supplemental Unemployment Benefits?

• Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q51A3

At any time during 2013 did (you/anyone in the household) receive any Union Unemployment or Strike Benefits?

1 Yes

2 No

Q51A3b

 Read only if necessary

Who received Union Unemployment or Strike Benefits?

• Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q52A

During 2013 did (you/anyone in the household) receive any Worker’s Compensation payments or other payments as a result of a job related injury or illness?

• Exclude sick pay and/or disability retirement.

1 Yes

2 No

Q52Ab

 Read only if necessary

Who received Worker’s Compensation or payments as a result of a job related injury or illness?

• Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

• Exclude those who received sick pay and/or disability retirement.

Enter persons line number (1-16)

Q52b

What was the source of (your/name’s Fill Q52Ab) payments?

• Read Categories if necessary

1 State Worker's Compensation

2 Employer or employer's insurance worker’s compensation

3 Own insurance worker’s compensation

4 Other (ask Q52Cs1)

Q52Cs1

• Specify other source from workers compensation/insurance

• Enter "Worker’s Compensation" if the answer is "Don't Know"

________________________________________________

SOCIAL SECURITY - Source

Q56a (if “yes” will ask Q56dp amount later)

During 2013 did (you/ anyone in this household) receive any Social Security payments from the U.S. Government?

3. Yes

4. No

Q56b

 Read only if necessary

Who received Social Security payments either for themselves or as combined payments with other family members?

Enter Line Number Of Parent Or Guardian For Payments Made To
Children Under Age 15
Enter all that apply, separate using the space bar or a comma.

Enter persons line number (1-16)

SSR

What were the reasons (name/you) (was/were) getting Social Security in 2013?

Mark all that apply

Probe: Any Other Reason?

9. Retired

10. Disabled

11. Widowed

12. Spouse

13. Surviving child

14. Dependent child

15. On behalf of surviving, dependent, or disabled children

16. Other

SSRs

 Specify other reason

________________________________________________

SSC

Which children under age 15 were receiving Social Security in 2013?

Probe: Anyone Else?

Enter all that apply, separate by commas.

Enter 0 if none listed

Enter persons line number (1-16)

SSCR

What were the reasons (Child’s name/the children) (was/were) getting Social Security in 2013?

Mark all that apply

Probe: Any Other Reason?

4. Disabled child

5. Surviving child

6. Dependent child

4 Other

SSDIa1

Did (name/you) receive (your/his/her) first Social Security Disability payment in 2013?

1. Yes

2. No

SOCIAL SECURITY FOR CHILDREN - Source

Q56f (if “yes” will ask Q56R amount later)

Did anyone in this household receive any Social Security income in 2013 that we have not already counted on behalf of children in this household?

 Includes all children under 19 years of age

 Social Security Income previously reported will appear here

LN  Name  Amount reported in Q56d amount

3. Yes

4. No

Q56g

Read only if necessary

Who received these Social Security payments?

Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

SSC-R

Which children under age 19 were receiving Social Security in 2013?

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

SSCR

What were the reasons (Child's name/the children) (was/were) getting Social Security in 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

7. Disabled child/children

8. Surviving child/children

9. Dependent child/children

4 Other

SUPPLEMENTAL SECURITY INCOME (SSI) - Source

Q57a

During 2013 did (you/ anyone in this household) receive:

any SSI payments, that is, Supplemental Security Income?

Note: SSI are assistance payments to low-income aged, blind and disabled persons, and come from state or local welfare offices, the Federal government, or both.

3. Yes

4. No

Q57b

Read only if necessary

 Who received SSI?

Supplemental Security Income

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

SSIR

What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2013?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

6. Disabled

7. Blind

8. On behalf of a disabled child

9. On behalf of a blind child

10. Other ________________

Q57d

Did anyone in this household receive any Supplemental Security Income in 2013 that we have not already counted on behalf of children in this household?

Includes all children under 18 years of age 

SSI previously reported will appear here

LN  Name  Amount for Q57C amount

3. Yes

4. No

Q57e

Read only if necessary

 Who received these Supplemental Security Income payments?

Enter line number of parent or guardian

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

RSSI

What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2013?

 Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

4. On behalf of a disabled child/children

5. On behalf of a blind child/children

6. Other ________________

CSSI

Which children under age 18 were receiving Supplemental Security Income

in 2013?

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

DISABILITY INCOME - Source

Q59AR

At any time in 2013 (did you/did anyone in the household) have a disability or health problem which prevented (you/them) from working, even for a short time, or which limited the work (you/they) could do?

1. Yes

2. No (skip to Q60A)

Q59b

 Read only if necessary

Who is that?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

 

Q60a

(Did you/Is there anyone in this household who) ever (retire or leave/ retired or left) a job for health reasons?

3. Yes (Ask to Q61B-R)

4. No

Q61b

Did (you/name) receive any disability income in 2013 as a result of (your/his/her) disability or health problem (other than Social Security Disability)?

1. Yes (Q61C)

2. No

Q61C

What was the source of this income?

Asking About: (name) (blank/- -CURRENT RESPONDENT)

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?

2. Worker’s compensation

3. Company or union disability

4. Federal Government (CIVIL SERVICE) disability

5. U.S. Military retirement disability

6. State or Local government employee disability

7. U.S. Railroad retirement disability

8. Accident or disability insurance

9. Black Lung miner’s disability

10. State temporary sickness

11. Other or don’t know – Specify – Enter last

Q61Cs1

Specify other source from health problem or disability

Enter "Other Health Problem/Disability" if the answer is "Don't Know"

_____________________________________________

VETERANS PAYMENTS - Source

Q60A88

At any time during 2013 did (you/ anyone in this household) receive:

Any Veterans’ (VA) payments?

 Include assistance received by children of veterans

3. Yes

4. No

Q60b_88

 Read only if necessary

Who received Veterans’ (VA) payments either for themselves or as combined payments with other family members?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q60C8

What type of Veterans' payment did (name/you) receive?

 Read list only if respondent is having difficulty answering the question.

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Payments?

6. Service-connected disability compensation

7. Survivor Benefits

8. Veterans’ Pension

9. Educational assistance (including assistance received by children of veterans)

10. Other Veterans’ payments ________________

Q60D88

(Are/Is) (name/you) required to fill out an annual income questionnaire for the Department of Veterans' Affairs?

3. Yes

4. No

SURVIVOR BENEFITS - Source

Q58a

Did (you/ anyone in this household) receive any survivor benefits in 2013 such as

widow’s pensions, estates, trusts, insurance annuities, or any other survivor benefits

(other than Social Security/ other than VA benefits/ other than Social Security or

VA benefits)?

11. Yes

12. No

Q58b

Read only if necessary

 

Who received this income?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q58C

What was the source of this income?

Asking About: (name/name- -CURRENT RESPONDENT) 

Read list if respondent is having difficulty answering the question

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Source?

2 Company or union survivor pension (INCLUDE PROFIT SHARING)

13. Federal Government survivor (CIVIL SERVICE) pension

14. U.S. Military retirement survivor pension

15. State or Local government survivor pension

16. U.S. Railroad retirement survivor pension

17. Worker's compensation survivor pension

18. Black Lung survivor pension

19. Regular payments from estates or trusts

20. Regular payments from annuities or paid-up insurance policies

11 Other or don't know (SPECIFY) - ENTER LAST

Q58Cs1

Specify other source of income as survivor or widow

Enter "Survivor Benefits" if the answer is "Don't Know"

________________________________________________

7. PUBLIC ASSISTANCE

Q59A88 (if “yes” will ask Q59A88 amount later)

At any time during 2013, even for one month, did (you/ anyone in this household) receive any CASH assistance from a state or county welfare program such as

(State Program Name)?

Include cash from: Don’t include:

Welfare or welfare to work food stamps

TANF SNAP

Aid to Families SSI

General Assistance Energy asst

Diversion payments WIC

Refugee Cash School meals

Gen Assist Indian Affairs Childcare

Education Assistance

3. Yes (skip to Q59b_88)

4. No (ask Q59A89)

Q59A89

Just to be sure, in 2013, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?

3. Yes

4. No

Q59b_88 

Who received this CASH assistance?

Enter line number

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q59C8r

From what type of program did (name/you) receive the CASH assistance? Was it a welfare or welfare to-work program such as (STATE PROGRAM NAME), General Assistance, Emergency Assistance, Diversion payments or some other program?

Enter all that apply,

Probe: Any Other Program?

1 (State Program Name)/Temporary Assistance to Needy Families (TANF)/welfare/AFDC

2 General Assistance

3 Emergency Assistance/short-term cash assistance

4 Diversion Payments

5 Refugee Cash and Medical Assistance program

6 General Assistance from Bureau of Indian Affairs, or Tribal Administered General Assistance

(If respondent mentions any of the following categories 7 through 12, note this, but probe: “Right now we are interested in cash assistance” and seek answer to Q59C8-R using categories above.)

7 Food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits/

8 SSI

9 Energy assistance

10 WIC

11 School meals

12 Transportation, childcare, rental or education assistance

13 Some other program (IF OTHER THAN 7-12 ABOVE, GO TO 59C8s)

Q59C8s

What was the name of the other program?

Specify other source of cash assistance

Enter "Cash" if the answer is "Don't Know"

_________________________________________________

FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) - Source

Q87r

Did (you/ anyone in this household) get food stamps or use a food stamp benefit card at any time during 2013?

• Do not include WIC benefits.

1 Yes (SKIP TO Q88)

2 No (ask Q87a-R)

Q87ar

At any time during 2013, even for one month, did (you/ anyone in this household) receive any food assistance from (State Program name)?

Do not include WIC benefits.

1 Yes (ask Q88)

2 No (SKIP TO SWRWIC)

Q88

Which of the people now living here were covered by that food assistance

during 2013?

List all household members covered by food assistance regardless of age

   Enter all that apply, separate using the space bar or a comma.

   Enter 96 for All

   Enter 0 for None

   Probe: Anyone else?

Enter persons line number (1-16)

PENSIONS - Source

Q62Ar

During 2013 did (you/ anyone in this household) receive any pension income from a previous employer or union, (other than Social Security/ other VA benefits/ other than Social Security or VA benefits)?.

PLEASE DO NOT INCLUDE DISTRIBUTIONS OR WITHDRAWALS FROM IRAs, 401ks, OR SIMILAR ACCOUNTS!

1 Yes

2 No

Q62b

Read only if necessary

Who received pension or retirement income?

 Enter all that apply, separate using the space bar or a comma.

 Probe: Anyone Else?

Enter persons line number (1-16)

Q62Cra

Was (name's/your) pension income from a:

Company or union pension (include profit sharing)?

Enter all that apply, separate using the space bar or a comma.

If “Yes”, probe to identify which source

1. Company Pension

2. Union Pension

3. Neither

Q62Crb

Was (name's/your) pension income from a:

Federal, State or Local Government pension?

Enter all that apply, separate using the space bar or a comma.

If “Yes”, probe to identify which source

1. Federal Government Pension

2. State Government Pension

3. Local Government Pension

4. None of the above

Q62Crc

Was (name's/your) pension income from a:

U.S Military pension?

1. Yes

2. No

Q62Crd

Did (you/name) receive pension income from some other source?

1. Yes

2. No

Q62Dr

What was the source of (name's/your) pension income?

Enter all that apply

Probe as needed: Who received this source?

Probe: Any Other pension income?

1 U.S. Railroad Retirement

2 Other sources or don’t know – Specify –

Enter other source of pension income _____________________________________________

Q62Cs1

Specify other source of pension income

Enter "Other Pension" if the answer is "Don't Know"

_________________________________________________

ANNUITIES - Source

Q96Ar

During 2013 did (you/ anyone in this household) receive any income from an annuity?

1 Yes

2 No (skip to Q97Ar)

Q96Br

 Read only if necessary

Who received annuity income?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

RETIREMENT ACCOUNTS - Source

Q97Ar

At any time during 2013 did (you/ anyone in this household) have any retirement accounts such as a 401(k), 403(b), IRA, or other account designed specifically for retirement savings?

1 Yes (ask Q97B-R)

2 No (skip to Q99A-R)

Q97Br

 Read only if necessary

Who had such a retirement account?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

Q97Cr

What type of retirement account (did you/ NAME) have? Did (you/he/she) have…

• READ EACH CATEGORY!

Enter all that apply, separate using the space bar or a comma.

a 401(k)	5. a KEOGH plan (“KEE-OH”)
a 403(b)	6. a SEP plan (Simplified Employee Pension)
a Roth IRA	7. another type of retirement account
a Regular IRA

Q97Dr

What was the source of (name's/your) retirement income?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Probe: Any Other retirement income?

Enter other source of retirement income _____________________________________________

Q98Ar

Did (you/NAME) withdraw any money or receive a distribution from (your/his/her) [ACCOUNT TYPE_ FILL IN FROM Q97CR or Q97DR] account in 2013?

(IF AGE 70+ ADD: including distributions you may have been required to take?)

1 Yes

2 No

INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT - Source

Q99ArA

IF ANY RETIREMENT ACCOUNTS IN HH, READ TRANSITION:

(Now I will ask about assets that may have paid interest or dividends in 2013 outside of the retirement account(s).)

At anytime during 2013, did (you/anyone in this household):

Have money in an interest-earning checking account?

1. Yes ( Probe as needed: Who received this source?)

2. No

Q99ArB

At anytime during 2013, did (you/anyone in this household):

Have a savings account?

1. Yes ( Probe as needed: Who received this source?)

2. No

Q99ArC

At anytime during 2013, did (you/anyone in this household):

Have a money-market fund?

1. Yes ( Probe as needed: Who received this source?)

2. No

Q99ArD

At anytime during 2013, did (you/anyone in this household):

Have CDs (certificates of deposit)?

1. Yes ( Probe as needed: Who received this source?)

2. No

Q99ArE

At anytime during 2013, did (you/anyone in this household):

Have Savings bonds?

1. Yes ( Probe as needed: Who received this source?)

2. No

Q99ArF

At anytime during 2013, did (you/anyone in this household):

Have shares of stock in corporations or mutual funds?

1. Yes ( Probe as needed: Who received this source?)

2. No

Q99ArG

Any other savings or investments that pay interest or dividends?

1. Yes

2. No

CAPGDIS

Did (you/NAME) receive any capital gains distributions from (your/his/her) share of stocks or mutual funds in 2013?

1. Yes

2. No

Q99Br

What was the other source of (name's/your) the savings or investments that pay interest or dividends?

Enter all that apply

Probe as needed: Who received this source?

Enter other source of retirement income _____________________________________________

PROPERTY INCOME - Source

Q65A1

During 2013 did (you/ anyone in this household):

Own any land, business property, apartments, or houses which were rented to others?

3. Yes

4. No

Q65A2

At anytime during 2013 did (you/ anyone in this household):

Receive income from royalties or from roomers or boarders? (exclude amounts paid by relatives)

3. Yes

4. No

Q65A3

At anytime during 2013 did (you/ anyone in this household):

Receive income from estates or trusts? (exclude estates or trusts already reported)

3. Yes

4. No

Q65b

Ask only if necessary

Who received this (income/rent) ?

Include each in cases of joint ownership. For self-employed persons, determine if

income was already included

Enter all that apply, separate using the space bar or a comma.
 Probe: Anyone Else?

Enter persons line number (1-16)

EDUCATION ASSISTANCE - Source

Q66a

During 2013 did (you/ anyone in this household) attend school beyond the high school level including a college, university, or other schools? 

(include vocational, business, or trade schools)

3. Yes

4. No

Q66b

Did (you/ anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2013?

 Exclude loans, assistance from household members, and VA educational benefits

3. Yes

4. No

Q66c

 Ask only if necessary

Which member received assistance?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else? 

Enter persons line number (1-16)

Q66d

What type of assistance did (name/you) receive?

Exclude assistance from household members

Enter all that apply, separate using the space bar or a comma.

 Probe: Any other assistance?

2. Pell Grant

3. Assistance from a welfare or social service office

4. Some other government assistance

5. Scholarships, grants, etc.

6. Other assistance (employers, friends, etc.)

CHILD SUPPORT - Source

Q70a

During 2013 did (you/ anyone in this household) receive:

Any child support payments?

3. Yes

4. No

Q70b

 Read only if necessary

Who received these payments?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else? 

Enter persons line number (1-16)

REGULAR FINANCIAL ASSISTANCE - Source

Q72a

Any regular financial assistance from friends

or relatives not living in this household?

Do not include loans

3. Yes

4. No

Q72b

Read only if necessary

Who received this assistance?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

OTHER MONEY INCOME - Source

Q73A1

During 2013 did (you/ anyone in this household) receive cash income not already covered such as:

income from foster child care, alimony, jury duty, armed forces reserves, severance pay, hobbies, or any other source?

3. Yes

4. No

Q73A1b

Ask only if necessary

Who received this income?

Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?

Enter persons line number (1-16)

COLLECTION OF INCOME AMOUNTS

AMTINTRO

Now I will ask you about the amount of income you and others in this household received from various sources in 2013.

UNEMPLOYMENT AND WORKER’S COMPENSATION - Amounts

Q51A1p

What is the easiest way for you to tell us (name's/your) State or Federal

unemployment compensation; weekly, every other week, twice a month, monthly, or

yearly?

1 Weekly

2 Every other week (bi-weekly)

3 Twice a month

4 Monthly

7 Yearly

Q51A11

How much did (name/you) receive (weekly/every other week/ twice a

month/monthly/ ) in State or Federal unemployment compensation during 2013?

Enter dollar amount

________________

Q51A11r1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in State or Federal unemployment compensation during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q51A11r2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in State or Federal unemployment compensation during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q51A1C

Do not read to the respondent.

The annual rate appears out of range. The total State or Federal unemployment

compensation received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to

Suppress. If No, press enter and correct entry.

Q51A12

How many (weekly/every other week/ twice a month/monthly) payments did

(name/you) receive from State or Federal unemployment compensation during 2013?

(1-12/1-24/1-26/1-52)

________________

Q51A13

According to my calculations (name/you) received (total) altogether from State or Federal unemployment compensation during 2013. Does that sound about right?

1 Yes

2 No

Q51A14

What is your best estimate of the correct total amount (name/you) received from State or Federal unemployment compensation during 2013?

PREVIOUS ENTRIES: Q51A11: (amount)

Q51A1p: (periodicity)

Q51A12: (number of pay periods)

Enter dollar amount

________________

Q51A2p

What is the easiest way for you to tell us (name's/your) Supplemental

Unemployment Benefits; weekly, every other week, twice a month, monthly, or

yearly?

1 Weekly

2 Every other week (bi-weekly)

3 Twice a month

4 Monthly

7 Yearly

Q51A21

How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in Supplemental Unemployment Benefits during 2013?

Enter dollar amount

_____________

Q51A21r1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Supplemental Unemployment Benefits during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q51A21r2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Supplemental Unemployment Benefits during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q51A2C

Do not read to the respondent.

The annual rate appears out of range. The total Supplemental Unemployment Benefits

received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A22

How many (weekly/every other week/twice a month/ monthly) payments did

(name/you) receive from Supplemental Unemployment Benefits during 2013?

(1-12/1-24/1-26/1-52)

________________

Q51A23

According to my calculations (name/you Fill) received (total) altogether from Supplemental Unemployment Benefits during 2013. Does that sound about right?

1 Yes

2 No

Q51A24

What is your best estimate of the correct total amount (name/you) received from Supplemental Unemployment Benefits during 2013?

PREVIOUS ENTRIES: Q51A21: (amount)

Q51A2p: (periodicity)

Q51A22: (number of pay periods)

Enter dollar amount

________________

Q51A3p

What is the easiest way for you to tell us (name's/your) Union Unemployment or Strike Benefits; weekly, every other week, twice a month, monthly, or yearly?

1 Weekly

2 Every other week (bi-weekly)

3 Twice a month

4 Monthly

7 Yearly

Q51A31

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in Union Unemployment or Strike Benefits during 2013?

Enter dollar amount

________________

Q51A31r1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Union Unemployment or Strike Benefits during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q51A31r2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Union Unemployment or Strike Benefits during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

C251A3

Do not read to the respondent.

The annual rate appears out of range. The total Union Unemployment or Strike Benefits

received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q51A32

How many (weekly/every other week/ twice a month/ monthly) payments did

(name/you) receive from Union Unemployment or Strike Benefits during 2013?

(1-12/1-24/1-26/1-52)

________________

Q51A33

According to my calculations (name/you) received (total) altogether from Union Unemployment or Strike Benefits during 2013. Does that sound about right?

1 Yes

2 No

Q51A34

What is your best estimate of the correct total amount (name/you) received from Union Unemployment or Strike Benefits during 2013?

PREVIOUS ENTRIES: Q51A31: (amount)

Q51A3p: (periodicity)

Q51A32: (number of pay periods)

Enter dollar amount

________________

Q52cp

What is the easiest way for you to tell us (your/name’s) (Fill Q52b or Q52Cs1); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly

2 Every other week (bi-weekly)

3 Twice a month

4 Monthly

7 Yearly

Q52c1

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in (Fill Q52b or Q52Cs1) during 2013?

Enter dollar amount

________________

Q52cr1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (Fill Q52b or Q52Cs1) during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q52cr2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (Fill Q52b or Q52Cs1) during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q52cC2

Do not read to the respondent.

The annual rate appears out of range. The total worker's compensation received in 2013

was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and

correct entry.

Q52c2

How many (weekly/every other week/ twice a month/ monthly) payments did

(name/you) receive from (Fill Q52b or Q52Cs1) during 2013?

(1-12/1-24/1-26/1-52)

________________

Q52c3

Then (name/you) received (total) altogether from (Fill Q52b or Q52Cs1) during 2013. Does that sound about right?

1 Yes

2 No

Q52c4

What is your best estimate of the correct total amount (name/you)

received from (Fill Q52b or Q52Cs1) during 2013?

PREVIOUS ENTRIES: Q52c1: (amount)

Q52cp: (periodicity)

Q52c2: (number of pay periods)

Enter dollar amount

________________

Social Security - Amounts

Q56dp

What is the easiest way for you to tell us (name's/your) Social Security payment; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q56d

How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments in 2013?

 Enter dollar amount 

 If already included in amount reported for another household member, press Enter

________________

Q56d_Char

Enter <A> for Already included

________________

Q56drn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Social Security payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

4. Don’t know/ refused

Q56drn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social Security payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

4. DK/refused

Q56d2

For how many (months/quarters) did (name/you) receive Social Security in 2013?

(1-4; 1-12)

________________

Q56d3

Is this $(amount from Q56d/amount from Q56d1) before or after the monthly Medicare deduction?

            1                    After Deduction 

         2                    Before Deduction

Q56md

How much was your monthly Medicare deduction?

Enter dollar amount 

________________

Q56d4

Was the cost of living increase the only change which occurred in monthly payments?

            1                    Yes

            2                    No

 

Q56dC2

Do not read to the respondent.

The annual rate appears out of range. The total Social Security received in XXXX was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q56d5

According to my calculations (name/you) received $(total) altogether from Social Security in 2013. Does that sound about right?

1                    Yes

2                    No

Q56d6

What is your best estimate of the correct amount (name/you) received in Social Security during 2013?

PREVIOUS ENTRIES: (amount)
Q56dp: (periodicity)
  Q56d2: (number of pay periods)
  Q56d3: (amount added per month)
Q56d4: (cost of living subtracted per month)
Enter dollar amount 

________________

Social Security Diability- Amounts

Q562dp

What is the easiest way for you to tell us (name's/your) Social Security Disability payment; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q562d

How much did (name/you) receive (monthly/quarterly/ ) in Social Security Disability payments in 2013?

 Enter dollar amount 

 If already included in amount reported for another household member, press Enter

________________

Q562d_Char

Enter <A> for Already included

________________

Q562drn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Social Security Disability payments in 2013?

5. Less than $10,000

6. Between $10,000 and $20,000

7. $20,000 or more

Q562drn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social Security Disability payments in 2013?

5. Less than $1,000

6. Between $1,000 and $5,000

7. Over $5,000 but less than $10,000

Q562d3

Is this $(amount from Q562d/amount from Q562d1) before or after the monthly Medicare deduction?

            1                    After Deduction 

            2                    Before Deduction

Q562md

How much was your monthly Medicare deduction?

Enter dollar amount 

________________

Q562d4

Was the cost of living increase the only change which occurred in monthly payments?

            1                    Yes

            2                    No

 

Q562dC2

Do not read to the respondent.

The annual rate appears out of range. The total Social Security received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

BACKPAY1

During 2013, did (name/you) receive an initial Social Security Disability payment that was larger than the usual payment that we haven’t accounted for yet?

(This is sometimes done to make up for a delay in the start of payments)

1. Yes

2. No

BACKPAY2

How much was that initial disability payment?

Enter dollar amount

______________

Q562d5

According to my calculations (name/you) received $(total) altogether from Social Security Disability in 2013. Does that sound about right?

1                    Yes

2                    No

Q562d6

What is your best estimate of the correct amount (name/you) received in Social Security Disability during 2013?

PREVIOUS ENTRIES: (amount)
Q56dp: (periodicity)
  Q56d2: (number of pay periods)
  Q56d3: (amount added per month)
Q56d4: (cost of living subtracted per month)
Enter dollar amount 

________________

SOCIAL SECURITY FOR CHILDREN – AMOUNTS

Q56r

Now we’re going to ask you to report the amount of Social Security received on behalf of children in the household.

2. Continue

Q56ip

What is the easiest way for you to tell us (name's/your) Social Security payment for children in this household; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q56i

How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments for children in this household in 2013?

Enter dollar amount 

If already included in amount reported for another household member, press Enter

________________

Q56i_Char

Enter A for Already included

________________

Q56irn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Social Security payments for children in this household in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q56irn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social Security payments for children in this household in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q56i1

What is the amount of the Social Security payment (name/you) received for children in this household last month?

 Enter dollar amount 

________________

Q56i2

For how many (months/quarters) did (name/you receive Social Security in 2013?

 (1-4; 1-12)

________________

Q56i3

Was the cost of living increase the only change which occurred in monthly payments for children in this household?

3. Yes

4. No

Q56iC2

Do not read to the respondent.

The annual rate appears out of range. The total Social Security received for children in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q56i4

According to my calculations (name/you) received $(total) altogether for children in this household from Social Security in 2013. Does that sound about right?

3. Yes

4. No

Q56i5

What is your best estimate of the correct amount (name/you fill) received in Social Security for children in this household during 2013?

 Previous entries: (amount)
  Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)

Enter dollar amount

________________

SUPPLEMENTAL SECURITY INCOME (SSI) – AMOUNTS

Q57cp

What is the easiest way for you to tell us (name's/your fill) Supplemental Security Income payment; monthly, quarterly, or yearly?

4 Monthly

5 Quarterly

7 Yearly

Q57c

How much did (name/you fill) receive (monthly/ quarterly/ ) in Supplemental Security Income payments in 2013?

Enter dollar amount 

________________

Q57crn1:

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Supplemental Security Income payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q57crn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Supplemental Security Income payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q57c1

What is the amount of the Supplemental Security Income payment (name/you) received last month?

Enter dollar amount

________________

Q57c2

For how many (months/quarters) did (name/you) receive Supplemental Security Income in 2013?

(1-4; 1-12)

________________

Q57c3

Was the cost of living increase the only change which occurred in monthly payments?

3. Yes

4. No

Q57cC2

Do not read to the respondent.

The annual rate appears out of range. The total Supplemental Security Income received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q57c4

According to my calculations (name/you) received $(total) altogether from Supplemental Security Income in 2013. Does that sound about right?

3. Yes

4. No

Q57c5

What is your best estimate of the correct amount (name/you) received in Supplemental Security Income during 2013?

Previous entries: (amount)

Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)

Enter Dollar Amount

________________

SUPPLEMENTAL SECURITY INCOME FOR CHILDREN – AMOUNTS

Q57R

Now we’re going to ask you to report the amount of Supplemental Security Income received on behalf of children in the household. What would be the easiest way for you to report the amount (name/you) received for [fill in from Q57d] – Is it easiest to report for them combined, or separately?

1 Separately

2 Combined

Q57ip

What is the easiest way for you to tell us the Supplemental Security
Income (name/you) received on behalf of children?

4 Monthly

5 Quarterly

7 Yearly

Q57i

How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security Income on behalf of children in 2013?

Enter dollar amount

________________

Q57irn1:

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in Supplemental Security Income on behalf of children in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Don’t know/ refused

Q57irn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Supplemental Security Income on behalf of children in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

DK/refused

Q57i1

What is the amount of the Supplemental Security Income payment (name/you fill Q57e) received on behalf of children last month?

Enter dollar amount 

________________

Q57i2

For how many (months/quarters) did (name/you) receive Supplemental Security Income on behalf of children in 2013?

(1-4;1-12)

________________

Q57i3

Was the cost of living increase the only change which occurred in monthly payments?

3. Yes

4. No

Q57iC2

Do not read to the respondent.

The annual rate appears out of range. The total Supplemental Security Income received on behalf of children in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q57i4

According to my calculations (name/you) received $(total) altogether from Supplemental Security Income on behalf of children in 2013.

Does that sound about right?

3. Yes

4. No

Q57i5

What is your best estimate of the correct amount (name/you fill Q57e) received in Supplemental Security Income on behalf of children during 2013?

PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)

 Enter dollar amount 

________________

DISABILITY INCOME – Amounts

Q61E1P

What is the easiest way for you to tell us (name's/your) (fill first answer from Q61C or Q61Cs1) payments; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week

7. Twice a month

8. Monthly

7 Yearly

Q61E1

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) before deductions in (fill first answer from Q61C or Q61Cs1) payments in 2013?

 Enter dollar amount

_______________

Q61e1rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 for the TOTAL amount (name/you) received in (fill first answer from Q61Cr or Q61Cs1) during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q61e1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill first answer from Q61C or Q61Cs1) during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q61E12

How many (weekly/ every other week/ twice a month/ monthly) payments did
(name/you) receive in (fill first answer from Q61C or Q61Cs1) payments in 2013?

Disability income source #1 (1-12; 1-52)

_______________

Q61E1C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q61c or Q61cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q61E13

According to my calculations (name/you) received (total) dollars altogether from
( first answer from Q61C or Q61Cs1) payments in 2013. Does that sound about right?

3. Yes

4. No

Q61E14

What is your best estimate of the correct amount (name/you) received from (fill first answer from Q61C or Q61Cs1) payments during 2013?

PREVIOUS ENTRIES: Q61E1: (amount)
Q61E1P: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount

_______________

Q61E2P

What is the easiest way for you to tell us (name's/your) (fill second answer from Q61C or Q61Cs1) payments; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week

7. Twice a month

8. Monthly

7 Yearly

Q61E2

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) before deductions in (fill second answer from Q61C or Q61Cs1)
payments in 2013?

Enter dollar amount

_______________

Q61e2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 for the TOTAL amount (name/you) received in (fill SECOND answer from Q61C or Q61Cs1) during 2013?

1. Less than $10,000 (proceed to next question)

2. Between $10,000 and $20,000

3. $20,000 or more

Q61e2rn1

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill SECOND answer from Q61C or Q61Cs1) during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q61E22

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (fill second answer from Q61C or Q61Cs1) payments in 2013?

 Disability income payment source #2 (1-12; 1-52)

_______________

Q61E2C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q61c or Q61cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q61E23

According to my calculations (name/you) received (total) dollars altogether

from (fill second answer from Q61C or Q61Cs1) payments in 2013. Does that

sound about right?

3. Yes

4. No

Q61E24

What is your best estimate of the correct amount (name/you) received from (fill second answer from Q61C or Q61Cs1) payments during 2013?

PREVIOUS ENTRIES:  Q61E2: (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)

 Enter dollar amount

_______________

VETERANS PAYMENTS – AMOUNTS

Q60V1P

What is the easiest way for you to tell us (name's/your) (fill from first answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q60V1

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) before deductions in (fill from first answer in Q60c8) in 2013?

Enter dollar amount

________________

Q60v1rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from first answer in Q60c8) payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q60v1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from first answer in Q60c8) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q60V12

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from first answer in Q60c8) in 2013?

(1-52)

________________

Q60V1C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q60c8) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q60V13

According to my calculations (name/you fill) received (total) dollars altogether from (fill from first answer in Q60c8) in 2013. Does that sound about right?

5. Yes

6. No

Q60V14

What is your best estimate of the correct amount (name/you) received in Veteran's benefits during 2013?

PREVIOUS ENTRIES:  Q60V1:  (amount) 

Q60V1P: (periodicity)

Q60V12:  (number of pay periods)

 Enter dollar amount

________________

Q60V2P

What is the easiest way for you to tell us (name's/your) (fill from second answer in Q60c8); weekly, every other week, twice a month, monthly, or yearly?

1 Weekly

2 Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q60V2

How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) before deductions in (fill from second answer in Q60c8) in 2013?

Enter dollar amount

________________

Q60v2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from second answer in Q60c8) payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q60v2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from second answer in Q60c8) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q60V22

How many (weekly/every other week/ twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q60c8) in 2013?

(1-52)

________________

Q60V2C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q60c8) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q60V23

According to my calculations (name/you) received (total) dollars altogether from

(fill from second answer in Q60c8) in 2013. Does that sound about right?

3. Yes

4. No

Q60V24

What is your best estimate of the correct amount (name/you) received in

(fill from second answer in Q60c8) during 2013?

PREVIOUS ENTRIES:  Q60V2:  (amount)

Q60V2P: (periodicity)

Q60V22: (number of pay periods)

Enter dollar amount

________________

SURVIVOR BENEFITS – Amounts

Q58E1P

What is the easiest way for you to tell us (name's/your) (fill from first answer

in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly,

or yearly?

5. Weekly

6. Every other week

7. Twice a month

8. Monthly

7 Yearly

Q58E1

How much did (name/you) receive (weekly/every other week/twice a month/

monthly/ ) in (fill from first answer in Q58C or Q58Cs1) in 2013?

Enter dollar amount

________________

Q58e1rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from first answer in Q58C or Q58Cs1) payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q58e1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from first answer in Q58C or Q58Cs1) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q58E12

How many (weekly/every other week/twice a month/monthly) payments did

(name/you) receive in (fill from first answer in Q58C or Q58Cs1) in 2013?

 (1-52)

________________

Q58E1C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q58C or Q58Cs1) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E13

According to my calculations (name/you) received (total) altogether from
(fill from first answer in Q58C or Q58Cs1) in 2013. Does that sound about right?

3. Yes

4. No

Q58E14

What is your best estimate of the correct amount (name/you) received from (fill from first answer in Q58C or Q58Cs1) during 2013?

PREVIOUS ENTRIES:  Q58E1: (amount)
Q58E1P: (periodicity)
Q58E12: (number of pay periods)
 Enter dollar amount

________________

Q58E2P

What is the easiest way for you to tell us (name's/your) (fill from second answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week

7. Twice a month

8. Monthly

7 Yearly

Q58E2

How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2013?

Enter dollar amount

________________

Q58e2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from second answer in Q58C or Q58Cs1) payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q58e2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from second answer in Q58C or Q58Cs1) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q58E22

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in (fill from second answer in Q58C or Q58Cs1) in 2013?

 (1-52)

________________

Q58E2C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from second answer in Q58C or Q58Cs1) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E23

According to my calculations (name/you) received (total) altogether from

(fill from second answer in Q58C or Q58Cs1) in 2013.

Does that sound about right?

3. Yes

4. No

Q58E24

What is your best estimate of the correct amount (name/you) received from (fill from second answer in Q58C or Q58Cs1) during 2013?

 PREVIOUS ENTRIES: Q58E2: (amount)

Q58E2P: (periodicity)

Q58E22: (number of pay periods)

Enter dollar amount

________________

Q58E3P

What is the easiest way for you to tell us (name's/your) (fill from third answer in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week

7. Twice a month

8. Monthly

7 Yearly

Q58E3

How much did (name/you) receive (weekly/every other week/twice a month/ monthly/ ) in (fill from third answer in Q58C or Q58Cs1) in 2013?

 Enter dollar amount

________________

Q58e3rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (fill from third answer in Q58C or Q58Cs1) payments in 2013?

1. Less than $10,000 (proceed to Q58e3rn2)

2. Between $10,000 and $20,000

3. $20,000 or more

Q58e3rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from third answer in Q58C-R or Q58D-R) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q58E32

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (fill from third answer in Q58C or Q58Cs1) in 2013?

 (1-52)

________________

Q58E3C

Do not read to the respondent.

The annual rate appears out of range. The total (fill from third answer in Q58C or Q58Cs1) received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q58E33

According to my calculations (name/you) received (total) altogether from (fill from third answer in Q58C or Q58Cs1) in 2013. Does that sound about right?

3. Yes

4. No

Q58E34

What is your best estimate of the correct amount (name/you) received from (fill from third answer in Q58C or Q58Cs1) during 2013?

PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)

Enter dollar amount

_______________

PUBLIC ASSISTANCE – Amounts

Q59ep

What is the easiest way for you to tell us [name's/your fill from Q59b 88] CASH assistance payments from [fill from Q59C8-R]; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q59e

During 2013, how much CASH assistance did [name's/your] receive (per week/every other week/twice a month/ monthly/ )?

 Enter dollar amount

___________

Q59Ern1

Could you tell me if (name's/your fill) received less than $1,000, between $1,000 and $3,000, or over $3,000 in TOTAL CASH assistance payments in 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q59Ern2

Did (name's/your) receive less than $100, between $100 and $500, or over $500 in TOTAL CASH assistance payments in 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q59e2

How many (weekly/every other week/ twice a month/ monthly) cash assistance payments did (name's/your) receive in 2013?

(1-12; 1-52)

________________

Q57eC2

Do not read to the respondent.

The annual rate appears out of range. The total cash assistance received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q59e3

According to my calculations (name's/your) received $(total) altogether in cash assistance from a state or county program in 2013. Does that sound about right?

3. Yes

4. No

Q59e4

What is your best estimate of the correct amount of cash assistance
(name's/your) received during 2013?

PREVIOUS ENTRIES:  Q59e: (amount)

Q59ep: (periodicity)

Q59e2: (number of pay periods)

Enter dollar amount 

________________

Q59f

Was the cash assistance for adults AND children, or JUST children?

4. Both adults AND children

5. Children only

6. Adults only

Q59g

(Who/Which children) in your household was the cash assistance for?

 

Probe: Anyone Else?

Enter all that apply, separate using the space bar or a comma.

Enter 0 if none listed

Enter 96 for All persons

Enter persons line number (1-16)

FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) – Amounts

Q90p

What is the easiest way for you to tell us the value of the food assistance:

monthly or yearly?

1. Monthly

2. Yearly

3. Already included with TANF/AFDC payment

Q90

What is the (monthly/ ) value of the food assistance received in 2013?

Enter dollar amount

________________

Q90rn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in food assistance in 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q90rn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in food assistance in 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q902

How many months was food assistance received in 2013?

 (1-12)

________________

Q90C2

Do not read to the respondent.

The annual rate appears out of range. The total food assistance payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q903

According to my calculations (total) was received altogether from food assistance in 2013. Does that sound about right?

1. Yes

2. No

Q904

What is your best estimate of the correct amount of food assistance received

during 2013?

PREVIOUS ENTRIES: Q90: (amount)
  Q90p: (periodicity)
Q902: (number of pay periods)

Enter dollar amount 

________________

PENSIONS – Amounts

Q62E1PR

What is the easiest way for you to tell us (name's/your) (first answer FILL IN FROM Q62C-R or Q62DR); weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week

7. Twice a month

8. Monthly

7 Yearly

Q62E1R

How much did (name's/your) receive (weekly/every other week/ twice a month/ monthly/ ) in (first answer FILL IN FROM Q62C-R or Q62DR) in 2013?

 Enter dollar amount

_______________

Q62E1rn1

Could you tell me if (you/name) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (first answer FILL IN FROM Q62CR or Q62DR) payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q62E1rn2

Did (you/name) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (first answer FILL IN FROM Q62CR or Q62DR) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q62E12R

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (first answer FILL IN FROM Q62CR or Q62DR) in 2013?

 Pension/Retirement #1 (1-12; 1-52)

_______________

Q62E1CR

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q62c or Q62cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E13R

According to my calculations (name/you) received (total) dollars altogether from (first answer FILL IN FROM Q62C-R or Q62DR) in 2013. Does that sound about right?

3. Yes

4. No

Q62E14R

What is your best estimate of the correct amount (name/you) received in (first answer FILL IN FROM Q62C-R or Q62DR) during 2013?

PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
  Q62E12: (number of pay periods)

Enter dollar amount

_______________

Q62E2PR

What is the easiest way for you to tell us (name's/your) (second answer FILL IN FROM Q62C-R or Q62DR); weekly, every other week, twice a month, monthly, or yearly?

9. Weekly

10. Every other week

11. Twice a month

12. Monthly

7 Yearly

Q62E2R

How much did (name's/your) receive (weekly/every other week/ twice a month/ monthly/ ) in (second answer FILL IN FROM Q62C-R or Q62D-R) in 2013?

 Enter dollar amount

_______________

Q62E2rn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in (second answer FILL IN FROM Q62CR or Q62DR) payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q62E2rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (second answer FILL IN FROM Q62CR or Q62DR) payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

Q62E22R

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in (second answer FILL IN FROM Q62C-R or Q62DR) in 2013?

 Pension/Retirement #1 (1-12; 1-52)

_______________

Q62E2CR

Do not read to the respondent.

The annual rate appears out of range. The total (fill from first answer in Q62c or Q62cs1) payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q62E23R

According to my calculations (name/you) received (total) dollars altogether from (second answer FILL IN FROM Q62CR or Q62DR) in 2013. Does that sound about right?

5. Yes

6. No

Q62E24R

What is your best estimate of the correct amount (name/you) received in (second answer FILL IN FROM Q62C-R or Q62DR) during 2013?

PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
  Q62E12: (number of pay periods)

Enter dollar amount

_______________

ANNUITIES – Amounts

ANNNEW1

What is the easiest way for you to tell us (name/your fill Q96BR) annuity income; weekly, every other week, twice a month, monthly, or yearly?

1. Weekly

2. Every other week

3. Twice a month

4. Monthly

7 Yearly

ANNNEW2

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in annuities in 2013?

 Enter dollar amount

_______________

ANNNEWrn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in annuity payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

ANNNEWrn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in annuity payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

ANNNEW3

How many (weekly/every other week/ twice a month/ monthly) annuity payments did (name/you) receive in 2013?

  (1-12; 1-52)

_______________

ANNNEW4

According to my calculations (name/you) received (total) dollars altogether from annuities in 2013. Does that sound about right?

PREVIOUS ENTRIES: ANNNEW2: (amount)
ANNNEW3: (periodicity)
1 Yes

2 No

ANNNEW5

What is your best estimate of the correct amount (name/you) received in annuities in 2013?

Enter dollar amount

_______________

WITHDRAWALS/DISTRIBUTIONS FROM RETIREMENT PLAN - Amounts

DISTNEWE1P

What is the easiest way for you to tell us the amount of money withdrawn or distributed from (name’s/your) [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013: monthly, quarterly, every 6 months, or yearly?

4 Monthly

5 Quarterly

6 Every 6 months

7 Yearly

DISTNEWE1

How much was (name's/your) withdraw or distribution (weekly/every other week/ twice a month/ monthly/ ) from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013?

 Enter dollar amount

_______________

DISTNEWE1rn1

Could you tell me if (name’s/your) withdraw or distribution was less than $10,000, between $10,000 and $20,000, or over $20,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

DISTNEWE1rn2

Did (name’s/your) withdraw or distribution was less than $1,000, between $1,000 and $5,000, or over $5,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

DISTNEWE12

How many (monthly/quarterly) withdrawals did (name’s/your) make or distributions did (name/you) receive in 2013 from the [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)]?

 Enter dollar amount

_______________

DISTNEWE13

According to my calculations (name/you) withdrew or was distributed (total) dollars altogether from the [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013. Does that sound about right?

1 Yes

2 No

DISTNEWE14

What is your best estimate of the correct amount (name/you) withdrew or the distribution received from the [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] during 2013?

 Enter dollar amount

_______________

ROLLAE1

Did [you/NAME] re-invest or "roll over" any of the money into an IRA or some other kind of retirement plan?

1 Yes

2 No

ROLLAMTAE1

How much did (you/NAME) re-invest or “roll over” into an IRA or some other kind of retirement plan in 2013?

 Enter dollar amount

_______________

ROLLBE1

Does (you/NAME) plan to re-invest or roll over any of the money?

1. Yes

2. No

ROLLAMTBE1

How much does (you/NAME) plan to re-invest or “roll over” into an IRA or some other kind of retirement plan?

 Enter dollar amount

_______________

DISTNEWE2P

What is the easiest way for you to tell us the amount of money withdrawn or distributed from (name’s/your) [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013: monthly, quarterly, every 6 months, or yearly?

4 Monthly

5 Quarterly

6 Every 6 months

7 Yearly

DISTNEWE2

How much was (name's/your) withdraw or distribution (weekly/every other week/ twice a month/ monthly/ ) from [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013?

 Enter dollar amount

_______________

DISTNEWE2rn1

Could you tell me if (name’s/your) withdraw or distribution was less than $10,000, between $10,000 and $20,000, or over $20,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013?

4. Less than $10,000

5. Between $10,000 and $20,000

6. $20,000 or more

DISTNEWE2rn2

Did (name’s/your) withdraw or distribution was less than $1,000, between $1,000 and $5,000, or over $5,000 from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013?

4. Less than $1,000

5. Between $1,000 and $5,000

6. Over $5,000 but less than $10,000

DISTNEWE22

How many (monthly/quarterly) withdrawals did (name’s /your) make or distributions did (name/you) receive in 2013 from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)]?

 Enter dollar amount

_______________

DISTNEWE23

According to my calculations (name/you) withdrew or was distributed (total) dollars altogether from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2013. Does that sound about right?

1 Yes

2 No

DISTNEWE24

What is your best estimate of the correct amount (name/you) withdrew or the distribution received from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] during 2013?

 Enter dollar amount

_______________

ROLLAE2

Did [you/NAME] re-invest or "roll over" any of the money into an IRA or some other kind of retirement plan?

1 Yes

2 No

ROLLAMTAE2

How much did (you/NAME) re-invest or “roll over” into an IRA or some other kind of retirement plan in 2013?

 Enter dollar amount

_______________

ROLLBE2

Does (you/NAME) plan to re-invest or roll over any of the money?

1 Yes (If ‘yes’, go to ROLLAMTB)

2 No

ROLLAMTBE2

How much does (you/NAME) plan to re-invest or “roll over” into an IRA or some other kind of retirement plan?

 Enter dollar amount

_______________

INTEREST AND DIVIDEND ON RETIREMENT ACCOUNTS- Amounts

RETNEW1

Within [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] account, how much did (name’s/your) earn in interest or dividends during 2013? Please include small amounts reinvested or credited to the account.

 Enter dollar amount

_____________

RETNEWrn1

Could you tell me if (name’s/your) earned less than $1,000, between $1,000 and $3,000, or over $3,000 in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

RETNEWrn2

Did (name’s/your) earn less than $100, between $100 and $500, or over $500 in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

RETNEW2

The Census Bureau can estimate the amount earned in this account based on the size of the account. So can you tell me how much money was in (name’s/your) [(ACCOUNT TYPE) FILL FROM Q97C-R or Q97D-R] at the end of 2013?

 Enter dollar amount

_____________

INTEREST/DIVIDEND ON NON- RETIREMENT ACCOUNTS - Amounts

NONRETIRENEW1

How much did (you/NAME) receive in (interest/dividends) from [FILL IN Q99AR or Q99BR] during 2013, including even small amounts reinvested or credited to accounts?

If a joint account please split interest income in half for each person.

 Enter dollar amount

_____________

NONRETIRENEW1rn1

Could you tell me if (you/NAME) received less than $1,000, between $1,000 and $3,000, or over $3,000 in interest or dividends from [FILL IN Q99A-R or Q99B-R] during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

NONRETIRENEW1rn2

Did (you/NAME) receive less than $100, between $100 and $500, or over $500 in interest or dividends from [FILL IN Q99AR or Q99BR] during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

NONRETIRENEW2

The Census Bureau can estimate the amount earned in this account based on the size of the account. How much money did (you/NAME) have in [FILL IN Q99AR or Q99BR] at the end of 2013?

 Enter dollar amount

_____________

Q63cp

Is this a weekly, every other week, twice a month, monthly, quarterly, every 6 months, or yearly amount?

1 Weekly

2 Every other week

3 Twice a month

4 Monthly

5 Quarterly

6 Every 6 months

7 Yearly

Q63c2

How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (you/NAME) receive in interest/dividend income in 2013 from [FILL IN Q99A-R or Q99B-R]?

_______________

Q63c3

According to my calculations (you/NAME) received (total) dollars from interest/dividend income from [FILL IN Q99A-R or Q99B-R] in 2013. Does that sound about right?

1 Yes

2 No

Q63c4

What is your best estimate of the correct amount (you/NAME) received from interest payments during 2013?

PREVIOUS ENTRIES: Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)

 Enter dollar amount

_______________

CAPGDAMT

How much did (you/NAME) receive in capital gains distributions in 2013?

 Enter dollar amount

_______________

CAPGDAMTrn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 for the TOTAL yearly amount in capital gains distributions during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

CAPGDAMTrn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in capital gains distributions during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. Over $5,000 but less than $10,000

PROPERTY INCOME – AMOUNTS

Q65c

How much did (name/you) receive in income from rent (blank /, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES during 2013?

 Separate amounts for joint ownership if response is "Broke Even" then enter 1.
   Enter dollar amount

If already included in amount reported for another household member,

or if response is "None",

or if response is "Lost Money"

press <Enter> key

_______________

Q65c_Char

Enter "A" for Already included 

Enter "L" for Lost Money

Enter "X" for None

______________

Q65cL

 Enter amount of money lost in 2013.

_______________

Q65crn1

Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000, or over $20,000 in income from rent (blank /, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES during 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q65crn2

Did (name/you)receive less than $1,000, between $1,000 and $5,000, or over $5,000 in income from rent (blank /, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES during 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. More than $5,000 but less than $10,000

Q65cp

Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly amount?

6. Weekly

7. Every other week

8. Twice a month

9. Monthly

10. Quarterly

7 Yearly

Q65c2

What is your best estimate of (name's/your) ANNUAL net income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts) AFTER EXPENSES in 2013?

 PREVIOUS ENTRIES:  Q65c: (amount)
  Q65cp: (periodicity)

 Enter dollar amount

_______________

Q65cC2

Do not read to the respondent.

The annual rate appears out of range. The total income received from rent ( /roomers or boarders, estates, trusts, or royalties) was (amount) in 2013. Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q65c2L

What is your best estimate of (name/you) ANNUAL LOSS from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES in 2013?

 PREVIOUS ENTRIES:  Q65cL: (amount)
  Q65cp: (periodicity)

Enter dollar amount 

_______________

EDUCATIONAL ASSISTANCE - Amounts

Q69F88

How much did (name/you) receive in Pell Grants during 2013?

Enter annual amount only

________________

Q69frn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in Pell Grants during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more \

Q69frn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in Pell Grants during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q66HP

What is the easiest way for you to tell us (name's/your) (other/blank) educational assistance during 2013; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q66H

How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ ) in educational assistance during 2013? 

Enter dollar amount

________________

Q66hrn1

Could you tell me if (name/you received less than $1,000, between $1,000 and $3,000, or over $3,000 in educational assistance during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q66hrn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in Pell Grants during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q66H2

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you fill Q66c) receive in educational assistance in 2013?

(1-12/1-24/1-26/1-52)

________________

Q66hC2

Do not read to the respondent.

The annual rate appears out of range. The total educational assistance received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q66H3

According to my calculations (name/you) received (total) altogether from educational assistance in 2013. Does that sound about right?

3. Yes

4. No

Q66H4

What is your best estimate of the correct amount (name/you) received from educational assistance during 2013?

 Previous entries: Q66h: (amount)

Q66hp: (periodicity)
  Q66h2: (number of pay periods)

Enter dollar amount

________________

CHILD SUPPORT - Amounts

Q70cp

What is the easiest way for you to tell us (name's/your) child support payments; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q70c

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in child support payments in 2013?

Enter dollar amount 

________________

Q70c1rn1

Could you tell me if (name/you fill Q70b) received less than $10,000, between $10,000 and $20,000, or over $20,000 in child support payments in 2013?

1. Less than $10,000

2. Between $10,000 and $20,000

3. $20,000 or more

Q70c1rn2

Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in child support payments in 2013?

1. Less than $1,000

2. Between $1,000 and $5,000

3. More than $5,000 but less than $10,000

Q70c2

How many (weekly/every other week/ twice a month/ monthly) child support payments did (name/you) receive in 2013?

 (1-12/1-24/1-26/1-52)

________________

Q70cC2

Do not read to the respondent.

The annual rate appears out of range. The total child support payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q70c3

According to my calculations (name/you) received (total) altogether from child support payments in 2013. Does that sound about right?

3. Yes

4. No

Q70c4

What is your best estimate of the correct amount (name/you) received from child support payments during 2013?

PREVIOUS ENTRIES: Q70c: (amount)
  Q70cp: (periodicity)
  Q70c2: (number of pay periods)

Enter dollar amount

________________

REGULAR FINANCIAL ASSISTANCE - AMOUNTS

Q72cp

What is the easiest way for you to tell us (name's/your) regular financial assistance; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q72c

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in regular financial assistance in 2013?

 Enter dollar amount

________________

Q72crn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in regular financial assistance in 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q72crn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in regular financial assistance in 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q72c2

How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2013?

(1-12/1-24/1-26/1-52)

_______________

Q72cC2

Do not read to the respondent.

The annual rate appears out of range. The total regular financial assistance payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q72c3

According to my calculations (name/you) received (total) altogether from regular financial assistance in 2013. Does that sound about right?

3. Yes

4. No

Q72c4

What is your best estimate of the correct amount (name/you fill) received from regular financial assistance during 2013?

PREVIOUS ENTRIES:  Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)

________________

OTHER MONEY INCOME - AMOUNTS

Q731P

What is the easiest way for you to tell us (name's/your) income not already covered such as:

income from foster child care, alimony, jury duty, armed forces reserves, severance pay, or any other source; weekly, every other week, twice a month, monthly, or yearly?

5. Weekly

6. Every other week (bi-weekly)

7. Twice a month

8. Monthly

7 Yearly

Q731

How much did (name/you) receive (weekly/ every other week/ twice a month/ monthly/ ) in income not already covered?

 Enter dollar amount

________________

Q73rn1

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in income not already covered?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q73rn2

Did (name/you) receive less than $100, between $100 and $500, or over $500 in income not already covered?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

Q7312

How many (weekly/every other week/ twice a month/ monthly) payments did (name/you fill Q73A1b) receive in income not already covered?

 (1-12/1-24/1-26/1-52)

________________

Q731C2

Do not read to the respondent.

The annual rate appears out of range. The total income from hobbies, home businesses, farms, or business interests not already covered in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q7313

According to my calculations (name/you) received (total) altogether from income not already covered in 2013.

Does that sound about right?

3. Yes

4. No

Q7314

What is your best estimate of the correct amount (name/you) received in income not already covered in 2013?

PREVIOUS ENTRIES: Q731: (amount)
Q731P: (periodicity)
Q7312: (number of pay periods)

Enter dollar amount 

________________

HEALTH INSURANCE

INTRODUCTION TO HEALTH INSURANCE SECTION

HINTRO

These next questions are about health coverage between January 1, 2013 and now.

Press 1 to Continue

1 Enter 1 to Continue

PINTRO

(First/Next) I'm going to ask about (name's/your) health coverage.

Press 1 to Continue

1 Enter 1 to Continue

SECTION A: ANY COVERAGE NOW?

MCARE1

?[F1]

Medicare is health insurance for people 65 years and older and people under 65 with disabilities. (Are/Is) (name/you) NOW covered by Medicare?

Code Medicare Parts A, B, and C and Medicare Advantage as "Yes"

1 Yes

2 No

ANYCOV

(Do/Does) (name/you) NOW have any type of health plan or health coverage?

1 Yes

2 No

MEDI

?[F1]

(Are/Is/Was/Were) (name/you) covered by Medicaid, Medical Assistance, or (CHIP/Medicare)?

1 Yes

2 No

OTHGOVT

(Are/Is) (name/you) NOW covered by a state or government assistance program that helps pay for healthcare, such as: State Medicaid, CHIP, Exchange/Portal, or other State Health program?

Stop reading list if respondent says "YES"

1 Yes

2 No

VET

(Are/Is) (name/you) NOW covered by Veteran's Administration (VA) care?

1 Yes

2 No

VERIFY

I recorded that (name/you) (are/is) not currently covered by a health plan. Is that correct?

1 Yes, is NOT covered

2 No, is covered

SECTION B: TYPE OF COVERAGE

SRCEGEN

?[F1]

ASK OR VERIFY

For the coverage (name/you) (have/has/had) NOW, (do/does/did) (you/he/she) get it through a job, the government or state, or some other way?

JOB GOVERNMENT OR STATE OTHER

Military (TRICARE, VA, etc.) Medical Assistance Privately purchased

Former job/Retiree Medicaid Parent or spouse

Union Medicare (Parts A+B; Part C) School

Spouse/parent's job Medicare Advantage Exchange plan/Marketplace

Job with the government State-provided health coverage Group or association

COBRA Indian Health Service Medicare Supplements

IF RESPONDENT CHOOSES MORE THAN ONE: Let's talk about one plan at a

time. Which would you like to tell me about first?

[ If respondent is not covered, go back to VERIFY and select "Yes"]

1 Job (current or former)

2 Government or State

3 Some other way

SRCEDEPDIR

ASK OR VERIFY

(Do/Does/Did) (name/you) get that coverage through a parent or spouse, (do/does/did) ( you/he/she) buy it (yourself/himself/herself), or (do/does/did) (you/he/she) get it some other way?

PARENT OR SPOUSE BUY IT DIRECTLY SOME OTHER WAY

Parent Buy it Former employer

Spouse Parent or spouse buys it Group or association

Medicare Supplement Indian Health Service

School

1 Parent or spouse

2 Buy it

3 Some other way

SRCEOTH

ASK OR VERIFY

(Do/Does/Did) (name/you) get it through a former employer, a union, a group or association, the Indian Health Service, a school, or some other way?

1 Former employer

2 Union

3 Group or association

4 Indian Health Service

5 School

6 Some other way

JOBCOV

(Is/Was) that coverage related to a JOB with the government or state?

READ IF NECESSARY: Include coverage through FORMER employers and unions,

and COBRA plans.

1 Yes

2 No

MILPLAN

ASK OR VERIFY

(Is/Was) that plan related to military service in any way?

Examples of military plans include:

- VA Care

- TRICARE

- TRICARE for Life

- CHAMPVA

- Other military care

1 Yes

2 No

GOVTYPE

?[F1]

ASK OR VERIFY

(Is/Was) that coverage Medicaid, CHIP, Medicare, a plan through the military, or some other program?

Code State Medicaid, CHIP, or Other Program as "Medicaid"

Code Medicare Parts A, B, and C and Medicare Advantage as "Medicare"

Code State Exchanges and Exchange Portals as "Other"

IF RESPONDENT CHOOSES MORE THAN ONE: Let's talk about one plan at a

time. Which would you like to tell me about first?

1 Medicaid or Medical Assistance

2 CHIP

3 Medicare

4 Military

5 Other

MILTYPE

ASK OR VERIFY

(Is/Was) that plan through TRICARE, TRICARE for Life, CHAMPVA, VA Care, military health care, or something else?

1 TRICARE

2 TRICARE for Life

3 CHAMPVA

4 Veterans Administration (VA) care

5 Military health care

6 Other

POLHOLDER

ASK OR VERIFY

Whose name (is/was) the policy in? (Who (is/was) the policyholder?)

1-16 Name on roster

17 Someone living outside the household

Enter persons line number (1-16), or 17 for person not in the household

SRCEPTSP

ASK OR VERIFY

(Do/Did) they get that coverage through their job, (do/did) they buy it themselves, or (do/did) they get it some other way?

1 Job (current or former)

2 Buy it

3 Some other way

GOVPLAN

ASK OR VERIFY

What do you call the program?

IF RESPONDENT ANSWERS WITH INSURANCE COMPANY NAME: OK, so

that would be the plan name. What do you call the program? Some examples of

programs in (state) are [read full list below].

1 Medicaid

2 Medical Assistance

3 Indian Health Service (IHS)

4-12 State Medicaid Programs Names

13-15 State Exchange Programs Names

16 Plan through State Exchange Portal

17 Other government plan

18 Other (please specify)

MISCSPEC

Please Specify

Write in plan name

_______________

PORTAL

ASK OR VERIFY

(Is/Was) that coverage through (State Exchange Portal Name) (such as State Exchange Program Name 1, Name 2, Name 3)?

1 Yes

2 No

EXCHTYPE

ASK OR VERIFY

Which plan (is/was) it – State Exchange Program (Name 1, Name 2, Name 3)?

1-3 State Exchange Programs Names

HIPAID

(Does/Did) (your/policyholder name's/the policyholder’s) employer or union pay for all, part, or none of the health insurance premium?

Report here employer's contribution to employee's health insurance premiums, not the

employee's medical bills.

1 All

2 Part

3 None

SHOP

Small businesses can offer health coverage to their employees through (State Exchange SHOP Portal Name). (Is/Was) the coverage at all related to (State Exchange SHOP Portal Name), (such as State SHOP Name 1, Name 2, Name 3).

1 Yes

2 No

POLHOLDER2

ASK OR VERIFY

Whose name (is/was) the policy in? (Who is the policyholder?)

1-16 Name on roster

17 Someone living outside the household

Enter persons line number (1-16), or 17 for person not in the household

PREMYN

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

PREMSUBS

Is the cost of the premium subsidized based on (your/family) income?

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.

Subsidized health coverage is insurance with a reduced premium.  Low and middle

income families are eligible to receive tax credits that allow them to pay lower

premiums for insurance bought through healthcare exchanges or marketplaces.

1 Yes

2 No

SECTION C: MONTHS OF COVERAGE

BEFORAFT

Did (name's/your) coverage from (plan type) start before January 1, 2013?

READ IF NECESSARY: Your best estimate is fine.

( READ IF NECESSARY:  If (policyholder) switched employers or plans through

(your/their) employer, consider it the same plan.)

( READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)

(buy/buys), consider it the same plan.)

1 Yes

2 No

MNTHBEG

In which month did that coverage start?

READ IF NECESSARY: Your best estimate is fine.

( READ IF NECESSARY:  If (policyholder) switched employers or plans through

(your/their) employer, consider it the same plan.)

( READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)

(buy/buys), consider it the same plan.)

This question refers to (plan type)

1 January

2 February

3 March

4 April

5 May

6 June

7 July

8 August

9 September

10 October

11 November

12 December

YEARBEG

ASK OR VERIFY

Which year was that?

( READ IF NECESSARY:  If (policyholder) switched employers or plans through

(your/their) employer, consider it the same plan.)

( READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)

(buy/buys), consider it the same plan.)

This question refers to (plan type)

1 2013

2 2014

CNTCOV

Has it been continuous since (beginning month)?

( READ IF NECESSARY:  If (policyholder) switched employers or plans through

(your/their) employer, consider it the same plan.)

( READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)

(buy/buys), consider it the same plan.)

READ IF NECESSARY: If the gap in coverage was less than 3 weeks, consider the

coverage "continuous."

This question refers to (plan type)

1 Yes

2 No

SPELLADD

I have recorded that (name/you) (was/were) covered by (plan type) in (months of coverage). Were there any OTHER months between January 2013 and now that (name/you) (was/were) also covered by (plan type)?

1 Yes

2 No

ANYTHIS

Which months (was/were) (name/you) covered by (plan type) THIS year -- in 2014?

1 January 2014

2 February 2014

3 March 2014

4 April 2014

20 All months of 2014

21 No months of 2014

ANYLAST

Which months (was/were) (name/you) covered by (plan type) LAST year -- in 2013?

1 January

2 February

3 March

4 April

5 May

6 June

7 July

8 August

9 September

10 October

11 November

12 December

20 All months during 2013

21 No months during 2013

SECTION D: OTHER HOUSEHOLD MEMBERS

OTHMEMB

Between January 1, 2013 and now, was anyone in the household other than (name/you) ALSO covered by (plan type)?

1 Yes

2 No

COVWHO

Who else was covered? Who else was covered by (plan type)?

PROBE: Anyone else?

0 No one listed

1-16 Person 1 through 16’s name

96 All persons listed

Enter persons line number (1-16), or 17 for person not in the household

SAMEMNTHS

(Were/Was) (name/names) also covered from January 2013 until now?

This question refers to (plan type)

1 All also covered until now

2 None covered until now

MNTHS_P(1-16)M

What months between Jan 2013 and now was (NAME) covered? [How about (NAME)?]

This question refers to (plan type)

1 January 2013

2 February 2013

3 March 2013

4 April 2013

5 May 2013

6 June 2013

7 July 2013

8 August 2013

9 September 2013

10 October 2013

11 November 2013

12 December 2013

13 January 2014

14 February 2014

15 March 2014

16 April 2014

20 All months from January 2013 until now

21 No months from January 2013 until now

OTHOUT

Does that plan cover anyone living outside this household?

1 Yes

2 No

OTHWHO

How old are they -- under 19, 19-25 or older than 25?

Mark all that apply

1 Under 19

2 19-25 years old

3 Older than 25

ADDITIONAL PLANS

ADDGAP

So far I have recorded that (name/you) (was/were) NOT covered in months of no coverage. (Were/Was) (name/you) covered by any type of health plan or health coverage in those months/that month?

1 Yes

2 No

GAPMNTHS

What months between January 2013 and now (was/were) (name/you) covered?

1 January 2013

2 February 2013

3 March 2013

4 April 2013

5 May 2013

6 June 2013

7 July 2013

8 August 2013

9 September 2013

10 October 2013

11 November 2013

12 December 2013

13 January 2014

14 February 2014

15 March 2014

16 April 2014

20 All months from January 2013 until now

21 No months from January 2013 until now

ADDOTH

Other than (plan types), (were/was) (name/you) covered by any other plans type of health plan or health coverage AT ANY TIME between January 1, 2013 and now?

READ IF NECESSARY: Do not include plans that cover only one type of care, such

as dental or vision plans.

1 Yes

2 No

EMPLOYER-SPONSORED INSURANCE OFFERS AND TAKEUP

ESIINTRO

Earlier I recorded that (name/you) (are/is) employed but (do/does) not have health coverage through (your/his/her) job.

1 Enter 1 to continue

OFFER

Does (employer name) offer a health insurance plan to any of its employees?

1 Yes

2 No

COULD

Could (name/you) be in this plan if (you/he/she) wanted to?

1 Yes

2 No

WNTAKE

Why (aren't/isn't) (you/he/she) in this plan?

Choose all that apply

1 Covered by another plan

2 Traded health insurance for higher pay

3 Too expensive

4 Don't need health insurance

5 Have a pre-existing condition

6 Haven't yet worked for this employer long enough to be covered

7 Contract or temporary employees not allowed in plan

8 Other/specify

WNTAKESPEC

Please specify other reason why not in the plan

WNELIG

Why not? Why can't (name/you) be in this plan if (you/he/she) wanted to?

Choose all that apply

1 Don't work enough hours per week or weeks per year

2 Contract or temporary employees not allowed in plan

3 Haven't yet worked for this employer long enough to be covered

4 Have a pre-existing condition

5 Too expensive

6 Other/specify

WNELIGSPEC

Please specify other reason why not eligible.

________________

HEALTH STATUS

HealthStatus_Intro

An important factor in evaluating a person's or family's health insurance situation is their current health status and/or the current health status of other family members.

Enter 1 to Continue

HealthStatus

Would you say (name's/your) health in general is excellent, very good, good, fair, or poor?

1 Excellent

2 Very good

3 Good

4 Fair

5 Poor

MEDICAL EXPENDITURES

MedExp_Intro

Next I would like to ask about out-of-pocket medical expenses during 2013.

Press 1 to Continue

1. Enter 1 to continue

HIPREM

[Earlier I recorded that (your/name’s) employer or union did not pay for (his/her) entire health insurance premium.] Last year, how much did (you/name) pay out-of-pocket for ALL health insurance premiums [covering (yourself/himself/herself) or others in the household]?

[What about (you/name)?]

(Include prescription drug insurance such as Medicare Part D premiums and Medicare Advantage premiums. DO NOT include Medicare Part B premiums.)

Enter dollar amount

________________

MEDAMT

?[F1]

Last year, how much was paid out-of-pocket for (your/name’s) OWN medical care, such as copays for doctor and dentist visits, diagnostic tests, prescription medicine, glasses and contacts, and medical supplies?

[What about (you/name)? Last year, how much was paid out-of-pocket for (your/name’s) OWN medical care, such as copays for doctor and dentist visits, diagnostic tests, prescription medicine, glasses and contacts, and medical supplies?]

Include any amount paid out-of-pocket on (your/his/her) behalf by anyone in this household.

Enter dollar amount

________________

OTCMEDAMT

Last year, how much was paid out-of-pocket for (name’s) non-prescription healthcare products such as vitamins, allergy and cold medicine, pain relievers, quit smoking aids, AND anything else not yet reported?

[What about (you/name)? Last year, how much was paid out-of-pocket for (your/name’s) non-prescription healthcare products such as vitamins, allergy and cold medicine, pain relievers, quit smoking aids, AND anything else not yet reported?]

Include any amount paid out-of-pocket on (your/his/her) behalf by anyone in this household.

Enter dollar amount

If unsure of the amount, a best guess is acceptable.

________________

EMPLOYER’S PENSION PLAN

Q74a

Other than Social Security did (ANY) employer or union that (name/you) worked for in 2013 have a pension or other type of retirement plan for any of its employees?

1. Yes

2. No

Q74b

(Were/Was) (name/you) included in that plan?

1. Yes

2. No

SCHOOL LUNCHES

Q80

During 2013 which of the children ages 5 to 18 in this household usually ate a complete lunch offered at school?

Probe: Anyone else?

Enter all that apply, separate using the space bar or a comma.

Enter 96 for All

Enter 0 for None

Enter persons line number (1-16)

Q83

During 2013 which of the children in this household received free or reduced priced lunches because they qualified for the Federal School Lunch Program?

  Probe: Anyone else?

  Enter all that apply, separate using the space bar or a comma.

  Enter 96 for All

  Enter 0 for None

 

Enter persons line number (1-16)

PUBLIC HOUSING

Q85

Is this public housing, that is, is it owned by a local housing authority or other public agency?

1. Yes

2. No

Q86

Are you paying lower rent because the Federal, State, or local government is paying part of the cost?

1. Yes

2. No

SPHS8

Is this through Section 8 or through some other government program?

1. Section 8

2. Some other government program

3. Not sure

FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) Traditional income path only

Q87_T

Did (you/ anyone in this household) get SNAP (Supplemental Nutrition Assistance Program), food stamps or a food stamp benefit card at any time during 2013?

Do not include WIC benefits.

1. Yes

2. No

Q87a_T

At any time during 2013, even for one month, did (you/ anyone in this household)
receive any food assistance from (State Program name) or a food assistance benefit card (such as State EBT card name)?

Do not include WIC benefits.

3. Yes

4. No

Q88_T

Which of the people now living here were covered by that food assistance

during 2013?

List all household members covered by food assistance regardless of age

   Enter all that apply, separate using the space bar or a comma.

   Enter 96 for All

   Enter 0 for None

   Probe: Anyone else?

Enter persons line number (1-16)

Q90p_T

What is the easiest way for you to tell us the value of the food assistance:

monthly or yearly?

4. Monthly

5. Yearly

6. Already included with TANF/AFDC payment

Q90_T

What is the (monthly/ ) value of the food assistance received in 2013?

Enter dollar amount

Q902_T

How many months was food assistance received in 2013?

 (1-12)

________________

Q90C2_T

Do not read to the respondent.

The annual rate appears out of range. The total food assistance payments received in 2013 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

Q903_T

According to my calculations (total) was received altogether from food assistance in 2013. Does that sound about right?

3. Yes

4. No

Q904_T

What is your best estimate of the correct amount of food assistance received

during 2013?

PREVIOUS ENTRIES: Q90: (amount)
  Q90p: (periodicity)
Q902: (number of pay periods)

Enter dollar amount 

________________

WIC

SWRWIC

At any time during 2013, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?

1. Yes

2. No

SWRW

Who received WIC for themselves or on behalf of a child?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone else?

Enter persons line number (1-16)

ENERGY ASSISTANCE

Q93

The government has an energy assistance program which helps pay heating and cooling costs. This assistance can be received directly by the household or it can be paid directly to the electric company, gas company, or fuel dealer.

In 2013, (have you/has this household) received assistance of this type from the federal, state, or local government?

1. Yes

2. No

Q93pr1

Do you remember receiving an additional or unexpected check that was sent during the year to help pay heating or cooling costs?

1. Yes

2. No

Q93pr2

Was it used to pay heating or cooling costs?

1. Yes

2. No

Q94

Altogether, how much energy assistance has been received in 2013?

Enter annual amount only

________________

Q94rn1 Ask only if the respondent “Doesn’t know” or refused Q94r and on the redesigned income path.

Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over $3,000 in energy assistance during 2013?

1. Less than $1,000

2. Between $1,000 and $3,000

3. $3000 or more

Q94rn2 Only redesigned income path.

Did (name/you) receive less than $100, between $100 and $500, or over $500 in energy assistance during 2013?

1. Less than $100

2. Between $100 and $500

3. More than $500 but less than $1000

MIGRATION

MIGSAM

(Were/Was) (reference person's name/you) living in this house (or apartment) one year ago?

1. Yes, this house (apt)

2. No, different house in U.S.

3. No, outside the U.S.

MIGPLC

Where did (reference person's name/you) live one year ago?

Name of city/town/post office

 Current: (city)
Enter correct city/town/post office or press ENTER for SAME

_______________

MIGSTA

?[F1]

Where did (reference person's name/you) live one year ago?

 Name of State

 Current: (state)
 Enter W for person living on a ship at sea
 Enter correct State or press ENTER for SAME

_______________

MIGZIP

Where did (reference person's name/you) live one year ago?

  Zip Code
Current: (zip)
  Enter correct Zip Code or press ENTER for SAME

_______________

MIGCLM

Did (reference person's name/you) live inside the city limits of (place name)?

1. Yes, inside city limits

2. No, outside city limits or post office name only

MIGCOU

What (county/parish) is (place name) in? 

 Enter "IND CITY" if an independent city, not a county

_____________________________________________

S_MIGCN1

What country did (reference person's name/you) live in one year ago?

MI1RES

What was [your/name’s] main reason for moving to this house (apartment)?

 The answer categories are separated into the following groups:

FAMILY-RELATED REASONS 1-3

EMPLOYMENT-RELATED REASONS 4-8

HOUSING-RELATED REASONS 9-13

OTHER REASONS 14-18

1. change in marital status

2. to establish own household

3. other family reason

4. new job or job transfer

5. to look for work or lost job

6. to be closer to work/easier commute

7. retired

8. other job-related reason

9. wanted to own home, not rent

10. wanted new or better house/ apartment

11. wanted better neighborhood/less crime

12. wanted cheaper housing

13. foreclosure/eviction

14. other housing reason

15. to attend or leave college

16. change of climate

17. health reasons

18. natural disaster (hurricane, tornado, etc.)

19. other reason (specify)

MI1s

What was the reason for moving?

_____________________________________________

MIGALL

(There are (number) other persons in this household ages 1 year or over/ ) 
Did (all of these persons/this person) live with (reference person's name/you) (in this house/in City, State/outside the U.S.) one year ago? 

1. Yes, all lived with (reference person's name/you)

2. No, some or all did not live with (reference person's name/you)

MIGM

Which of the other members of this household did NOT live with (reference person's name/you) one year ago?

 PROBE: Anyone else?

 Enter all that apply, separate using the space bar or a comma.

Enter persons line number (1-16)

NXTSAM

Did (name/you) live in this house (apartment) one year ago?

1. Yes , this house

2. No, different house in U.S.

3. No, outside the U.S.

NXTPLC

Where did (name/you) live one year ago?

 Name of city/town/post office 

 Current: (city) Enter correct city/town/post office or

 Press ENTER for SAME

_____________________________________________

NXTSTA

?[F1]

Where did (name/you) live one year ago?

 Name of State
   Current: (state)
   Enter correct State or press ENTER for SAME

_____________________________________________

NXTZIP

Where did (name/you) live one year ago?

Zip Code Current: (zip) 

Enter correct zip code or

Press ENTER for SAME

_______________

NXTCLM

Did (name/you) live inside the city limits of (place name)?

1. Yes, inside city limits

2. No, outside city limits or post office name only

NXTCOU

What (county/parish) is (place name) in?

Enter "IND CITY" if an independent city, not a county

_____________________________________________

S_NXTCN1

What country did (name/you) live in one year ago?

NX1RES

What was (name’s/your) main reason for moving to this house (apartment)?

 The answer categories are separated into the following groups:

FAMILY-RELATED REASONS 1-3

EMPLOYMENT-RELATED REASONS 4-8

HOUSING-RELATED REASONS 9-13

OTHER REASONS 14-18

1. change in marital status

2. to establish own household

3. other family reason

4. new job or job transfer

5. to look for work or lost job

6. to be closer to work/easier commute

7. retired

8. other job-related reason

9. wanted to own home, not rent

10. wanted new or better house/ apartment

11. wanted better neighborhood/less crime

12. wanted cheaper housing

13. foreclosure/eviction

14. other housing reason

15. to attend or leave college

16. change of climate

17. health reasons

18. natural disaster (hurricane, tornado, etc.)

19. other reason (specify)

NX1OTH

What was the reason for moving?

_____________________________________________

SUNITS

Ask if necessary

How many housing units are in your building?

1. Only one

2. Two

3. Three or four

4. Five to nine

5. Ten or more

PROPERTY VALUE/PRESENCE OF MORTGAGE-

VALPROP

About how much do you think this (house and lot/apartment/mobile home)
would sell for if it were for sale?

 Enter dollar amount

________________

VALPROP

Could you tell me if (name/you) think this (house and lot/apartment/mobile home) would sell for less than $100,000, between $100,000 and $250,000, between $250,000 and $500,000, or $500,000 or more?

1. Less than $100,000

2. Between $100,000 and $250,000

3. Between $250,000 and $500,000

4. $500,000 or more

MORTYN

Not counting home equity loans, do you or any other member of this household have a mortgage, deed of trust, contract to purchase, or similar debt on THIS property?

1 Yes

2 No

SMORTYN

Do you or any member of this household have a second mortgage or a home equity loan on THIS property?

1 Yes, home equity loan.

2 Yes, second mortgage.

3 Yes, second mortgage and home equity loan.

4 No

CHILD CARE

Q95

Now we want to ask about some of your expenses for children.

Did (you/ anyone in this household) PAY for the care of (your/their) (child/children) while (you/they) worked in 2013?

Include: All child care expenses including preschool and nursery school expenses,
before and after school care, and summer care.
Do not include: cost of kindergarten or grade/elementary school.

1. Yes

2. No

Q95A

Which children needed care while their parents worked?

 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone else?

Enter 96 for All persons

Enter persons line number (1-16)

CCFREQ

What is the easiest way for you to tell us how much (you/you and others in this household) paid for child care while (you/they) worked in 2013: weekly, every other week, twice a month, monthly, or yearly?

1 Weekly

2 Every other week

3 Twice a month

4 Monthly

7 Yearly

CCAMT

How much did (you/they) pay for child care?

Include child care payments made for all children in the household.

For example, if there are two adults in the household with childcare
expenses use the total paid by both adults.  Do not try to separate
the payments. Record one total for the entire household.

________________

CCNUMPAY

How many (weekly/every other week/twice a month/monthly) payments did (you/they) make during 2013?

________________

CCTOT

Then (you/they) paid (total dollar amount) altogether in child care while (you/they) worked during 2013.  Does that sound about right?

1 Yes

2 No

CCEST

What is your best estimate of the correct amount (you/they) paid for child care while (you/they) worked in 2013?

________________

CHILD SUPPORT PAID

CSPCHILD

Does anyone in this household have any children who lived elsewhere with their other parent or guardian at anytime during 2013?

1 Yes

2 No

CSPWHO

 

Who had children who lived elsewhere? Anyone else?

   Enter line number
  Enter all that apply, separate using the space bar or a comma.

________________

 

CSPREQ

In 2013, (were/was) (name/you) required to pay child support? 

1 Yes

2 No

CSPAMT

How much child support did (name/you) pay in 2013?

 Enter dollar amount

 COUNT ALL FORMS OF CHILD SUPPORTS PAYMENTS, INCLUDING:
...PAYMETNS MADE DIRECTLY TO THE OTHER PARENT/GUARDIAN;
...PAYMENTS MADE THROUGH A COURT OR AGENCY; AND
...PAYMENTS WITHHELD FROM THIS PERSON'S PAYCHECK

________________

0