WIC Participant

OMB Approval No. 0584-XXXX

Approval Expires: XX/XX/20XX

APPENDIX U.1

WIC ITFPS-2 Participant Interview

New Caregiver Module - ENGLISH

Before we begin today, I’d like to ask a few background questions about you and your household.

Caregiver Ethnicity

SD2. Are you Latino or Hispanic? [Source: CHIRP Study; modified]

Yes 01

No 02

Refused 99

Caregiver Race

SD3. What is your race? (choose all that apply) [Source: OMB Standard Categories]

White 01

Black or African American 02

American Indian or Alaska Native 03

Asian 04

Native Hawaiian or Other Pacific Islander 05

Other 06

Don't know 98

Refused 99

US or foreign born

SD13. Were you born in the United States? [Source: WIC IFPS-1]

Yes 01

No 02

Marital status

Do not ask SD14 if interview is 13 months; question will be asked during regular interview.

SD14. Are you married, separated, divorced, widowed, or never married? [Source: WIC IFPS-1]

Married 01

Separated 02

Divorced 03

Widowed 04

Never Married 05

Don’t know 98

Refused 99

Household size

Do not ask SD18 if interview is 7, 13, or 24 months; question will be asked during regular interview.

SD18. How many people live in your household? By household I mean people who live together and share living expenses. Please include yourself in this count, and (If PN enrollment: please add 1 to the total for your pregnancy, too/If postnatal enrollment or 7, 13, or 24 months: If you are pregnant right now please add 1 to the total for your pregnancy. [Source: FITS 2002, modified]

Number of people in household [number]

Household income

Do not ask SD19 if interview is 7, 13, or 24 months; question will be asked during regular interview.

SD19. During [PREVIOUS MONTH], what was your household income before taxes? Please include any income in the past month from you, your family members who live with you, and any other people who live with you and share living expenses with you [Source: WIC IFPS-1, modified]

$500 or less 01

$501-$1000 02

$1001-$1500 03

$1501-$2000 04

$2001-$2500 05

$2501-$3000 06

$3001-$3500 07

$3501-$4000 08

$4001-$4500 09

$4501-$5000 10

$5001+ 11

Don’t know 98

Refused 99

Receipt of public assistance

Do not ask SD21 if interview is 13 or 24 months; question will be asked in regular interview.

SD21. Are you or your family currently receiving any of the following: [Source: WIC IFPS-1; modified]

a. Supplemental nutrition assistance benefits, sometimes called SNAP or Food Stamps?

Yes 01

No 02

Don’t know 98

b. Temporary assistance to needy families, sometimes called TANF or welfare?

Yes 01

No 02

Don’t know 98

c. Are you receiving Medicaid or [state specific name for medicaid]?

Yes 01

No 02

Don’t know 98

d. Are any children in your household receiving free or reduced price meals from the National School Lunch or School Breakfast Program, or the Summer Foods Program?

Yes 01

No 02

Don’t know 98

Household food insecurity

Do not ask SD21 if interview is 13 or 24 months; question will be asked in regular interview.

SD22. Now I’m going to read you several statements that people have made about their food situation. For each of these statements, please tell me whether this was often true, sometimes true, or never true for your household in the last 12 months—that is, since last (name of current month). [Source: USDA Food Security Module subscale; Hager et al., 2010; Nord et al., 2009]

a. "We worried whether our food would run out before we got money to buy more.” Was that often true, sometimes true, or never true for your household in the last 12 months?

Often true 01

Sometimes true 02

Never true 03

Don't know 98

Refused 99

b. "The food that we bought just didn’t last, and we didn’t have money to get more.” Was that often, sometimes, or never true for your household in the last 12 months?

Often true 01

Sometimes true 02

Never true 03

Don't know 98

Refused 99

Educational attainment

Do not ask SD26 if interview is 24 months; question will be asked in regular interview.

SD26. What is the highest year or grade you finished in school? [Source: FITS 2002; modified]

(do not read – endorse based on participant response, probe if needed)

NEVER ATTENDED SCHOOL 01

GRADES 1 TO 11, ENTER NUMBER 02

High school diploma or GED 03

Some college/some postsecondary vocational courses 04

2-year or 3-year college degree (AA degree)

or vocational school diploma 05

4-year college degree (BA, BS degree) 06

Some graduate work/no graduate degree 07

Doctoral or graduate degree (MA, MBA, PhD, JD, MD) 08

DON’T KNOW 98

REFUSED 99

Educational status

Do not ask SD27 if interview is 3, 7, 13, 18, or 24 months; these will be asked during interview.

SD27. As of today, are you in school or college? [Source: IFPS-1]

Yes 01

No 02

Current employment status

Do not ask SD29 if interview is 3, 7, 13, 18, or 24 months; these will be asked during interview.

SD29. Are you currently working for pay full time, part time, or not at all? [Source: LA WIC Survey]

Full time (35 hours or more) 01

Part time 02

Not at all 03

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number.  The valid OMB control number for this information collection is 0584-XXXX.  The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.