2015 ASEC Parallel

Attachment A
2015 Annual Social and Economic Supplement (Parellel Survey)
Items Booklet - March 2015

2015 ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT
PARELLEL SURVEY
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, 2014?
1
2

Yes
No

HH32d
Did any of the following household members live here during the week of
November 19, 2014?
1
2

Yes
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
2
3
4
5
6
7
8

Less than $5,000
5,000 to 7,499
7,500 to 9,999
10,000 to 12,499
12,500 to 14,999
15,000 to 19,999
20,000 to 24,999
25,000 to 29,999

9
10
11
12
13
14
15
16

30,000 to 34,999
35,000 to 39,999
40,000 to 49,999
50,000 to 59,999
60,000 to 74,999
75,000 to 99,999
100,000 to 149,000
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
2

Above
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 2014?
1
2

Yes
No

Q29b
Did (you/he/she) do any temporary, part-time, or seasonal work even
for a few days during 2014?
1
2

Yes
No

2

Q30
Even though (name/you) did not work in 2014, did (you/he/she) spend any time
trying to find a job or on layoff?
1
2

Yes
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 2014?
Read categories if necessary
1
2
3
4
5
6

Ill, or disabled and unable to work
Retired
Taking care of home or family
Going to school
Could not find work
Doing something else

Q33
During 2014 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
________________

3

Q33mon
Enter number of months worked
(1-12)
________________
Q33ver
Then (name/you) worked about (number) weeks. Is that correct?
1
2

Yes
No – back to Q33 and obtain estimate

Q35
Did (name/you) lose any full weeks of work in 2014 because (you/he/she)
(were/was) on layoff from a job or lost a job?
Number of weeks worked in 2014: (number)
1
2
7

Yes
No
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
________________

4

Q37
Were the (number) weeks (name/you) (was/were) looking for work or on layoff all in
one stretch?
Yes – one stretch
No – two stretches
No – 3 or more stretches

1
2
3
Q38

What was the main reason (name/you) (was/were) not working or looking for work
in the remaining weeks of 2014?
Read list only if respondent is having difficulty answering the question
1
2
3
4
5
6

Ill, or disabled and unable to work
Taking care of home or family
Going to school
Retired
No work available
Other (Specify - Q38sp)

Q38sp
Enter verbatim response
_________________________________________________
Q39
For how many employers did (name/you) work in 2014?
If more than one at the same time, only count it as one employer.
1
2
3

One
Two
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
________________

5

Q43
During 2014, 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
2

Yes
No

Q44
In the weeks that (name/you) worked, how many weeks did (name/you) work less
than 35 hours in 2014?
Number of weeks worked in 2014: (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
2
3
4

Could not find a full time job
Wanted to work part time or only able to work part time
Slack work or material shortage
Other reason

6

Q46
What was (name's/your) longest job during 2014?
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
2

Same as listed
Different job

Q47a
For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job
during 2014?))
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 2014)

_________________________________________________
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)
_________________________________________________

7

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
2
3
4

Manufacturing
Retail
Wholesale trade
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)
_________________________________________________

8

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
2
3
4
5

Government
Private for profit company
Non profit organization including tax exempt and charitable organizations
Self employed
Working in family business

Q47E1a
Would that be the federal, state, or local government?
1
2
3

Federal
State
Local (county, city, township)

Q47E1b
Was this business incorporated?
1
2

Yes
No

9

Q47E1c
(Were/Was) (you/name) the owner of the business?
1
2

Yes
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
2
3
4
5
6

under 10
10-49
50-99
100-499
500-999
1,000+

EARNED INCOME
Q48aa
How much did (name/you) earn from this employer before taxes and other
deductions during 2014?
Enter dollar amount
Enter 0 for none
________________
Q48aap
Read if necessary
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

10

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 2014?
(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 2014 before deductions. Does that sound about right?
1
2

Yes
No

Q48a2
What is your best estimate of (name's/your) correct total amount of earnings from
this employer during 2014 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 2014?
1
2

Yes
No

11

Q48aad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from
this employer in 2014?
Enter dollar amount
________________
Q48b
What were (name's/your) net earnings from this business/farm after expenses
during 2014?
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 2014
Enter annual amount only
________________
Q48bp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly
amount?
1
2
3
4
5
7

Weekly
Every other week
Twice a month
Monthly
Quarterly
Yearly

12

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 2014?
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 2014?
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 2014?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is “Lost Money” press enter
Enter dollar amount
________________

13

Q48b3_char
Enter "L" for Lost Money
________________
Q48B3L
Enter amount of money lost in the first quarter of 2014.
________________
Q48b4
What were (name's/your) net earnings from this business/farm during the SECOND
quarter of 2014?
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 2014.
________________
Q48b5
What were (name's/your) net earnings from this business/farm during the THIRD
quarter of 2014?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
________________

14

Q48b5_char
Enter "L" for Lost Money
________________
Q48B5L
Enter amount of money lost in the third quarter of 2014.
________________
Q48b6
What were (name's/your) net earnings from this business/farm during the FOURTH
quarter of 2014?
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 2014.
________________
Q48b7
Does this amount include all tips, bonuses, overtime pay, or commissions
(name/you) may have received from this business in 2014?
1
2

Yes
No

15

Q48bad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions
in 2014?
Enter dollar amount
________________
Q49a
Did (name/you) earn money from any other work (you/he/she) did during 2014?
1
2

Yes
No

Q49b1d
How much did (name/you) earn from all other employers before taxes and other
deductions during 2014?
Enter dollar amount
Enter “0” for None
________________
Q49b1p
Read if necessary
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
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 2014?
(1-12/1-24/1-26/1-52)
________________

16

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 2014. Does that sound about right?
1
2

Yes
No

Q49B12
What is your best estimate of (name's/your) correct total amount of earnings from
all other employers during 2014?
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 2014?
1
2

Yes
No

Q49B1A
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from
all other employers in 2014?
Enter dollar amount
________________

17

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
________________
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
_______________
Q49b4_char
Enter "L" for Lost Money
________________
Q49b5
Enter annual amount lost only
________________

18

UNEMPLOYMENT AND WORKERS COMPENSATION
Q51A1
At any time during 2014 did (name/you) receive any State or Federal unemployment
compensation?
1
2

Yes
No

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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q51A11
How much did (name/you) receive (weekly/every other week/ twice a
month/monthly/ ) in State or Federal unemployment compensation during 2014?
Enter dollar amount
________________
Q51A1C
Do not read to the respondent.
The annual rate appears out of range. The total State or Federal unemployment
compensation received in 2014 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.

19

Q51A12
How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive from State or Federal unemployment compensation during
2014?
(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 2014. Does that sound about right?
1
2

Yes
No

Q51A14
What is your best estimate of the correct total amount (name/you) received from
State or Federal unemployment compensation during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
________________
Q51A2
At any time during 2014 did (name/you) receive any Supplemental Unemployment
Benefits (SUB)?
1
2

Yes
No

20

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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q51A21
How much did (name/you) receive (weekly/every other week/twice a month/
monthly/ ) in Supplemental Unemployment Benefits during 2014?
Enter dollar amount
_____________
Q51A2C
Do not read to the respondent.
The annual rate appears out of range. The total Supplemental Unemployment Benefits
received in 2014 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 2014?
(1-12/1-24/1-26/1-52)
________________
Q51A23
According to my calculations (name/you) received (total) altogether from
Supplemental Unemployment Benefits during 2014. Does that sound about right?
1
2

Yes
No

21

Q51A24
What is your best estimate of the correct total amount (name/you) received from
Supplemental Unemployment Benefits during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
________________
Q51A3
At any time during 2014 did (name/you) receive any Union Unemployment or Strike
Benefits?
1
2

Yes
No

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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q51A31
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/ ) in Union Unemployment or Strike Benefits during 2014?
Enter dollar amount
________________

22

C251A3
Do not read to the respondent.
The annual rate appears out of range. The total Union Unemployment or Strike Benefits
received in 2014 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 2014?
(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 2014. Does that sound about right?
1
2

Yes
No

Q51A34
What is your best estimate of the correct total amount (name/you) received from
Union Unemployment or Strike Benefits during 2014?
PREVIOUS ENTRIES: Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount
________________
Q52a
During 2014 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
2

Yes
No

23

Q52b
What was the source of these payments?
1
2
3
4

State Worker's Compensation
Employer or employer's insurance
Own insurance
Other

Q52cp
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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q52c1
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/ ) in Worker’s Compensation during 2014?
Enter dollar amount
________________
Q52cC2
Do not read to the respondent.
The annual rate appears out of range. The total worker's compensation received in 2014
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 Worker’s Compensation during 2014?
(1-12/1-24/1-26/1-52)
________________

24

Q52c3
Then (name/you) received (total) altogether from Worker’s Compensation
during 2014. Does that sound about right?
1
2

Yes
No

Q52c4
What is your best estimate of the correct total amount (name/you)
received from Worker’s Compensation during 2014?
PREVIOUS ENTRIES:

Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)

Enter dollar amount
________________

SOCIAL SECURITY
Q56a
During 2014 did (you/ anyone in this household) receive any Social Security
payments from the U.S. Government?
1
2

Yes
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)

25

Q56dp
What is the easiest way for you to tell us (name's/your) Social Security payment;
monthly, quarterly, or yearly?
4
5
7

Monthly
Quarterly
Yearly

Q56d
How much did (name/you) receive (monthly/quarterly/ ) in Social Security
payments in 2014?
Enter dollar amount
If already included in amount reported for another household member, press Enter
________________
Q56d_Char
Enter for Already included
________________
Q56d1
What is the amount of the Social Security payment (name/you) received last month?
Enter dollar amount
________________
Q56d2
For how many (months/quarters) did (name/you) receive Social Security in 2014?
(1-4; 1-12)
________________

26

Q56d3
Is this $(amount from Q56d/amount from Q56d1) before or after the Medicare part
B monthly deduction?
1
2

After Deduction
Before Deduction

Q56d4
Were there any changes since last year in your monthly payments?
1
2

Yes
No

Q56dC2
Do not read to the respondent.
The annual rate appears out of range. The total Social Security received in 2014 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 2014. Does that sound about right?
1
2

Yes
No

Q56d6
What is your best estimate of the correct amount (name/you) received in Social
Security during 2014?
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
________________

27

SSR
What were the reasons (name/you) (was/were) getting Social Security in 2014?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3
4
5
6
7
8

Retired
Disabled
Widowed
Spouse
Surviving child
Dependent child
On behalf of surviving, dependent, or disabled children
Other

SSRs
Specify other reason
________________________________________________
SSC
Which children under age 15 were receiving Social Security in 2014?
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 2014?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3
4

Disabled child/children
Surviving child/children
Dependent child/children
Other

28

SOCIAL SECURITY FOR CHILDREN
Q56f
Did anyone in this household receive any Social Security income in 2014 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
1
2

Name

Amount reported in Q56d amount

Yes
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)
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
5
7

Monthly
Quarterly
Yearly

Q56i
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments
for children in this household in 2014?
Enter dollar amount
If already included in amount reported for another household member, press Enter
________________

29

Q56i_Char
Enter A for Already included
________________
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 2014?
(1-4; 1-12)
________________
Q56i3
Was the cost of living increase the only change which occurred in monthly payments
for children in this household?
1
2

Yes
No

Q56iC2
Do not read to the respondent.
The annual rate appears out of range. The total Social Security received for children in
2014 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter
and correct entry.

30

Q56i4
According to my calculations (name/you) received $(total) altogether for children in
this household from Social Security in 2014. Does that sound about right?
1
2

Yes
No

Q56i5
What is your best estimate of the correct amount (name/you) received in Social
Security for children in this household during 2014?
Previous entries:

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

Enter dollar amount
________________
CSS
Which children under age 19 were receiving Social Security in 2014?
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
What were the reasons (Child’s name/the children) (was/were) getting Social
Security in 2014?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3
4

Disabled child/children
Surviving child/children
Dependent child/children
Other

31

SUPPLEMENTAL SECURITY INCOME (SSI)
Q57a
During 2014 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
2

Yes
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)
Q57cp
What is the easiest way for you to tell us (name's/your) Supplemental Security
Income payment; monthly, quarterly, or yearly?
4
5
7

Monthly
Quarterly
Yearly

Q57c
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security
Income payments in 2014?
Enter dollar amount
________________

32

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 2014?
(1-4; 1-12)
________________
Q57c3
Was the cost of living increase the only change which occurred in monthly
payments?
1
2

Yes
No

Q57cC2
Do not read to the respondent.
The annual rate appears out of range. The total Supplemental Security Income received
in 2014 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 2014. Does that sound about right?
1
2

Yes
No

33

Q57c5
What is your best estimate of the correct amount (name/you) received in
Supplemental Security Income during 2014?
Previous entries: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)
Enter Dollar Amount
________________
SSIR
What were the reasons (name/you) (was/were) getting Supplemental Security
Income in 2014?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3
4
5

Disabled
Blind
On behalf of a disabled child
On behalf of a blind child
Other

SSIC
Which children under age 15 were receiving Supplemental Security Income
in 2014?
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)

34

SUPPLEMENTAL SECURITY INCOME FOR CHILDREN
Q57d
Did anyone in this household receive any Supplemental Security Income in 2014
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
1
2

Amount for Q57C amount

Yes
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)
Q57ip
What is the easiest way for you to tell us the Supplemental Security
Income (name/you) received on behalf of children?
4
5
7

Monthly
Quarterly
Yearly

Q57i
How much did (name/you) receive (monthly/ quarterly/ ) in Supplemental Security
Income on behalf of children in 2014?
Enter dollar amount
________________

35

Q57i1
What is the amount of the Supplemental Security Income payment (name/you)
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 2014?
(1-4;1-12)
________________
Q57i3
Was the cost of living increase the only change which occurred in monthly
payments?
1
2

Yes
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 2014 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 2014.
Does that sound about right?
1
2

Yes
No

36

Q57i5
What is your best estimate of the correct amount (name/you) received in
Supplemental Security Income on behalf of children during 2014?
PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)
Enter dollar amount
________________
RSSI
What were the reasons (name/you) (was/were) getting Supplemental Security
Income on behalf of children in 2014?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3

On behalf of a disabled child/children
On behalf of a blind child/children
Other

CSSI
Which children under age 18 were receiving Supplemental Security Income
in 2014?
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)

37

PUBLIC ASSISTANCE
Q59A88
At any time during 2014, 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
2

Yes
No

Q59A89
Just to be sure, in 2014, did anyone receive CASH assistance from a state or county
welfare program, on behalf of CHILDREN in the household?
1
2

Yes
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)

38

Q59C8
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
2
3
4

(State Program Name)/welfare/AFDC
General Assistance
Emergency Assistance/short-term cash assistance
Some other program (specify)

Q59C8s
What type of program?
_________________________________________________
Q59ep
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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q59e
During 2014, how much CASH assistance did (name/you) receive (per week/every
other week/twice a month/ monthly/ )?
Enter dollar amount
___________
Q59e2
How many (weekly/every other week/ twice a month/ monthly) cash assistance
payments did (name/you) receive in 2014?
(1-12; 1-52)
________________

39

Q57eC2
Do not read to the respondent.
The annual rate appears out of range. The total cash assistance received in 2014 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/you) received $(total) altogether in cash
assistance from a state or county program in 2014. Does that sound about right?
1
2

Yes
No

Q59e4
What is your best estimate of the correct amount of cash assistance
(name/you) received during 2014?
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?
1
2
3

Both adults AND children
Children only
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)

40

VETERANS PAYMENTS
Q60A88
At any time during 2014 did (you/ anyone in this household) receive:
Any Veterans’ (VA) payments?
Include assistance received by children of veterans
1
2

Yes
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?
1
2
3
4
5

Service-connected disability compensation
Survivor Benefits
Veterans’ Pension
Educational assistance (including assistance received by children of veterans)
Other Veterans’ payments

Q60D88
(Are/Is) (name/you) required to fill out an annual income questionnaire for the
Department of Veterans' Affairs?
1
2

Yes
No

41

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?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
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 2014?
Enter dollar amount
________________
Q60V12
How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive in (fill from first answer in Q60c8) in 2014?
(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 2014 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) received (total) dollars altogether from
(fill from first answer in Q60c8) in 2014. Does that sound about right?
1
2

Yes
No

42

Q60V14
What is your best estimate of the correct amount (name/you) received in Veteran's
benefits during 2014?
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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
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 2014?
Enter dollar amount
________________
Q60V22
How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive in (fill from second answer in Q60c8) in 2014?
(1-52)
________________

43

Q60V2C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q60c8)
received in 2014 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 2014. Does that sound about right?
1
2

Yes
No

Q60V24
What is your best estimate of the correct amount (name/you) received in
(fill from second answer in Q60c8) during 2014?
PREVIOUS ENTRIES:

Q60V2: (amount)
Q60V2P: (periodicity)
Q60V22: (number of pay periods)

Enter dollar amount
________________

SURVIVOR BENEFITS
Q58A
Did (you/ anyone in this household) receive any survivor benefits in 2014 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
2

Yes
No

44

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
3
4
5
6
7
8
9
10
11

Company or union survivor pension (INCLUDE PROFIT SHARING)
Federal Government survivor (CIVIL SERVICE) pension
U.S. Military retirement survivor pension
State or Local government survivor pension
U.S. Railroad retirement survivor pension
Worker's compensation survivor pension
Black Lung survivor pension
Regular payments from estates or trusts
Regular payments from annuities or paid-up insurance policies
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"
________________________________________________

45

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?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
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 2014?
Enter dollar amount
________________
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 2014?
(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 2014 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 2014. Does that sound about right?
1
2

Yes
No

46

Q58E14
What is your best estimate of the correct amount (name/you) received from (fill
from first answer in Q58C or Q58Cs1) during 2014?
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?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
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 2014?
Enter dollar amount
________________
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 2014?
(1-52)
________________

47

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 2014 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 2014.
Does that sound about right?
1
2

Yes
No

Q58E24
What is your best estimate of the correct amount (name/you) received from (fill
from second answer in Q58C or Q58Cs1) during 2014?
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?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

48

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 2014?
Enter dollar amount
________________
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 2014?
(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 2014 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 2014. Does that sound about right?
1
2

Yes
No

Q58E34
What is your best estimate of the correct amount (name/you) received from (fill
from third answer in Q58C3 or Q58Cs1) during 2014?
PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)
Enter dollar amount
_______________

49

DISABILITY INCOME
Q59A
(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
2

Yes
No

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?
1
2

Yes
No

Q60b
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)

50

Q61b
Did (name/you) receive any income in 2014 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
2

Yes
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
3
4
5
6
7
8
9
10
11

Worker’s compensation
Company or union disability
Federal Government (CIVIL SERVICE) disability
U.S. Military retirement disability
State or Local government employee disability
U.S. Railroad retirement disability
Accident or disability insurance
Black Lung miner’s disability
State temporary sickness
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"
_____________________________________________

51

Q61E1P
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
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q61E1
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 2014?
Enter dollar amount
_______________
Q61E12
How many (weekly/ every other week/ twice a month/ monthly) payments did
(name/you) receive in (first answer from Q61c or Q61cs1) payments in 2014?
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 2014 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 2014. Does that sound about
right?
1
2

Yes
No

52

Q61E14
What is your best estimate of the correct amount (name/you) received from (first
answer from Q61c or Q61cs1) payments during 2014?
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) (second fill from Q61c or
Q61cs1) payments; weekly, every other week, twice a month, monthly, or yearly?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q61E2
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 2014?
Enter dollar amount
_______________
Q61E22
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (second answer from Q61c or Q61cs1) payments in 2014?
Disability income payment source #2 (1-12; 1-52)
_______________

53

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 2014 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 (second answer from Q61c or Q61cs1) payments in 2014. Does that
sound about right?
1
2

Yes
No

Q61E24
What is your best estimate of the correct amount (name/you) received from (second
fill from Q61c or Q61cs1) payments during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
_______________

RETIREMENT AND PENSIONS

Q62A
During 2014 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
2

Yes
No

54

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)

Q62C
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
2
3
4
5
6
7
8

Company or union pension (INCLUDE PROFIT SHARING)
Federal Government (CIVIL SERVICE) retirement
U.S. Military retirement
State or Local government pension
U.S. Railroad Retirement
Regular payments from annuities or paid up insurance policies
Regular payments from IRA, KEOGH, 401(k), 403(b), and 457(b) and (f)
accounts
Other sources or don’t know – Specify – Enter last

Q62Cs1
Enter other source of pension or retirement income
Enter "Other Pension Or Retirement" if the answer is "Don't Know"
_____________________________________________
Q62E1P
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
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

55

Q62E1
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/ ) in (first answer from Q62c or Q62cs1) in 2014?
Enter dollar amount
_______________
Q62E12
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (first answer from Q62c or Q62cs1) in 2014?
Pension/Retirement #1 (1-12; 1-52)
_______________
Q62E1C
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 2014 was (amount). Is this a correct entry? If Yes, enter "S"
to Suppress. If No, press enter and correct entry.
Q62E13
According to my calculations (name/you) received (total) dollars altogether from
(first answer from Q62c or Q62cs1) in 2014. Does that sound about right?
1
2

Yes
No

Q62E14
What is your best estimate of the correct amount (name/you) received in (first
answer from Q62c or Q62cs1) during 2014?
PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
_______________

56

Q62E2P
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
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q62E2
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/ ) in (second answer from Q62c or Q62cs1) in 2014?
Enter dollar amount
_______________
Q62E22
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (second answer from Q62c or Q62cs1) in 2014?
Pension/Retirement #2 (1-12; 1-52)
_______________
Q62E2C
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 2014 was (amount). Is this a correct entry? If Yes, enter "S"
to Suppress. If No, press enter and correct entry.
Q62E23
According to my calculations (name/you) received (total) dollars altogether from
(second answer from Q62c or Q62cs1) in 2014. Does that sound about right?
1
2

Yes
No

57

Q62E24
What is your best estimate of the correct amount (name/you) received in (second
answer from Q62c or Q62cs1) during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
_______________
Q62E3P
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
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q62E3
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/) in (third answer from Q62c or Q62cs1) in 2014?
Enter dollar amount
_______________
Q62E32
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (third answer from Q62c or Q62cs1) in 2014?
Pension/Retirement #3 (1-12; 1-52)
_______________

58

Q62E3C
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 2014 was (amount). Is this a correct entry? If Yes, enter "S"
to Suppress. If No, press enter and correct entry.
Q62E33
According to my calculations (name/you) received (total) dollars altogether from
(third answer fromQ62c or Q62cs1) in 2014. Does that sound about right?
1
2

Yes
No

Q62E34
What is your best estimate of the correct amount (name/you) received in (third
answer from Q62c or Q62cs1) during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
_______________
INTEREST
Q63A1
At anytime during 2014 did (you/ anyone in this household):
Have money in any kind of money market fund, interest earning checking account,
or savings account?
1
2

Yes
No

Q63A2
At anytime during 2014 did (you/ anyone in this household):
Have any savings bonds?
1
2

Yes
No

59

Q63A3
At anytime during 2014 did (you/ anyone in this household):
Have any treasury notes, IRAs, certificates of deposit, or any other investments
which pay interest?
1
2

Yes
No

Q63b
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
How much did (name/you) receive in interest from these sources during 2014,
including even small amounts reinvested or credited to accounts?
Only include interest received from U.S. Savings Bonds cashed during 2014
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
_______________
Q63c_Char
Enter A for "Already Included"
_______________

60

Q63cp
Read if necessary
Is this a weekly, every other week, twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1
2
3
4
5
6
7

Weekly
Every other week
Twice a month
Monthly
Quarterly
Every 6 months
Yearly

Q63c2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6
months) payments did (name/you) receive in interest income in 2014?
(1-2; 1-52)
_______________
Q63cC2
Do not read to the respondent.
The annual rate appears out of range. The total interest income received in 2014 was
(amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q63c3
According to my calculations (name/you) received (total) dollars altogether from
interest income in 2014. Does that sound about right?
1
2

Yes
No

61

Q63c4
What is your best estimate of the correct amount (name/you) received from interest
payments during 2014?
PREVIOUS ENTRIES: Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
_______________
DIVIDENDS
Q64A
At anytime during 2014 did (anyone in this household ages 15 and over/you) own
any shares of stock in corporations (PAUSE) or any mutual fund shares?
1
2

Yes
No

Q64b
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
How much did (name/you) receive in dividends from stocks (or mutual funds)
during 2014, 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
_______________

62

Q64c_Char
Enter for Already included
_______________
Q64cp
Read if necessary
Is this a weekly, every other week, twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1
2
3
4
5
6
7

Weekly
Every other week
Twice a month
Monthly
Quarterly
Every 6 months
Yearly

Q64c2
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 2014?
(1-2; 1-52)
_______________
Q64cC2
Do not read to the respondent.
The annual rate appears out of range. The total dividend payments received in 2014 was
(amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q64c3
According to my calculations (name/you) received (total) dollars altogether from
dividend payments in 2014. Does that sound about right?
1
2

Yes
No

63

Q64c4
What is your best estimate of the correct amount (name/you) received from
dividend payments during 2014?
PREVIOUS ENTRIES: Q64c: (amount)
Q64cp: (periodicity)
Q64c2: (number of pay periods)
Enter dollar amount
_______________

PROPERTY INCOME
Q65A1
During 2014 did (you/ anyone in this household):
Own any land, business property, apartments, or houses which were rented to
others?
1
2

Yes
No

Q65A2
At anytime during 2014 did (you/ anyone in this household):
Receive income from royalties or from roomers or boarders? (exclude amounts paid
by relatives)
1
2

Yes
No

Q65A3
At anytime during 2014 did (you/ anyone in this household):
Receive income from estates or trusts? (exclude estates or trusts already reported)
1
2

Yes
No

64

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)
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) AFTER EXPENSES during 2014?
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 key
_______________
Q65c_Char
Enter "A" for Already included
Enter "L" for Lost Money
Enter "X" for None
______________
Q65cL
Enter amount of money lost in 2014.
_______________

65

Q65cp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly
amount?
1
2
3
4
5
7

Weekly
Every other week
Twice a month
Monthly
Quarterly
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 2014?
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 2014. 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’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 2014?
PREVIOUS ENTRIES:

Q65cL: (amount)
Q65cp: (periodicity)

Enter dollar amount
_______________

66

EDUCATION ASSISTANCE
Q66a
During 2014 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
2

Yes
No

Q66b
Did (you/ anyone in this household) receive any educational assistance for tuition,
fees, books, or living expenses during 2014?
Exclude loans, assistance from household members, and VA educational
benefits
1
2

Yes
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
3
4
5
6

Pell Grant
Assistance from a welfare or social service office
Some other government assistance
Scholarships, grants, etc.
Other assistance (employers, friends, etc.)

67

Q69F88
How much did (name/you) receive in Pell Grants during 2014?
Enter annual amount only
________________
Q66HP
What is the easiest way for you to tell us (name's/your) (other/blank ) educational
assistance during 2014; weekly, every other week, twice a month, monthly, or
yearly?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q66H
(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 2014?
Enter dollar amount
________________
Q66H2
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in educational assistance in 2014?
(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 2014
was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.

68

Q66H3
According to my calculations (name/you) received (total) altogether from
educational assistance in 2014. Does that sound about right?
1
2

Yes
No

Q66H4
What is your best estimate of the correct amount (name/you) received from
educational assistance during 2014?
Previous entries:

Q66h: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)

Enter dollar amount
________________

CHILD SUPPORT AND ALIMONY
Q70a
During 2014 did (you/ anyone in this household) receive:
Any child support payments?
1
2

Yes
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)

69

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?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q70c
How much did (name/you) receive (weekly/ every other week/ twice a month/
monthly/ ) in child support payments in 2014?
Enter dollar amount
________________
Q70c2
How many (weekly/every other week/ twice a month/ monthly) child support
payments did (name/you) receive in 2014?
(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
2014 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 2014. Does that sound about right?
1
2

Yes
No

70

Q70c4
What is your best estimate of the correct amount (name/you) received from child
support payments during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
________________
Q71a
During 2014 did (you/ anyone in this household) receive:
Any alimony payments?
1
2

Yes
No

Q71b
Read only if necessary
Who received these payments during 2014?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q71cp
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
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

71

Q71c
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/ ) in alimony payments in 2014?
Enter dollar amount
________________
Q71c2
How many (weekly/every other week/ twice a month/ monthly) alimony payments
did (name/you) receive in 2014?
(1-12/1-24/1-26/1-52)
________________
Q71cC2
Do not read to the respondent.
The annual rate appears out of range. The total alimony payments received in 2014
was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q71c3
According to my calculations (name/you) received (total) altogether from alimony
payments in 2014. Does that sound about right?
1
2

Yes
No

Q71c4
What is your best estimate of the correct amount (name/you) received from alimony
payments during 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
________________

72

REGULAR FINANCIAL ASSISTANCE
Q72a
During 2014 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
2

Yes
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)
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?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q72c
How much did (name/you) receive (weekly/ every other week/ twice a month/
monthly/ ) in regular financial assistance in 2014?
Enter dollar amount
________________

73

Q72c2
How many (weekly/every other week/twice a month/monthly) payments did
(name/you) receive in regular financial assistance in 2014?
(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 2014 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 2014. Does that sound about right?
1
2

Yes
No

Q72c4
What is your best estimate of the correct amount (name/you) received from regular
financial assistance during 2014?
PREVIOUS ENTRIES:

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

________________

74

OTHER MONEY INCOME
Q73A1
During 2014 did (you/ anyone in this household) receive income from:
Hobbies, home businesses, farms, or business interests not already
covered?
1
2

Yes
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)
Q73A1c
What was the source of this income?
Asking about: (name/you) (name/name- -CURRENT RESPONDENT)
_________________________________________________
Q731P
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 2014;
weekly, every other week, twice a month, monthly, or yearly?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

75

Q731
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 2014?
Enter dollar amount
________________

Q7312
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 2014?
(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 2014 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 hobbies,
home businesses, farms, or business interests not already covered in 2014.
Does that sound about right?
1
2

Yes
No

76

Q7314
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 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
________________
Q73A2
During 2014 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
2

Yes
No

Q73A2b
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
What was the source of this income?
Asking about: (name/you) (name/name- -CURRENT RESPONDENT)
_________________________________________________

77

Q732P
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 2014;
weekly, every other week, twice a month, monthly, or yearly?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q732
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 2014?
Enter dollar amount
________________
Q7322
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 2014?
(1-12/1-24/1-26/1-52)
________________
Q732C2
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 2014 was (amount). Is this a correct
entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.

78

Q7323
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 2014. Does that sound about right?
1
2

Yes
No

Q7324
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 2014?
PREVIOUS ENTRIES:

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

Enter dollar amount
________________

HEALTH INSURANCE
SHI1
These next questions are about health insurance coverage during the calendar
year 2014. The questions apply to ALL persons of ALL ages.
Enter 1 to Continue
SHI2
At any time in 2014, (was/were) (you/ anyone in this household) covered by a health
insurance plan provided through (their/your) current or former employer or union?
Military health insurance will be covered later in another question.
1
2

Yes
No

79

SHI3
Who in this household were policyholders?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHI4
In addition to (name/you) who else in this household was covered by (name’s/your)
plan?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if no one listed
Enter 96 for All persons
Probe: Anyone else?
Enter persons line number (1-16)
SHI5
Did (name’s/your) plan cover anyone living outside this household?
1
2

Yes
No

SHI6
Did (name’s/your) former or current employer or union pay for all, part, or none of
the health insurance premium?
NOTE: Report here employer's contribution to employee's health insurance premiums,
not the employee's medical bills.
1
2
3

All
Part
None

80

SHI7
At any time during 2014, (was/were) (you/ anyone in this household) covered by a
health insurance plan that (you/they) PURCHASED DIRECTLY FROM AN
INSURANCE COMPANY, that is, not related to current or past employment?
1
2

Yes
No

SHI8
Who in this household were policyholders?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHI9
In addition to (name/you) who else in this household was covered by
(name’s/your) plan?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if None listed
Enter 96 for All persons
Probe: Anyone else?
Enter persons line number (1-16)
SHI10
Did (name’s/your) plan cover anyone living outside this household?
1
2

Yes
No

SHI11
At any time in 2014, (was/were) (you/ anyone in this household) covered by the
health insurance plan of someone who does not live in this household?
1
2

Yes
No

81

SHI12
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHI13
At any time in 2014, (was/were) (you/ anyone in this household) covered by
Medicare?
Read if necessary: Medicare is the health insurance for persons 65 years old and over
OR persons with disabilities.
1
2

Yes
No

SHI14
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHI15
At any time in 2014, (was/were) (you/ anyone in this household) covered by
Medicaid / (fill state name)?
Read if necessary: Medicaid / (fill state name) is the Government Assistance Program
that pays for health care.
1
2

Yes
No

82

SHI16
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHI17
How many months during 2014, (was/were) (name/you) covered by Medicaid/(fill
state name)?
Enter number of months (1-12)
_______________
SHI21
In (state), the (fill state CHIP program name) helps families get health insurance for
CHILDREN. (Just to be sure,) Were any of the children in this household covered
by that program?
Read if necessary: (fill state CHIP program name) is the name of your state's CHIP
program. It is the same as the Children's Health Insurance Program, which helps pay for
children's health care.
1
2

Yes
No

SHI22
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)

83

SHI18
At any time in, 2014 (was/were) (you/ anyone in this household) covered by
TRICARE, CHAMPVA, VA, military health care, or Indian Health Service?
NOTE: CHAMPVA is the Civilian Health And Medical Program of the
Department of Veteran's Affairs.
1
2

Yes
No

SHI19
Who was that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHI20
What plan (was/were) (name/you) covered by?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Plan?
1
2
3
4
5

TRICARE
CHAMPVA
VA
Indian Health Service
Other

SHI20s
Enter other type of plan
_______________

84

SHIC1
Other than the plans I have already talked about, during 2014, was anyone in this
household covered by a health insurance plan [such as the (state-specific name plan)
or any other type of plan/of any other type]?
1
2

Yes
No

SHIC2
Who has insurance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHIC3
What type of health insurance (was/were) (name/you) covered by in 2014?
Up to six entries allowed
Probe: Any Other Type Of Plan?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Medicare
Medicaid
TRICARE
CHAMPVA (CHAMPVA IS THE CIVILIAN HEALTH AND MEDICAL
PROGRAM OF THE DEPARTMENT OF VETERAN\'S AFFAIRS)
VA
Military Health Care
Children\'s Health Insurance Program (CHIP)
Indian Health Service
Other government health care
Employer/union provided (policyholder)
Employer/union provided (as dependent)
Privately purchased (policyholder)
Privately purchased (as dependent)
Plan of someone outside the household
Other

SHIC3s
Enter other type of plan
_____________________________________________

85

SHIC4
I have recorded that (you/read list of names) (were/was) not covered by a health
plan at any time during 2014. Is that correct?
1
2

Yes
No

SHIC4A
Who should be marked as covered?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SHIC6
What type of health insurance (was/were) (name/you) covered by in 2014?
Up to six entries allowed
Probe: Any other type of plan?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Medicare
Medicaid
TRICARE
CHAMPVA (CHAMPVA IS THE CIVILIAN HEALTH AND MEDICAL
PROGRAM OF THE DEPARTMENT OF VETERAN\'S AFFAIRS)
VA
Military Health Care
Children\'s Health Insurance Program (CHIP)
Indian Health Service
Other government health care
Employer/union provided (policyholder)
Employer/union provided (as dependent)
Privately purchased (policyholder)
Privately purchased (as dependent)
Plan of someone outside the household
Other

SHIC6s
Enter other type of health insurance covered by in 2014
_____________________________________________

86

SHI24
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
SHI25
Would you say (name's/your) health in general is excellent, very good, good, fair, or
poor?
1
2
3
4
5

Excellent
Very good
Good
Fair
Poor

MEDICAL EXPENDITURES
HIPREM
During 2014, about how much did (name/you) pay for health insurance premiums
for (yourself/himself/herself) or others in the household, after any reimbursements?
Please include premiums paid for HMOs, Fee for Service Plans,
Commercial Medicare Supplements, or other special purpose plans,
such as vision or dental plans. Include prescription drug insurance
such as medicare Part D premiums,and Medicare Advantage premiums.
DO NOT include Medicare Part B premiums.
Enter dollar amount
________________
OTCMEDAMT
During 2014, about how much was paid for (name/you) for over-the-counter health
related products such as aspirin, cold remedies, bandages, first aid supplies, and
other items?
Include any amount paid on (your/his/her) behalf by anyone in this household, that
was not reimbursed.
Enter dollar amount
________________
87

MEDAMT
Aside from over-the-counter items, during 2014, about how much was paid for
(name's/your) own medical care, including payments and co-payments for hospital
visits, medical providers, dental services, prescription medicine, vision aids, and
medical supplies?
Include any amount paid on (your/his/her) behalf by anyone in this household, that
was not reimbursed.
Enter dollar amount
________________
COTCAMT
How about (name)?
During 2014, about how much was paid for (name) for over-the-counter health
related products such as aspirin, cold remedies, bandages, first aid supplies, and
other items?
Include only amounts paid that were not reimbursed.
Enter dollar amount
________________
CMEDAMT
Aside from over-the-counter items, during 2014, about how much was paid for
(name's) own medical care, including payments and co-payments for hospital visits,
medical providers, dental services, prescription medicine, vision aids, and medical
supplies?
Include only amounts paid that were not reimbursed.
Enter dollar amount
________________

88

EMPLOYER’S PENSION PLAN
Q74a
Other than Social Security did (ANY) employer or union that (name/you) worked
for in 2014 have a pension or other type of retirement plan for any of its employees?
1
2

Yes
No

Q74b
(Were/Was) (name/you) included in that plan?
1
2

Yes
No

SCHOOL LUNCHES
Q80
During 2014 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 2014 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)

89

PUBLIC HOUSING
Q85
Is this public housing, that is, is it owned by a local housing authority or other
public agency?
1
2

Yes
No

Q86
Are you paying lower rent because the Federal, State, or local government is paying
part of the cost?
1
2

Yes
No

SPHS8
Is this through Section 8 or through some other government program?
1
2
3

Section 8
Some other government program
Not sure

90

FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE
PROGRAM (SNAP)
Q87
Did (you/ anyone in this household) get SNAP (Supplemental Nutrition Assistance
Program), food stamps or a food stamp benefit card at any time during 2014?
Do not include WIC benefits.
1
2

Yes
No

Q87a
At any time during 2014, 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
4

Yes
No

Q88
Which of the people now living here were covered by that food assistance
during 2014?
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
What is the easiest way for you to tell us the value of the food assistance:
monthly or yearly?
1
2
3

Monthly
Yearly
Already included with TANF/AFDC payment

Q90
What is the (monthly/ ) value of the food assistance received in 2014?
Enter dollar amount
91

Q902
How many months was food assistance received in 2014?
(1-12)
________________

Q90C2
Do not read to the respondent.
The annual rate appears out of range. The total food assistance payments received in
2014 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 2014. Does that sound about right?
1
2

Yes
No

Q904
What is your best estimate of the correct amount of food assistance received
during 2014?
PREVIOUS ENTRIES:

Q90: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)

Enter dollar amount
________________
SWRWIC
At any time during 2014, (was/were) (you/ anyone in this household) on WIC, the
Women, Infants, and Children Nutrition Program?
1
2

Yes
No

92

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)

93

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 2014, (have you/has this household) received assistance of this type from the
federal, state, or local government?
1
2

Yes
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
2

Yes
No

Q93pr2
Was it used to pay heating or cooling costs?
1
2

Yes
No

Q94
Altogether, how much energy assistance has been received in 2014?
Enter annual amount only

94

MIGRATION
MIGSAM
(Were/Was) (reference person's name/you) living in this house (or apartment) one
year ago?
1
2
3

Yes, this house (apt)
No, different house in U.S.
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
_______________

95

MIGCLM
Did (reference person's name/you) live inside the city limits of (place name)?
1
2

Yes, inside city limits
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
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

change in marital status
to establish own household
other family reason
new job or job transfer
to look for work or lost job
to be closer to work/easier commute
retired
other job-related reason
wanted to own home, not rent
wanted new or better house/ apartment
wanted better neighborhood/less crime
wanted cheaper housing
foreclosure/eviction
other housing reason
to attend or leave college
change of climate
health reasons
natural disaster (hurricane, tornado, etc.)
other reason (specify)
96

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
2

Yes, all lived with (reference person's name/you)
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
2
3

Yes , this house
No, different house in U.S.
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
_____________________________________________

97

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
2

Yes, inside city limits
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?

98

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
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

change in marital status
to establish own household
other family reason
new job or job transfer
to look for work or lost job
to be closer to work/easier commute
retired
other job-related reason
wanted to own home, not rent
wanted new or better house/ apartment
wanted better neighborhood/less crime
wanted cheaper housing
foreclosure/eviction
other housing reason
to attend or leave college
change of climate
health reasons
natural disaster (hurricane, tornado, etc.)
other reason (specify)

NX1OTH
What was the reason for moving?
_____________________________________________
SUNITS
Ask if necessary
How many housing units are in your building?
1
2
3
4
5

Only one
Two
Three or four
Five to nine
Ten or more
99

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
________________

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
2

Yes
No

SMORTYN
Do you or any member of this household have a second mortgage or a home equity
loan on THIS property?
1
2
3
4

Yes, home equity loan.
Yes, second mortgage.
Yes, second mortgage and home equity loan.
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 2014?
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
2

Yes
No
100

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 2014: weekly, every other
week, twice a month, monthly, or yearly?

1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
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 2014?
________________

101

CCTOT
Then (you/they) paid (total dollar amount) altogether in child care while (you/they)
worked during 2014. Does that sound about right?

1
2

Yes
No

CCEST
What is your best estimate of the correct amount (you/they) paid for child care
while (you/they) worked in 2014?
________________

CHILD SUPPORT PAID
CSPCHILD
Does anyone in this household have any children who lived elsewhere with their
other parent or guardian at anytime during 2014?

1
2

Yes
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 2014, (were/was) (name/you) required to pay child support?

1
2

Yes
No

102

CSPAMT
How much child support did (name/you) pay in 2014?
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
________________

103