WIA Evaluation Telephone Survey Pretest Memo

APPENDIX I
WIA EVALUATION TELEPHONE SURVEY PRETEST MEMO

MEMORANDUM

TO:

Sheena McConnell

FROM:

Julita Milliner-Waddell and Jamie Marincic

SUBJECT:

WIA Gold Standard Evaluation 15-Month Follow-Up Survey
Pre-Test

8/23/2012
WIA-233
DATE:

A. INTRODUCTION
In preparation for conducting follow-up surveys with participants in the WIA Adult and
Dislocated Worker Programs Gold Standard Evaluation, Mathematica conducted a
comprehensive pretest of the 15-month follow-up survey questionnaire.
The goals of the pretest were to test respondents’ ability to provide the requested
information, identify and eliminate problems with specific questionnaire items, including
question clarity and skip errors, obtain an accurate estimate of average interview length and
respondent burden, and make corrections to the instrument prior to requesting clearance from the
Office of Management and Budget (OMB) and before beginning computer-assisted telephone
interviewing (CATI) programming.
A total of six pretests were completed. For the first three pretests, Mathematica utilized
cognitive interviewing techniques in which respondents were encouraged to think aloud as they
provided their responses. Survey researchers encouraged respondents to identify any words and
phrases that were confusing as the questions were asked rather than waiting for an end of
interview debriefing. These techniques were applied to the survey introduction, answers
provided to frequently asked questions, as well as to questionnaire items. The survey researchers
used non-leading probes in the interviews to minimize bias and asked follow up que stions to
strengthen the language in some questions (for example, “Would you have referred to that by a
different name?”).
Mathematica employed an iterative pretesting approach; that is, the survey team
administered the first cognitive pretest and refined and updated the questionnaire before
proceeding with each of the next two. After the first three pretests were completed as cognitive
interviews, the final three pretest interviews provided more accurate timing estimates. Project
staff debriefed respondents to determine if any words or questions were difficult to understand
and answer. All six pretest interviews were recorded to facilitate review and revision. The first
three cognitive interviews were conducted by the deputy survey director and survey researcher
who developed the questionnaire. The final three pretests were conducted by a trained
interviewer at Mathematica’s Survey Operations Center.

MEMO TO:
FROM:
DATE:
PAGE:

Sheena McConnell
Julita Milliner-Waddell and Jamie Marincic
8/23/2012
2

B. PRETEST SAMPLE
In an effort to match pretest respondents as closely as possible to the ultimate study
participants, Mathematica obtained referrals of customers who would be interested in completing
the pretest interview from a local New Jersey American Jobs Center. These names were
supplemented by confidential referrals by Mathematica staff of family members and associates
who met the study criteria. Using these referrals, we aimed to interview a mix of respondents that
represented diversity in terms of participation in WIA sponsored training and employment
experiences following their initial registration for services.
Key employment and training related characteristics of the six pretest respondents are
provided below.

Pretest
#
1

UI Filing
Date
October
2010

2

August
2010

3

April
2010

4

May
2008

5

March
2010

6

June
2009

WIA Services
Accessed
Workshops
Individual
Counseling
Workshops
Individual
Counseling
Workshop
Tests/Assessments
Individual
Counseling
Individual
Counseling
Workshops
Tests/Assessments
Individual
Counseling
Resource Room
Workshops
Tests/Assessments
Peer Support
Individual
Counseling

# of Training
Programs Since
Filing
1

# of Jobs
Since
Initial
Filing
0

Current
Employment
Status
Unemployed

Survey
Length
(minutes)
35

2

1

Self-employed

45

1

1

Employed

45

0

2

Employed

34

4

0

Self-employed

54

2

2

Employed

52

Average Length of Pretest Surveys

44.16

As the table shows, our pretest respondents utilized a range of WIA services—one
participated in only a single mandatory workshop, another in individual counseling only; while
others took advantage of multiple workshops, tests and assessments, training programs, and
support groups. Five of our respondents were female. Five accessed services in New Jersey and a

MEMO TO:
FROM:
DATE:
PAGE:

Sheena McConnell
Julita Milliner-Waddell and Jamie Marincic
8/23/2012
3

sixth respondent accessed services in New York. Five are currently employed, including two
who are self-employed on a part-time basis and another who is employed through a temporary
placement agency. This diversity of experiences allowed us to test every section of our
questionnaire.
C. PRETEST ADMINISTRATION
Although the WIA follow-up surveys will be administered using CATI, the pretest was
conducted using hard copy questionnaires, reserving programming until the questionnaire is
thoroughly tested and considered closer to final. One experienced interviewer was trained to
administer the pretest questionnaire in a two-hour session during which a summary of the project
was provided and each questionnaire item was reviewed.
To facilitate the administration of the survey on hard copy, the CATI instrument was
modified to provide more assistance for the interviewer and reduce the inefficiencies of hard
copy over CATI. For example, a “ch eat sheet” was developed on which to record critical and
repetitive item fills such as UI Claim date (used as the proxy for random assignment date in the
main study), and the name of the American Job Center at which services were received. In
addition, the cheat sheet provided spaces to record start and end dates for training program
participation and jobs the first time this information was collected to facilitate future references
to those dates. Page numbers for the next question were included with skip instructions for
questions that were several pages away; and skip instructions were written out more fully, for
example, instead of saying, “Does C8= 2” (which works for programming), the pretest version
was more explicit, adding, “Does C8=2—still in program)”.
Administration times ranged from 34 minutes for a respondent who had not participated in
any training programs, to 54 minutes for a respondent who had participated in four training
programs (in fact, this turned out to be four courses for a single program, but the interviewer did
not administer the training grid correctly). Given this interviewer error and the fact that paper
and pencil administration requires more time than CATI, we estimate that the average interview
length would be decreased by approximately five minutes when CATI is used. This suggests an
average administration time of 40 minutes, which is consistent with our goal and respondent
burden estimates.
The pretest was very valuable in improving the questionnaire. Overall, pretest respondents
were able to provide valid answers to questions and did not report any major problems
comprehending the questions or recalling the requested information.
D. QUESTIONNAIRE REVISIONS
Based on these pretests, we have revised the 15- and 30-month questionnaires. Major
substantive revisions are summarized in the table below. Note that the specific survey items

MEMO TO:
FROM:
DATE:
PAGE:

Sheena McConnell
Julita Milliner-Waddell and Jamie Marincic
8/23/2012
4

referenced below align with the 15-month questionnaire. Equivalent changes have been made to
the 30-month version. Appendix A shows the 15-month instrument with the specific changes marked.

Survey Item
FAQ: Is the Survey
Confidential?
B2

Revision
Clarified and simplified wording

Rationale
To improve clarity

Modified third response option

B4, B10, B17, B19, B24,
B26, B30, B34, B37, B43,
B49, B51, B55, B57
B6, B7, B12, B13, B39,
B40, B45, B46
B8

Deleted open-end numeric response
and merged with subsequent pre-coded
numeric response
Deleted

Cognitive respondents commonly said
“required”
To reduce respondent burden associated with
free recall and decrease length of interview

B31

Added probe about tests on different
subjects completed in a single setting
Split into B47a and B47b to screen out
respondents based on whether service
received
Modified or added to ask about inperson appointments and appointments
over the phone separately

B47
B50, B52, B52a, B52b

B59
C27

C32, C33, C34, C35, C36
C37
D12, D29

D16, D33

Added additional probe clarifying
definition of resource room

Split into B59a and B59b to screen out
respondents based on whether service
received
Changed “an educational degree” to “a
diploma or degree”
Added probe to distinguish diplomas
and degrees from certifications and
licenses
Modified wording to allow for
possibility of multiple tests or exams
Split into C37a and C37b to screen out
respondents based on whether have
had job since program completion
Split into D12a and D12b to screen out
respondents based on whether worked
all or nearly all of the time vs. some
time not working
Deleted

Duration information no longer necessary for
cost analysis
Cognitive respondents reported using library
computers not explicitly in a dedicated area
used to look for a job
Cognitive respondents expressed some
confusion about how to count these tests
To decrease length of interview
Cognitive respondents reported that inperson and appointments over the phone
were of different durations so it was
necessary to separate
To decrease length of interview
Cognitive respondent interpreted
“educational degree” as degree in education
Cognitive respondent misreported
certification as diploma or degree
Cognitive respondent reported having to take
more than one test
Original question awkward to administer to
respondents who had not had job since
program completion
To simplify administration of question in
response to cognitive respondent confusion
Information is calculable from other
responses

MEMO TO:
FROM:
DATE:
PAGE:

Sheena McConnell
Julita Milliner-Waddell and Jamie Marincic
8/23/2012
5

Survey Item
D20

Revision
Modified response options so
interviewer only reads them if
necessary

D21

Split into D21a and D21b to separately
assess employment status and whether
looking for work
Added examples to probe

F5a

Rationale
To decrease interview length; cognitive
respondents often interrupted when their
response was read and were able to perform
this free recall task
To capture underemployment reported by
cognitive respondents
To clarify meaning of question; cognitive
respondents often reported insurance carrier

In addition, other non-substantive changes were made to the questionnaires as characterized
below:
1. To decrease interview time and simplify question wording, we now only include the
respondent’s specific LWIA One-Stop as an example of a career center or job center
the first time a series of questions is asked (see B3). The specific name is included as
an interviewer probe in subsequent questions (see B5).
2. Numerous other wording tweaks are documented in the appended version containing
electronically-tracked revisions.

cc: Linda Rosenberg, Pat Nemeth

Appendix A
Tracked Changes to 15-Month Survey

Deleted: APPENDIX A¶
¶
WIA EVALUATION 15- MONTH FOLLOWUP SURVEY¶

OMB Approval No.: xxxx-xxxx
Expiration Date: xx/xx/xxxx
Mathematica Reference No.: 06503.151

Section Break (Next Page)
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Formatted: Font: (Default) Arial, 10 pt

WIA Adult and Dislocated Worker
Programs Evaluation
15-Month Follow-Up Survey
Deleted: February 6

August 23, 2012

NOTE TO REVIEWERS: IN GENERAL, TEXT IN UPPERCASE IS NOT READ TO THE RESPONDENT.
SECTION A – INTRODUCTION AND SCREENING
(INCLUDING CATI FRONT END QUESTIONS)
A1.

Hello
May I speak with [fill SAMPLE MEMBER NAME]?

A2.

SPEAKING TO [FILL FIRSTNAME] ...................................................................... 1

A3

PERSON ASKS WHAT CALL IS ABOUT ............................................................. 2

WHAT ABOUT A2

NOT A GOOD TIME, SCHEDULE CALLBACK .................................................... 3

CALLBACK

[FILL FIRSTNAME] HAS A HEALTH PROBLEM ................................................. 4

HEALTHPROB Q3

[FILL FIRSTNAME] IS IN AN INSTITUTION ........................................................ 5

INSTITUTION Q10

[FILL FIRSTNAME] HAS MOVED ........................................................................ 6

KNOW WHERE Q17

[FILL FIRSTNAME] DOES NOT SPEAK ENGLISH ............................................. 7

LANG Q20

NEVER HEARD OF [FILL FULLNAME]/WRONG NUMBER................................ 8

THANKS Q36 STATUS 530

HUNG UP DURING INTRODUCTION.................................................................. 9

STATUS 640

What about
I’m calling from Mathematica Policy Research about a survey we are conducting for the
U.S. Department of Labor. [fill FirstName] should have received a letter from the U.S. Department
of Labor about the study. Is [fill FirstName] available?

Deleted: When is a good time to reach

[FILL FIRSTNAME] COMES TO THE PHONE ..................................................... 1

A3

Deleted: ]?

NOT A GOOD TIME, SCHEDULE CALLBACK .................................................... 2

CALLBACK

[FILL FIRSTNAME] HAS A HEALTH PROBLEM/IS DECEASED ........................ 3

HEALTHPROB Q3

[FILL FIRSTNAME] IS IN AN INSTITUTION ........................................................ 4

INSTITUTION Q10

[FILL FIRSTNAME] HAS MOVED ........................................................................ 5

KNOW WHERE Q17

[FILL FIRSTNAME] DOES NOT SPEAK ENGLISH ............................................. 6

LANG Q20

ASKS ABOUT LETTER ........................................................................................ 7

A13

NEVER HEARD OF [FILL SAMPLE MEMBER NAME]/WRONG NUMBER ........ 8

Thanks Q36 Status 530

HUNG UP DURING INTRODUCTION.................................................................. 9

Status 640

SUPERVISOR REVIEW ....................................................................................... 10

STATUS 380

REFUSED ............................................................................................................. r

Status 220

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Q3 HealthProb
ENTER TYPE OF HEALTH PROBLEM.
HEARING PROBLEM ........................................................................................... 1

AMP TTY Q4

SPEECH PROBLEM ............................................................................................. 2

AMP TTY Q4

PHYSICAL PROBLEM .......................................................................................... 3

CALLLATER Q8

COGNITIVE PROBLEM ........................................................................................ 4

THANKS Q36 STATUS 410

TOO OLD/FRAIL ................................................................................................... 5

CALLLATER Q8

IN A COMA ........................................................................................................... 6

THANKS Q36 STATUS 410

DECEASED .......................................................................................................... 7

DECEASED Q9

REFUSED ............................................................................................................. r

Status 220

Q4 AmpTTY
I can get on a phone that will amplify my voice or [fill FirstName]’s voice, or we could use a TTY
service. Would either of these enable [fill FirstName] to complete the interview?
CODE ONE ONLY
YES – USE AMPLIFIER PHONE.......................................................................... 1

RESPAVAIL Q5

YES – USE TTY CAPABILITY .............................................................................. 2

RESPAVAIL Q5

NO ......................................................................................................................... 0

THANKS Q36 STATUS 410

DON’T KNOW ....................................................................................................... d

CALLBACK

REFUSED ............................................................................................................. r

Status 220

Q5 RespAvail
Is [fill FirstName] available now?
YES ....................................................................................................................... 1

IF AMPTTY (Q4) = 1
THEN AMPPHONE (Q6)
ELSE CALLTTY (Q7)

NO ......................................................................................................................... 0

Callback

Q6 AmpPhone
Please hold while I get the amplifier phone.
INTERVIEWER:

SET UP AMPLIFIER/WEAK SPEECH EQUIPMENT AND ASK GATEKEEPER TO
CALL [fill FirstName] TO THE PHONE.

[FILL FIRSTNAME] COMES TO THE PHONE ..................................................... 1

SAMPMEMB Q31

CALLBACK ........................................................................................................... 2

Callback

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Q7 CallTTY
I will call back in a few minutes after I have the help of the TTY operator.
ARRANGE CALL WITH OPERATOR ................................................................... 1

SAMPMEMB Q31

IF UNSUCCESSFUL SET CALLBACK................................................................. 2

Callback

Q8 CallLater
Will [fill FirstName] be able to talk on the telephone if I call back in the next few weeks?
YES/MAYBE – CALLBACK .................................................................................. 1

CALLBACK

NO ......................................................................................................................... 0

THANKS Q36 STATUS 419

DON’T KNOW ....................................................................................................... d

CALLBACK

REFUSED ............................................................................................................. r

Status 220

Q9 Deceased
I am very sorry to hear that. I am calling about a survey we are conducting for the U.S. Department
of Labor. Just so I can update my records, when did [fill FirstName] pass away?
Thank you. Please accept my condolences. Good-bye.
| | |/| | |/| | | | |
MONTH DAY
YEAR
(01-12) (01-31) (2004-2012)
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
STATUS 440
Q10 Institution
ENTER TYPE OF INSTITUTION.
HOSPITAL ............................................................................................................ 1

HOMESOON Q11

NURSING HOME .................................................................................................. 2
ASSISTED LIVING FACILITY ............................................................................... 3
GROUP HOME ..................................................................................................... 4
JAIL OR PRISON .................................................................................................. 5

Thanks Q36 Status 421

Q11 HomeSoon
So I know when to call back, do you expect [fill FirstName] to come home from the hospital within
a month or so?
YES, ARRANGE CALLBACK ............................................................................... 1

CALLBACK

NO ......................................................................................................................... 0

Thanks Q36 Status 421

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Deleted: HeShe

Q17 KnowWhere
Do you or anyone there know how we can reach [fill FirstName]?
YES ....................................................................................................................... 1

NEW PHONE Q18

NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SKIP TO THANKS (Q36) STATUS S30
Q18 New Phone
May I please have [fill FirstName]’s telephone number, beginning with the area code?
|

|

|

|-|

|

|

|-|

|

|

|

Deleted: HisHer]

|

(AREA CODE)

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SKIP TO NEW ADDR (Q19)
Is this a home, cell, or work telephone number?
CODE ALL THAT APPLY
HOME.................................................................................................................... 1
CELL ..................................................................................................................... 2
WORK ................................................................................................................... 3
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
Could you please tell me another telephone number where we might be able to reach [fill
FirstName]?
SECOND PHONE NUMBER:
|

|

|

|-|

|

|

|-|

|

|

|

|

(AREA CODE)

NO OTHER NUMBER........................................................................................... 0

New Addr Q19

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

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New Addr Q19

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Is this a home, cell, or work telephone number?
CODE ALL THAT APPLY
HOME.................................................................................................................... 1
CELL ..................................................................................................................... 2
WORK ................................................................................................................... 3
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
Q19 New Addr
Deleted: HisHer]

May I please have [fill FirstName]’s address?
___________________________________________________
HOUSE NUMBER / STREET NAME
APT. #
___________________________________________________
CITY
___________________________________________________
STATE
___________________________________________________
ZIP
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SKIP TO A8
A8 TollFree#
Let me give you a toll-free number where [fill FirstName] can reach someone to complete the
survey and receive [$25] for participating. The toll-free number is XXX-XXX-XXXX. Thank you.
SKIP TO THANKS (Q36) IF NEW PHONE EQUALS DK/RF THEN STATUS 530, ELSE STATUS 899

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Q20 Lang
CODE LANGUAGE NEEDED TO COMPLETE INTERVIEW IF KNOWN.
ARABIC ................................................................................................................. 1

Thanks Q36 Status 400

BOSNIAN .............................................................................................................. 2

Thanks Q36 Status 400

CAMBODIAN ........................................................................................................ 3

Thanks Q36 Status 400

CHINESE .............................................................................................................. 4

Thanks Q36 Status 400

CREOLE ............................................................................................................... 5

Thanks Q36 Status 400

ENGLISH .............................................................................................................. 6

Thanks Q36 Status 400

HINDI..................................................................................................................... 7

Thanks Q36 Status 400

HMONG................................................................................................................. 8

Thanks Q36 Status 400

ITALIAN ................................................................................................................. 9

Thanks Q36 Status 400

LAOTIAN ............................................................................................................... 10

Thanks Q36 Status 400

POLISH ................................................................................................................. 11

Thanks Q36 Status 400

PORTUGUESE ..................................................................................................... 12

Thanks Q36 Status 400

RUSSIAN .............................................................................................................. 13

Thanks Q36 Status 400

SPANISH .............................................................................................................. 14

Thanks Q36 Status 401

TAGALOG ............................................................................................................. 15

Thanks Q36 Status 400

VIETNAMESE ....................................................................................................... 16

Thanks Q36 Status 400

OTHER (SPECIFY) ............................................................................................... 99

OtherLang Q21

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SKIP TO THANKS (Q36) STATUS 400
Q21 OtherLang
SPECIFY OTHER LANGUAGE.
LANGUAGE: ________________________________________
SAY:

We will try and call back with someone who speaks your language.
SKIP TO ELSE THANKS (Q36) STATUS 400

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A3.

My name is [fill Interviewer Name] and I’m calling from Mathematica Policy Research. Recently,
you should have received a letter about a survey we are conducting for the U.S. Department of
Labor. We are calling people who participated in a study conducted at [fill LWIA ONE-STOP] and
need to hear about your experiences. This survey is for research purposes only and will help to
improve services for workers in the future. We will mail you a check for [$25] when the survey is
completed.

Deleted: in Princeton, New Jersey.

Deleted: The interview takes about 30
minutes and

IF HAS QUESTIONS/DON’T KNOW WHAT WE’RE TALKING ABOUT – SEE FAQ
BEGIN INTERVIEW .............................................................................................. 1

A4

NOT A GOOD TIME, SCHEDULE CALLBACK .................................................... 2

Callback

HUNG UP DURING INTRODUCTION.................................................................. 3

Status 640

DOESN’T REMEMBER STUDY ........................................................................... 4

Q32

ASKS ABOUT LETTER ........................................................................................ 5

A12

SUPERVISOR REVIEW ....................................................................................... 6

Status 380

REFUSED ............................................................................................................. r

Status 200

Doesn’t Remember Study (Q32)
Just to refresh your memory, Over a year ago in [fill RA MONTH/YEAR], you agreed to be part of a
national study, called the Workforce Investment Act (WIA) Adult and Dislocated Worker Programs
Gold Standard Evaluation. At that time, you filled out paperwork including a Consent Form,
Registration Form, and Contact Form. We’re now calling to follow-up and hear about any services
you may have received and any jobs you may have had since that time. The questions may jog
your memory so how about we get started?

A4.

YES, BEGIN INTERVIEW ..................................................................................... 1

A4

NO, SUPERVISOR REVIEW ................................................................................ 2

Status 380

NOT A GOOD TIME, SCHEDULE CALLBACK .................................................... 3

Callback

HUNG UP DURING INTRODUCTION.................................................................. 4

Status 640

REFUSED ............................................................................................................. r

Status 200

BLAISE SCREEN: SHOW DOB FROM SAMPLE.
To get started I need to verify that I am speaking with the correct person. Could you please tell me
your date of birth?
PROBE IF RESPONDENT RESISTS:
me the month and day?

I have your year of birth as [fill YEAR], would you please tell

IF NECESSARY: READ DOB ALOUD AND CONFIRM.
RECORD:

|

|

|/|

MONTH

|
DAY

|/|

|

|
YEAR

|

|

IF MATCHES SAMPLE INFO Start Survey (B1), IF DOES NOT
MATCH SAMPLE INFO, ASK (A5)

REFUSED ............................................................................................................. r

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A5

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Deleted: A computer assigned you
Deleted: one of three groups. Let’s
Deleted: .

BLAISE SCREEN: SHOW LAST 4-DIGITS OF SS# FROM SAMPLE.
A5.

Again, for verification purposes, could you please tell me the last four digits of your social
security number?

Deleted: A5. What are

IF NECESSARY: READ LAST 4-DIGITS ALOUD AND CONFIRM.
|

|

|

|

| LAST FOUR SSN DIGITS [IF MATCHES SAMPLE INFO - START SURVEY
(B1), IF DOES NOT MATCH
SAMPLE INFO, READ A9]

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
A9.

I am sorry. Before I continue with the interview I will need to check with my supervisor. Thank you
for your time.
SKIP TO END

Q36 Thanks
Thank you very much for your time.
ENTER 1 TO CONTINUE
SAMPLE MEMBER AND LETTER
A12.

The letter was from ___________, Federal Project Officer for the U.S. Department of Labor, and
addressed to you. The letter explained that this study is sponsored by the U.S. Department of
Labor. The purposes of the study are to help the government provide better services to people
looking for jobs and be more responsive to the needs of those who are unemployed. It also
mentioned that we would be mailing you a check for [$25] when the survey is completed.
May we begin the interview?
IF NECESSARY:

BEGIN INTERVIEW .............................................................................................. 1

A4

NOT A GOOD TIME, SCHEDULE CALLBACK .................................................... 2

Callback

HUNG UP DURING INTRODUCTION.................................................................. 3

Status 640

SUPERVISOR REVIEW ....................................................................................... 4

Status 380

REQUESTS ANOTHER LETTER ......................................................................... 5

Send Letter

REFUSED ............................................................................................................. r

Status 200

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Deleted: study’s purpose is
Deleted: jobseekers in the future
Deleted: the

The letter was sent from the U.S. Department of Labor, and was printed on
letterhead with the U.S. Department of Labor’s name on the top.

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[SendLetter (Q35)]
A12a. Okay, I can read you what the letter says, or I’ll mail another letter and will call back in a few days.
To what address should we mail the letter?
___________________________________________________
HOUSE NUMBER / STREET NAME
APT. #
___________________________________________________
CITY
___________________________________________________
STATE
___________________________________________________
ZIP
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
THANKS (Q36) STATUS 831
GATEKEEPER AND LETTER
A13.

The letter was from the U.S. Department of Labor, and addressed to [fill SAMPLE MEMBER
NAME]. The letter explained that this study is sponsored by the U.S. Department of Labor. The
purposes of the study are to help the government provide better services to people looking for
jobs and be more responsive to the needs of those who are unemployed. It also mentioned that
we would be mailing [fill SAMPLE MEMBER NAME] a check for [$25] when the survey is
completed.
May I speak to [fill SAMPLE MEMBER NAME]?
IF NECESSARY:

A4

NOT A GOOD TIME, SCHEDULE CALLBACK .................................................... 2

CALLBACK

HUNG UP DURING INTRODUCTION.................................................................. 3

STATUS 640

SUPERVISOR REVIEW ....................................................................................... 4

STATUS 380

REFUSED ............................................................................................................. r

Status 200

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Deleted: study’s purpose is
Deleted: at [fill ONE-STOP CENTER
NAME] to jobseekers in the future
Deleted: the
Deleted: SM FirstName LastName

The letter was sent from the U.S. Department of Labor, and was printed on
letterhead with the U.S. Department of Labor’s name on the top.

BEGIN INTERVIEW .............................................................................................. 1

Deleted: and

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CALLBACK SCREENS
Q101 Hello
Hello, my name is [fill InterviewerName]. I am calling from Mathematica on behalf of the
U.S. Department of Labor. May I please speak to [fill SAMPLE MEMBER NAME]?

Deleted: FullName

SPEAKING TO [FILL FIRSTNAME] ...................................................................... 1
[FILL FIRSTNAME] COMES TO THE PHONE ..................................................... 2
PERSON ASKS WHAT CALL IS ABOUT ............................................................. 3

WHATABOUT Q102

NEED TO CALLBACK .......................................................................................... 4

CALLBACK

NEVER HEARD OF [FILL FULLNAME]/WRONG NUMBER................................ 5

PHONECHECK Q106

REFUSED ............................................................................................................. r

STATUS 200
IF NOT SAMPLE MEMBER

IF SAMPLE MEMBER, THEN SKIP TO SAMPMEMB (Q103)
Q102 WhatAbout
[if SampleMember then]
I’m calling to finish the interview we are conducting with [fill FirstName].

Deleted: SM

When is a good time to reach [fill FirstName]?
[FILL FIRSTNAME] COMES TO THE PHONE ..................................................... 1
NEED TO CALLBACK .......................................................................................... 2

CALLBACK

SUPERVISOR REVIEW ....................................................................................... 3

STATUS 380

REFUSED ............................................................................................................. r

STATUS 200
IF NOT SAMPLE MEMBER

IF SAMPLE MEMBER, THEN SKIP TO SAMPMEMB (Q103)
Q103 SampMemb
[if Hello = 2 or WhatAbout = 1 then]
Hello, my name is [fill InterviewerName].
[endif]
I’m calling to finish the interview we are conducting of people who participated in a study
conducted at [fill ONE-STOP NAME]. Is now a good time?
CONTINUE INTERVIEW ...................................................................................... 1

A4

NOT A GOOD TIME.............................................................................................. 2

CALLBACK

SUPERVISOR REVIEW ....................................................................................... 3

STATUS 380

REFUSED ............................................................................................................. r

Status 200

Q106 PhoneCheck
I’m sorry, I thought I dialed [fill PHONE]. Can you tell me what number I’ve reached to see what
kind of mistake I made?
RIGHT NUMBER, NO SUCH PERSON ............................................................... 1

WRONGNUMBER Q107

WRONG CONNECTION/MISDIAL ....................................................................... 2

THANKS Q108

SUPERVISOR REVIEW REQUIRED ................................................................... 3

STATUS 380

REFUSED TO CONFIRM NUMBER .................................................................... 4

Thanks Q108

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Deleted: I must have misdialed.

Deleted: Q10

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Q107 WrongNumber
I’m [fill InterviewerName] from Mathematica Policy Research. I thought we’d recently spoken to
someone there and according to the information I have, we were supposed to call back to
interview [fill SAMPLE MEMBER NAME]. There must have been some mistake. Thank you for your
help. I’ll turn this over to my supervisor.
ENTER 1 TO CONTINUE ..................................................................................... 1

Status 380

Q108 Thanks
Thank you for your time.
ENTER 1 TO CONTINUE ..................................................................................... 1

Backup Q109

Q109 Backup
BACKUP AND REDIAL PHONE NUMBER.

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Deleted: in Princeton, New Jersey
Deleted: FullName].

FREQUENTLY ASKED QUESTIONS (FAQs)

PROGRAMMER: ALLOW INTERVIEWER TO VIEW FAQS AT ANY TIME.
WHO/WHICH AGENCY IS SPONSORING THE STUDY?
This study is being sponsored by the U.S. Department of Labor.
WHO IS CONDUCTING THE STUDY?
The study is being conducted by a team of researchers at Mathematica Policy Research, Social Policy Research
Associates and MDRC, under contract to the U.S. Department of Labor.
WHAT IS THE PURPOSE OF THE STUDY?
Our goal is to learn about how effectively some employment and training programs meet the needs of
unemployed and underemployed workers. This study is very important for improving services to jobseekers in the
future. It will allow us to understand what works well and what doesn’t.
NO LONGER IN TRAINING/NEVER PARTICIPATED.
We are calling people who signed up to participate, even if they never did get any training, or are no longer
participating. Your responses and views are important because they help us understand why some individuals
never received services.
I’M DISSATISFIED WITH MY UNEMPLOYMENT BENEFITS/LOCAL AGENCIES.
I understand. Your comments will be especially important to the research. The U.S. Department of Labor needs to
hear from people who were satisfied and people who were dissatisfied with their experiences.
I’M DISSATISFIED WITH THE TRAINING PROGRAM.
I understand. Your comments will be especially important to the research. The U.S. Department of Labor wants to
have feedback from people who were satisfied and dissatisfied with their experiences.
HOW DID YOU GET MY NAME?
Your name was scientifically selected from among persons in your state who participated in the study registration
process at a local One-Stop or [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]. The
Consent Form that you signed mentioned we may be calling you to conduct an interview.
I GOT A JOB SOON AFTER I SIGNED UP.
That is wonderful, but we still need to talk to people who didn’t participate in any of the services as well as those
who did.
THERE WAS NO FUNDING/NO MONEY FOR ME TO GET TRAINING.
I am sorry to hear that and understand that federal funds run out quickly. We still need to talk to you about your
experiences and what you’re currently doing.

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FAQs – continued
Deleted: IS

WILL THE INFORMATION FROM THE SURVEY BE KEPT PRIVATE?

Deleted: CONFIDENTIAL

All of the information we collect in the survey will be kept private to the extent allowed by federal law and will be
used for research purposes only. Your answers will be combined with those of others and your name will never be
used in reporting the results of the study. Your answers to questions will not affect your eligibility for any public
program.
I DON’T HAVE THE TIME.
We can schedule a call to do the survey at your convenience. Our interviewers are available to speak with you
seven days a week as follows: on Mondays through Thursdays from 9:00 A.M. to 12:00 midnight, on Fridays from
9:00 A.M. to 8:00 P.M., Saturdays from 9:00 A.M.-5:00 P.M. and Sundays from 1:00 P.M. to 9:00 P.M. Eastern
Standard Time. We can also complete the survey in more than one call, if necessary.
WHAT HAPPENS IF I DON’T PARTICIPATE IN THE SURVEY?
Your participation is voluntary and will not affect your eligibility to receive any services or benefits. Your selection
for the survey was done scientifically. You were chosen to represent other people who also consented to the
study in your area. Your answers will help the U.S. Department of Labor improve services to people who become
unemployed. There are no right or wrong answers. We’re interested in your experiences and opinions.
I’M NOT INTERESTED.
Let me reassure you that we are not selling anything. The questions we ask are designed to help the
U.S. Department of Labor improve services to people who are unemployed and seeking jobs. There are no right
or wrong answers. We’re interested in your experiences and opinions. Your answers will be combined with those
of others and your name will never be included in any report. If you complete the survey we will pay you $25 as a
token of appreciation.
HOW LONG WILL THIS TAKE?
The length of the interview varies, but it usually takes about 40 minutes.
WHO GAVE YOU THE AUTHORITY TO CONDUCT THE STUDY?
As stated in the letter we mailed you, and can be remailed if you like, this study is being sponsored by the U.S.
Department of Labor and has been approved by the U.S. Office of Management and Budget under OMB control
number XXXX-XXXX. Without this approval we would not be able to conduct this survey. Questions regarding any
aspect of this survey may be directed to Eileen Pederson, WIA Evaluation, U.S. Department of Labor, ETA, 200
Constitution Avenue, NW, Frances Perkins Bldg., Room N-5641, Washington, DC 20210, telephone number
(202) 693-3647 (this is not a toll-free number) or by email: [email protected].
WILL I BE PAID?
Yes, we will mail you a check in the amount of $25 within 2 weeks of completing the survey.

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Deleted: Yes. Your responses are protected
from disclosure by federal statue [P.L. 107-347,
Title V Confidential Information Protection and
Statistical Efficiency Act of 2002 (CIPSEA)].¶

FAQs – continued
WILL THERE BE A REPORT ON THE FINDINGS THAT I CAN READ? WHERE/WHEN CAN I SEE A
PUBLISHED REPORT ABOUT THE NATIONAL EVALUATION?
Survey results will be reported in several reports prepared by Mathematica for the U.S. Department of Labor.
Once these reports are cleared by the U.S. Department of Labor for public release, they will be available on
Mathematica’s website—www.mathematica-mpr.com.
WHAT ARE YOU GOING TO DO FOR ME NOW? ARE YOU GOING TO HELP ME FIND A JOB? ARE YOU
GOING TO SEND ME FOR MORE TRAINING?
Mathematica is a private, independent research firm. Our firm is conducting this evaluation for the
U.S. Department of Labor, and this survey is part of this evaluation. We cannot provide assistance finding jobs or
training. You will, however, receive $25 for completing the survey.
I’M ON THE NATIONAL “DO NOT CALL LIST/REGISTRY.” WHY ARE YOU CALLING ME?
The do not call list or registry applies to telemarketing calls, not to calls like this one that are approved by the
government. Lawmakers recognize the need for the public to participate in studies like this to learn how
government programs are working and how to improve them. We will not sell you anything, nor will we ask for
money. Your privacy will be respected, and your cooperation is appreciated. For more information on who is
included and excluded on the do not call list, you can visit the website at www.donotcall.gov.
DOES THE MONEY I RECEIVE FOR COMPLETING THIS SURVEY COUNT TOWARDS MY INCOME FOR
THIS YEAR?
No, the money received for completing this survey is not considered employment income. Employment income is
generated from an employment contract. This is a one-time payment for volunteering to take part in the survey.
WHO CAN I CONTACT FOR MORE INFORMATION?
For more information about the study, you can visit the U.S. Department of Labor (DOL) website at
http://www.dol.gov/. You can also call the study’s project officer, Eileen Pederson of DOL at (202) 693-3647 or
Mathematica’s Project Director, Dr. Sheena McConnell at 202-484-4518. For questions about the survey you can
call Mathematica’s Survey Director, Ms. Pat Nemeth at 609-275-2294.
WILL THERE BE ANOTHER FOLLOW-UP TO THIS STUDY?
Yes. In another 15 months, we will contact you again to learn more about your experiences.
CAN SOMEONE ELSE RESPOND TO THIS QUESTIONNAIRE ON MY BEHALF?
Because of the types of questions we ask, it is important that we talk specifically to you. If, however, you need a
family member or friend to translate our questions or your answers, that is okay.

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SECTION B – SERVICE RECEIPT
IF SRF25 MISSING
B1.

Prior to [fill RA MO/YR DATE], had you ever used services at [fill LWIA ONE-STOP NAME] or a
[fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)] like it?

Deleted: have

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B2.

Thinking back to [fill RA MO/YR DATE], what was the main reason you went to [fill LWIA ONESTOP NAME]?

Deleted: sought services from a

INTERVIEWER:

Deleted: (E.G., CAREER CENTER, JOB
CENTER)]?

IF NECESSARY, READ ALL OPTIONS.
CODE ONE ONLY

Deleted: SPECIFIC

SEARCH FOR A NEW JOB (INCLUDING ANYTHING RELATED TO
FINDING A NEW JOB—LEARNING NEW STRATEGIES FOR FINDING
A JOB, LEARNING ABOUT A DIFFERENT CAREER, ACCESSING JOB
MARKET INFORMATION) .................................................................................... 1
FIND OUT ABOUT TRAINING OPPORTUNITIES OR GET TRAINING
FOR A JOB ........................................................................................................... 2
REQUIRED TO GET UNEMPLOYMENT INSURANCE (UI) ................................ 3
OBTAIN INFORMATION ON HOW AN EMPLOYER CAN PROVIDE
ACCOMMODATIONS FOR MY DISABILITY (FOR EXAMPLE,
WHEELCHAIR ACCESS, TECHNOLOGY THAT CAN READ THE
PRINTED PAGE) .................................................................................................. 4
Deleted: 5

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
RESOURCE ROOM
B3.

Now I’m going to ask about services you may have received. Each [fill LWIA SPECIFIC NAME
(E.G., CAREER CENTER, JOB CENTER)] usually has an area open to anyone, typically called a
resource room. In these areas, you can use computers and the Internet to look for a job, and you
can get information about specific jobs, different careers, and services available in the
community.

Deleted: , where

Since [fill RA MO/YR DATE], did you go to any [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER,
JOB CENTER)], including the [fill LWIA ONE-STOP NAME], to use a resource room?

Deleted: [fill LWIA ONE-STOP NAME] or a

PROBE:

Do not include times you used a resource room as part of a workshop, job club, or
meeting with a counselor.

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B8

DON’T KNOW ....................................................................................................... d

SKIP TO B8

REFUSED ............................................................................................................. r

SKIP TO B8

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Deleted: resources such as
Deleted: where
Deleted: )] like it

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NO B4 IN THIS VERSION.
Deleted: B4. Since [fill RA MO/YR DATE],

B5.

About how many different times did you go to a [fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)] to use a resource room? Would you say . . .
PROBE:

Since [fill RA MO/YR DATE].

PROBE:

Include in-person visits only.
CODE ONE ONLY

Once or twice, ...................................................................................................... 1
3 to 5 times, ......................................................................................................... 2
6 to 10 times, or ................................................................................................... 3
More than 10 times? ........................................................................................... 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
NO B6 IN THIS VERSION.
NO B7 IN THIS VERSION.

B8.

Since [fill RA MO/YR DATE], did you go somewhere other than a [fill LWIA SPECIFIC NAME (E.G.,
CAREER CENTER, JOB CENTER)] to use a resource room? This would include other government
agencies such as [fill STATE TANF NAME], libraries, churches, community-based organizations
such as United Way or Goodwill, and community colleges, among other places.
PROBE:

By resource room, we mean a dedicated area used to look for a job. In these areas,
you can use computers and the Internet to look for a job, and get information about
specific jobs, different careers, and services available in the community.

PROBE:

Do not include times you used a resource room as part of a workshop.

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B14

DON’T KNOW ....................................................................................................... d

SKIP TO B14

REFUSED ............................................................................................................. r

Deleted: | | | NUMBER OF
TIMES
SKIP TO B6¶
Deleted: ¶
¶
IF B4 = d OR r¶
B5. Would you say you used a resource
room only once or twice, 3 to 5 times, 6 to
10 times, or more than 10 times?¶
CODE ONE ONLY¶
ONCE OR TWICE 1¶
3 TO 5 TIMES 2¶
6 TO 10 TIMES 3¶
MORE THAN 10 TIMES 4¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
B6. About how long did you spend using
a resource room during an average visit?¶
PROBE: Do not include time waiting
in line or attending workshops.¶
| | | NUMBER
SKIP TO B8¶
MINUTES 1¶
HOURS 2¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
IF B6 = d OR r¶
B7. Would you say you spent . . .¶
CODE ONE ONLY
Deleted: ¶
15 minutes or less, 1¶
More than 15 minutes but less than
1 hour, 2¶
1 to 2 hours, 3¶
More than 2 but less than 4
hours, 4¶
4 to 6 hours, or 5¶
More than 6 hours? 6¶
DON’T KNOW d¶
REFUSED r¶
Page Break

Deleted: to a location

SKIP TO B14

Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: like it
Deleted: ¶
PROBE: Do not include times you
used a resource room as part of a
workshop.¶
YES 1¶
NO 0 SKIP TO B14¶
DON’T KNOW d SKIP TO B14¶
REFUSED r SKIP TO B14¶
¶
¶
B9. Where else did you use a resource
room?
Deleted: other

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B9.

Where else did you use a resource room?
CODE ALL THAT APPLY
A GOVERNMENT AGENCY OTHER THAN [fill LWIA ONE-STOP NAME] (FOR
EXAMPLE, [fill STATE TANF NAME], SNAP, FOOD STAMPS, OR THE VA)
(SPECIFY) ............................................................................................................ 1

LIBRARIES ........................................................................................................... 2
CHURCHES .......................................................................................................... 3
Deleted: OTHER

COMMUNITY-BASED ORGANIZATIONS SUCH AS UNITED WAY OR
GOODWILL ........................................................................................................... 4
COMMUNITY COLLEGES.................................................................................... 5
ONLINE ................................................................................................................. 6
OTHER EDUCATIONAL OR TRAINING ENTITY ................................................ 7

Deleted: 8

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
NO B10 IN THIS VERSION.
B11.

About how many different times did you go to (this/these) place(s) to use a resource room? Would
you say . . .
PROBE:

Since [RA MO/YR DATE].

PROBE:

Include in-person visits only.

Deleted: any location other than a [fill
LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)]
Deleted: | | | NUMBER OF
TIMES
SKIP TO B12¶
DON’T KNOW d¶
REFUSED r¶

CODE ONE ONLY
.............................................................................................................................. Onc
e or twice, .............................................................................................................. 1

Page Break

¶
IF B10 = d OR r¶
B11. Would you say you went to a
resource room only

3 to 5 times, ......................................................................................................... 2
6 to 10 times, or ................................................................................................... 3

Deleted: 3 to 5 times, 6 to 10 times, or
more than 10 times?¶
CODE ONE ONLY¶
ONCE OR TWICE

More than 10 times? ........................................................................................... 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
NO B12 IN THIS VERSION.
NO B13 IN THIS VERSION.

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Deleted: ¶
¶
B10. Since [fill RA MO/YR DATE],

19Cumulative changes made to WIA 15-Mo Follow-Up Survey between

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WORKSHOPS
B14.

Deleted: ¶
¶
B12. About how long did you spend
using a resource room during an average
visit?¶
PROBE: Do not include time waiting
in line or attending workshops.¶
| | | NUMBER
SKIP TO

The next questions are about workshops you may have attended to support you in your job
search or career planning. First, let’s talk about workshops that took place at a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER).
Since [fill RA MO/YR DATE], have you attended any of those workshops?
PROBE:

Include workshops you have attended at the [fill LWIA ONE-STOP NAME].

PROBE:

A workshop involves a small group of people coming together with a leader or
instructor to learn how to do something, like use a computer, write a resume, or
conduct a job search.

Deleted: ¶
MINUTES 1¶
HOURS 2¶
DON’T KNOW d¶
REFUSED r¶

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B21

DON’T KNOW ....................................................................................................... d

SKIP TO B21

REFUSED ............................................................................................................. r

SKIP TO B21

PROGRAMMER BOX
CATI: IF B15 DOES NOT HAVE ANY FILLS, GO TO B16.

B15.

Did you go to any of the following workshops offered at [fill LWIA ONE-STOP NAME]?

¶
¶
IF B12 = d OR r¶
B13. Would you say you spent . . .¶
CODE ONE ONLY¶
15 minutes or less, 1¶
More than 15 minutes but less than
1 hour, 2¶
1 to 2 hours, 3¶
More than 2 but less than 4
hours, 4¶
4 to 6 hours, or 5¶
More than 6 hours? 6¶
DON’T KNOW d¶
REFUSED r¶
Page Break

¶

CODE ONE PER ROW

B14. Now we

YES

NO

DON’T
KNOW

REFUSED

a. [fill LWIA INTENSIVE WORKSHOP NAME1] .....................

1

0

d

r

Deleted: [fill LWIA ONE-STOP NAME] or

b. [fill LWIA INTENSIVE WORKSHOP NAME2] .....................

1

0

d

r

c.

[fill LWIA INTENSIVE WORKSHOP NAME3] .....................

1

0

d

r

Deleted: )] like it. Since [fill RA MO/YR
DATE], have you attended any of those
workshops?

d. [fill LWIA INTENSIVE WORKSHOP NAME4] .....................

1

0

d

r

Deleted: interested in learning
Deleted: any

Deleted: facilitator
Deleted: I’m going

B16.

Did you go to any (other) [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]
workshops (that I haven’t mentioned)?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B21

DON’T KNOW ....................................................................................................... d

SKIP TO B21

REFUSED ............................................................................................................. r

SKIP TO B21

Deleted: read a list of some
Deleted: and I would like you to tell me if
you did or did not go to each of these
workshops.
Deleted: workshops at a

NO B17 IN THIS VERSION.
Deleted:
¶
B17. Since [fill RA MO/YR DATE],

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B18.

Deleted: different

About how many of these (other) workshops did you go to? Would you say . . .
PROBE:

Deleted: attend at a [fill LWIA SPECIFIC
NAME (E.G., CAREER CENTER, JOB
CENTER)]?¶
| | | NUMBER OF
WORKSHOPS
SKIP TO B19¶
DON’T KNOW d¶
REFUSED r¶

Since [RA MO/YR DATE].
CODE ONE ONLY

1, ........................................................................................................................... 1
2 or 3, .................................................................................................................... 2

¶
¶
IF B17 = d OR r¶
B18.

4 or 5, or ............................................................................................................... 3
More than 5 workshops? .................................................................................... 4
DON’T KNOW ....................................................................................................... d

Deleted: you attended only 1, 2 or 3, 4 or
5, or more than 5?

REFUSED ............................................................................................................. r

Deleted:

1

Deleted: OR

NO B19 IN THIS VERSION.

Deleted:

2

Deleted: 4 OR

B20.

And about how long was an average workshop? Would you say . . .

Deleted: 3¶
MORE THAN 5

CODE ONE ONLY

Deleted: ¶
¶
B19.

Less than 1 hour, ................................................................................................ 1
1 to 2 hours, ......................................................................................................... 2

Deleted: much time did you spend at

More than 2 but less than 4 hours, .................................................................... 3

Deleted: ¶
| | | NUMBER
HOURS 1¶
DAYS 2¶
DON’T KNOW d¶
REFUSED r¶

4 to 6 hours, or .................................................................................................... 4
More than 6 hours? ............................................................................................. 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B21.

Since [fill RA MO/YR DATE], have you gone to any workshops held somewhere other than a [fill
LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]?
PROBE:

This would include other government agencies such as [fill STATE TANF NAME],
libraries, churches, community-based organizations such as United Way or Goodwill,
and community colleges, among other places.

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO BOX BEFORE B27

DON’T KNOW ....................................................................................................... d

SKIP TO BOX BEFORE B27

REFUSED ............................................................................................................. r

SKIP TO BOX BEFORE B27

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SKIP TO B21¶

¶
¶
IF B19 = d OR r¶
B20.
Deleted: you spent
Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: )] like it?
Deleted: other

B22.

Where were these workshops held?
CODE ALL THAT APPLY

Deleted: ONE ONLY

A GOVERNMENT AGENCY OTHER THAN [fill LWIA ONE-STOP NAME]
(FOR EXAMPLE, [fill STATE TANF NAME], SNAP, FOOD STAMPS, VA)
(SPECIFY) ............................................................................................................ 1

LIBRARIES ........................................................................................................... 2
CHURCHES .......................................................................................................... 3
Deleted: OTHER

COMMUNITY-BASED ORGANIZATIONS SUCH AS UNITED WAY OR
GOODWILL ........................................................................................................... 4
COMMUNITY COLLEGES.................................................................................... 5
OTHER EDUCATIONAL OR TRAINING ENTITY ................................................ 6

Deleted: 8

ONLINE ................................................................................................................. 7

Deleted: ¶
¶
B23

OTHER (SPECIFY) ............................................................................................... 99

Deleted: different

DON’T KNOW ....................................................................................................... d

Deleted: attend that were held
somewhere other than a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER,
JOB CENTER)]?¶
| | | NUMBER OF
WORKSHOPS
SKIP TO B25¶
DON’T KNOW d¶
REFUSED r¶

REFUSED ............................................................................................................. r
NO B23 IN THIS VERSION.
B24.

About how many of these workshops did you go to? Would you say . . .

Page Break

¶
IF B23 = d OR r¶
B24.

CODE ONE ONLY
1, ........................................................................................................................... 1
2 or 3, .................................................................................................................... 2

Deleted: you attended only 1, 2 or 3, 4 or
5, or more than 5?

4 or 5, or ............................................................................................................... 3

Deleted:

More than 5 workshops? .................................................................................... 4

Deleted: OR

DON’T KNOW ....................................................................................................... d

Deleted:

Deleted: 3¶
MORE THAN 5

NO B25 IN THIS VERSION.

Deleted: ¶
¶
B25.

And about how long did an average workshop last? Would you say . . .

Deleted: much time

CODE ONE ONLY

Deleted: you spend at

Less than 1 hour, ................................................................................................ 1

Deleted: ?¶
| | | NUMBER
HOURS 1¶
DAYS 2¶
DON’T KNOW d¶
REFUSED r¶

1 to 2 hours, ......................................................................................................... 2
More than 2 but less than 4 hours, .................................................................... 3
4 to 6 hours, or .................................................................................................... 4

¶
¶
IF B25 = d OR r¶
B26.

More than 6 hours? ............................................................................................. 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
Prepared by Mathematica Policy Research

8-23-12 (v37).docx

22Cumulative changes made to WIA 15-Mo Follow-Up Survey between

2

Deleted: 4 OR

REFUSED ............................................................................................................. r

B26.

1

Deleted: you spent

3-21-12 and

SKIP TO B27¶

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

23Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

PROGRAMMER BOX
CATI: IF B16 = 0, d OR r AND B21 = 0, d OR r, SKIP B27.

B27.

Please think about (all of) the workshop(s) we’ve talked about, (regardless of where they were
held). (Were any of these/Was this) workshop(s) meant to help you with . . .

Deleted: workshops

YES

NO

DON’T
KNOW

a. Job search-related activities such as resume writing,
interviewing, and networking? ......................................

1

0

d

r

b. Basic computer skills or the use of specific computer
programs?.....................................................................

REFUSED

1

0

d

r

Appropriate ways to act on the job like how to
manage your time and communicate with your boss
and co-workers? ...........................................................

1

0

d

r

d. Preparing for or learning about tests or
assessments, like WorkKeys or the TABE, that help
you learn about your basic skills like math or
reading? ........................................................................

1

0

d

r

PROBE: This does NOT include actually taking the
test.
e. Managing your own finances? ......................................

1

0

d

r

f.

Starting your own business? ........................................

1

0

d

r

g. And were any of these workshops meant to help you
with something else that I haven’t mentioned?
(SPECIFY) ....................................................................

1

0

d

r

Prepared by Mathematica Policy Research

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24Cumulative changes made to WIA 15-Mo Follow-Up Survey between

Deleted: workshops
Deleted: ,

CODE ONE PER ROW

c.

Deleted: Thinking

3-21-12 and

TESTS OR ASSESSMENTS
B28.

Now I’d like to ask you about tests or assessments you may have taken at any location to help
you with your job search or training. You may have taken these tests on the computer or using
paper and pencil.

Deleted: on the computer or using paperand-pencil

Since [fill RA MO/YR DATE], have you taken . . .
CODE ONE PER ROW
YES

NO

DON’T
KNOW

REFUSED

a. Tests, like WorkKeys or the TABE, that help you learn about
your basic skills like math or reading? ...................................

1

0

d

r

b. Tests, like the ONET Profiler or CareerPath.com, that help
you identify your occupational abilities or interests? .............

1

0

d

r

1

0

d

r

c.

And have you taken any other tests that I haven’t
mentioned? (SPECIFY) .........................................................

PROGRAMMER BOX
CATI: IF NO, DON’T KNOW, OR REFUSED TO ALL IN B28, SKIP TO B36.
B29.

Did you take any of these tests at a [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB
CENTER)]?
PROBE:

Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: )] like it?

Including the [fill LWIA ONE-STOP NAME].

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B32

DON’T KNOW ....................................................................................................... d

SKIP TO B32

REFUSED ............................................................................................................. r

SKIP TO B32

NO B30 IN THIS VERSION.
Deleted: ¶
¶
B30. Since [fill RA MO/YR DATE],

Prepared by Mathematica Policy Research

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25Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

B31.

About how many different tests did you take at a [fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)]? Would you say . . .
PROBE:

Since [fill RA MO/YR DATE].

PROBE:
Please count tests on different subjects that you completed in a single sitting
as one test.
CODE ONE ONLY
1, ........................................................................................................................... 1

B32.

Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: )] like it?¶
PROBE: Include in-person visits only.¶
| | | NUMBER OF
TESTS
SKIP TO B32¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
IF B30 = d OR r¶
B31.

2 or 3, .................................................................................................................... 2

Deleted: you took only 1, 2 or 3, 4 or 5, or
more than 5?

4 or 5, or ............................................................................................................... 3

Deleted:

More than 5 tests? .............................................................................................. 4

Deleted: OR

DON’T KNOW ....................................................................................................... d

Deleted:

REFUSED ............................................................................................................. r

Deleted: 4 OR

Did you take any of these tests somewhere other than a [fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)]?
PROBE:

This would include other government agencies such as [fill STATE TANF NAME],
libraries, churches, community-based organizations such as United Way or Goodwill,
and community colleges, among other places.

1

2

Deleted: 3¶
MORE THAN 5
Deleted: at a place
Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: )] like it?
Deleted: other

YES ....................................................................................................................... 1

B33.

NO ......................................................................................................................... 0

SKIP TO B36

DON’T KNOW ....................................................................................................... d

SKIP TO B36

REFUSED ............................................................................................................. r

SKIP TO B36
Deleted: go to

Where else did you take these tests?
CODE ALL THAT APPLY
A GOVERNMENT AGENCY OTHER THAN [fill LWIA ONE-STOP NAME] (FOR
EXAMPLE, [fill STATE TANF NAME], SNAP, FOOD STAMPS, VA) (SPECIFY) 1

LIBRARIES ........................................................................................................... 2
CHURCHES .......................................................................................................... 3
Deleted: OTHER

COMMUNITY-BASED ORGANIZATIONS SUCH AS UNITED WAY OR GOODWILL 4
COMMUNITY COLLEGES.................................................................................... 5
ONLINE ................................................................................................................. 6
OTHER EDUCATIONAL OR TRAINING ENTITY ................................................ 7

Deleted: 8

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

26Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

NO B34 IN THIS VERSION.
B35.

About how many different tests did you take at (this/these) place(s)? Would you say . . .
PROBE:

Since [RA MO/YR DATE].

PROBE:

Include in-person visits only.

Deleted: ¶
¶
B34. Since [fill RA MO/YR DATE],
Deleted: any
Deleted: other than [fill LWIA ONE-STOP
NAME] or a [fill LWIA SPECIFIC NAME
(E.G., CAREER CENTER, JOB CENTER)]
like it?

CODE ONE ONLY

Deleted: | | | NUMBER OF
TESTS
SKIP TO B36¶

1, ........................................................................................................................... 1
2 or 3, .................................................................................................................... 2

Deleted: ¶
IF B34 = d OR r¶
B35. Would you say you took only 1, 2 or
3, 4 or 5, or more than 5?¶
CODE ONE ONLY

4 or 5, or ............................................................................................................... 3
More than 5 tests? .............................................................................................. 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
PEER SUPPORT
B36.

The next questions are about any job clubs or job groups that you may have participated in.

These groups involve getting together with other job seekers for support and to talk about job leads and
ways to find jobs. First, let’s talk about group meetings that took place at a [fill LWIA SPECIFIC
NAME (E.G., CAREER CENTER, JOB CENTER)].

Deleted: ¶
1 1¶
2 OR 3 2¶
4 OR 5 3¶
MORE THAN 5 4¶
DON’T KNOW d¶
REFUSED r¶
Page Break

¶
Deleted: Now we
Deleted: interested in learning

Since [fill RA MO/YR], have you gone to a [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB
CENTER)] to attend meetings for any of these groups?

Deleted: search support

PROBE:

Include job clubs or job groups that took place at [fill LWIA ONE-STOP NAME].

Deleted: such as job clubs

PROBE:

Include in-person participation only.

Deleted: First, let’s talk about meetings
that took place at [fill LWIA ONE-STOP
NAME] or a [fill LWIA SPECIFIC NAME
(E.G., CAREER CENTER, JOB CENTER)]
like it. Since [fill RA MO/YR], have you
attended meetings for any of these
groups?¶
PROBE: Job search support and peernetworking groups

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B41

DON’T KNOW ....................................................................................................... d

SKIP TO B41

REFUSED ............................................................................................................. r

SKIP TO B41

Deleted: peer networking

Deleted: to provide

NO B37 IN THIS VERSION.
B38.

About how many different times did you go to a [fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)] to attend meetings for (this/these) group(s)? Would you say . . .
Since [fill RA MO/YR DATE].

PROBE:

Include in-person participation only.
CODE ONE ONLY

2 or 3 times, ......................................................................................................... 2
4 or 5 times, or ..................................................................................................... 3
More than 5 times? ............................................................................................. 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
27Cumulative changes made to WIA 15-Mo Follow-Up Survey between

|

| # TIMES

SKIP TO B39¶

Deleted: ¶
¶
IF B37 = d OR r¶
B38. Would you say you attended only 1
group meeting, 2 or 3, 4 or 5, or more than
5 group meetings?¶
CODE ONE ONLY¶
1 1¶
2 OR 3 2¶
4 OR 5 3¶
MORE THAN 5 4¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
...

Once, .................................................................................................................... 1

8-23-12 (v37).docx

Deleted: any of these groups?
Deleted: |

PROBE:

Prepared by Mathematica Policy Research

Deleted: ¶
¶
B37. Since [fill RA MO/YR DATE],

3-21-12 and

NO B39 IN THIS VERSION.

NO B40 IN THIS VERSION.

B41.

Since [fill RA MO/YR DATE], have you attended any job club or job group meetings somewhere
other than or a [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]?
PROBE:

This would include other government agencies such as [fill STATE TANF NAME],
libraries, churches, community-based organizations such as United Way or Goodwill,
and community colleges, among other places.

PROBE:

Job clubs and job groups involve getting together with other job seekers for support
and to talk about job leads and ways to find jobs.

PROBE:

Include in-person participation only.

Deleted: ¶
30 minutes or less, 1¶
More than 30 but less than 60
minutes, or 2¶
1 hour or more? 3¶
DON’T KNOW d¶
REFUSED r¶
¶
Deleted: search peer-networking
Deleted: support
Deleted: at a place
Deleted: [fill LWIA ONE-STOP NAME]

YES ....................................................................................................................... 1

Deleted: )] like it?

NO ......................................................................................................................... 0

SKIP TO B47a

Deleted: other

DON’T KNOW ....................................................................................................... d

SKIP TO B47a

Deleted: search support

REFUSED ............................................................................................................. r

SKIP TO B47a

Deleted: peer-networking
Deleted: to provide

B42.

Where did these job clubs or job groups meet?

Deleted: B47

CODE ALL THAT APPLY
A GOVERNMENT AGENCY OTHER THAN [fill LWIA ONE-STOP
NAME] (SPECIFY) ................................................................................................ 1

Deleted: B47
Deleted: B47
Deleted: search support
Deleted: peer-networking

LIBRARIES ........................................................................................................... 2
CHURCHES .......................................................................................................... 3
Deleted: OTHER

COMMUNITY-BASED ORGANIZATIONS SUCH AS UNITED WAY OR
GOOD WILL .......................................................................................................... 4
COMMUNITY COLLEGES.................................................................................... 5
OTHER EDUCATIONAL OR TRAINING ENTITY ................................................ 6

Deleted: 7

OTHER (SPECIFY) ............................................................................................... 99
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

28Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

NO B43 IN THIS VERSION.
B44.

Deleted: B43. Since [fill RA MO/YR
DATE],

About how many different times did you go to (this/these) places(s) to attend meetings for
(this/these) group(s)? Would you say . . .
PROBE:
PROBE:

Deleted: a place other than a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER,
JOB CENTER)]

Since [RA MO/YR DATE].
Include in-person participation only.

Deleted: any of these groups?

CODE ONE ONLY

Deleted: |

|

| # TIMES

SKIP TO B45¶

Once, .................................................................................................................... 1
2 or 3 times, ......................................................................................................... 2
4 or 5 times, or ..................................................................................................... 3
More than 5 times? ............................................................................................. 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
NO B45 IN THIS VERSION.

NO B46 IN THIS VERSION.

INDIVIDUAL COUNSELING
B47a. Now we are interested in learning about any counseling or one-on-one assistance you may have
received to support you in your job search or training from an employment professional at any
location. We’re interested in individual appointments you may have had in person or over the
phone.
PROBE:

“Employment professional” is a generic name and may include counselors or case
managers.

PROBE:

Do not include assistance received during workshops or conversations with
employment professionals as part of a visit to a resource room.

Since [fill RA MO/YR DATE], did you have any individual appointments with an employment
professional?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B59a

DON’T KNOW ....................................................................................................... d

SKIP TO B59a

REFUSED ............................................................................................................. r

SKIP TO B59a

Deleted: ¶
¶
IF B43 = d OR r¶
B44. Would you say you attended only 1
group meeting, 2 or 3, 4 or 5, or more than
5 group meetings?¶
CODE ONE ONLY¶
1 1¶
2 OR 3 2¶
4 OR 5 3¶
MORE THAN 5 4¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
B45. About how long did an average
group meeting last?¶
| | | HOURS
SKIP TO B47¶
| | | MINUTES
SKIP TO B47¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
IF B45 = d OR r¶
B46. Would you say these meetings
lasted . . .¶
CODE ONE ONLY
Deleted: ¶
30 minutes or less, 1¶
More than 30 but less than 60
minutes, or 2¶
1 hour or more? 3¶
DON’T KNOW d¶
REFUSED r¶
Page Break

¶
B47
Deleted: from an employment
professional
Deleted: . . .

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

29Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

B47b. At (this/these) appointment(s). . .
CODE ONE PER ROW
YES

NO

DON’T
KNOW

REFUSED

1

0

d

r

a. Did you talk about your job search? ...................................
PROBE: This includes creating a resume, developing a
job search strategy, or discussing progress in
pursuing job leads and completing job
applications.
b. Did you talk about your results on tests or assessments
that measure basic skills, aptitudes, or career interests?...

1

0

d

r

c.

1

0

d

r

d. Did you get referrals for other services to support work or
training? ..............................................................................

1

0

d

r

e. And did you get any other assistance at (this/these)
appointment(s) that I haven’t mentioned? (SPECIFY) .......

1

0

d

r

Did you talk about training options or education plans? .....
PROBE: This includes comparing different training
programs, or developing specific plans for
selecting and paying for training.

PROGRAMMER BOX
CATI: IF NO, DON’T KNOW, OR REFUSED TO ALL IN B47b, SKIP TO B59.
B48.

(Was this/Were any of these) appointment(s) with an employment professional from a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]?
PROBE:

Include appointments at the [fill LWIA ONE-STOP NAME].

Deleted: Did you receive
Deleted: this individual help at [fill LWIA
ONE-STOP NAME] or
Deleted: )] like it?

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO B53

DON’T KNOW ....................................................................................................... d

SKIP TO B53

REFUSED ............................................................................................................. r

SKIP TO B53

NO B49 IN THIS VERSION.
Deleted:
¶
B49. Since [fill RA MO/YR DATE],

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8-23-12 (v37).docx

30Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

B50.

About how many of these individual appointments, if any, did you have in person? Would you
say . . .
CODE ONE ONLY
0, ........................................................................................................................... 1
2 or 3, .................................................................................................................... 3
4 or 5, or ............................................................................................................... 4

¶
¶
IF B49 = d OR r¶
B50.

More than 5 individual appointments in person? ............................................ 5
DON’T KNOW ....................................................................................................... d

Deleted: you received this help only
once, 2 or 3 times, 4 or 5 times, or more
than 5 times?

REFUSED ............................................................................................................. r
NO B51 IN THIS VERSION.

Deleted: ONCE
Deleted: TIMES 2

And would you say an average appointment lasted . . .

Deleted: OR

CODE ONE ONLY

Deleted: TIMES 3

15 minutes or less, .............................................................................................. 1

Deleted: MORE THAN 5 TIMES 4¶

16 to 30 minutes, ................................................................................................. 2
31 to 45 minutes, ................................................................................................. 3
46 to 60 minutes, or ............................................................................................ 4
More than 60 minutes? ....................................................................................... 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B52x. About how many individual appointments, if any, did you have over the phone? Would you say . . .

Deleted: 61 to 90 minutes, or 5¶
Deleted: 90

1, ........................................................................................................................... 2
2 or 3, .................................................................................................................... 3
4 or 5, or ............................................................................................................... 4
More than 5 individual appointments over the phone? .................................. 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

8-23-12 (v37).docx

31Cumulative changes made to WIA 15-Mo Follow-Up Survey between

Deleted: ¶
B51. About how much time did you
spend working one-on-one with an
employment professional during an
average visit or phone call?¶
| | | HOURS
SKIP TO B53¶
| | | MINUTES
SKIP TO B53¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
IF B51 = d OR r¶
Deleted: you spent

CODE ONE ONLY
0, ........................................................................................................................... 1

Prepared by Mathematica Policy Research

Deleted: talk one-on-one with any
employment professionals at [fill LWIA
ONE-STOP NAME] or a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER,
JOB CENTER)] like it
Deleted: or by phone?¶
| | | # TIMES
SKIP TO B51¶
DON’T KNOW d¶
REFUSED r¶

1, ........................................................................................................................... 2

B52.

Deleted: times

3-21-12 and

B52xx. And would you say an average appointment lasted . . .
CODE ONE ONLY
Deleted: ? 6

10 minutes or less, .............................................................................................. 1
11 to 20 minutes, ................................................................................................. 2
21 to 30 minutes, or ............................................................................................ 3
More than 30 minutes? ....................................................................................... 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B53.

(We are also interested in learning about any counseling or one-on-one assistance to support you
in your job search or training you may have received from somewhere other than a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)].)

Deleted: you have received

Since [fill RA MO/YR DATE], did you receive any of this individual help from somewhere other
than a [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]?

Deleted: [fill LWIA ONE-STOP NAME] or

PROBE:

Deleted: a place

PROBE:

This would include other government agencies such as [fill STATE TANF NAME],
libraries, churches, community-based organizations such as United Way or Goodwill,
and community colleges, among other places.
The counseling may have been provided in person or over the phone.

Deleted: an employment professional at a
place

Deleted: )] like it.

Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: other

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

B54.

SKIP TO B59

DON’T KNOW ....................................................................................................... d

SKIP TO B59

REFUSED ............................................................................................................. r

SKIP TO B59

Where else did you receive these counseling or one-on-one services?
CODE ALL THAT APPLY
A GOVERNMENT AGENCY OTHER THAN [fill LWIA ONE-STOP NAME]
(FOR EXAMPLE, [fill STATE SPECIFIC TANF NAME], SNAP, FOOD
STAMPS, VA) (SPECIFY)..................................................................................... 1

LIBRARIES ........................................................................................................... 2
CHURCHES .......................................................................................................... 3
Deleted: OTHER

COMMUNITY-BASED ORGANIZATIONS SUCH AS UNITED WAY OR
GOODWILL ........................................................................................................... 4
COMMUNITY COLLEGES.................................................................................... 5
ONLINE ................................................................................................................. 6
OTHER EDUCATIONAL OR TRAINING ENTITY ................................................ 7

Deleted: 8

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

32Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

NO B55 IN THIS VERSION.
B56.

About how many individual appointments, if any, did you have in person? Would you say . . .

Deleted: times

CODE ONE ONLY
0, ........................................................................................................................... 1

SKIP TO B58x

1, ........................................................................................................................... 2

4 or 5, or ............................................................................................................... 4

Page Break

More than 5 in-person individual appointments? ............................................ 5

¶
IF B55 = d OR r¶
B56.

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Deleted: you received this help only
once, 2 or 3 times, 4 or 5 times, or more
than 5 times?

NO B57 IN THIS VERSION.

Deleted: ONCE

And would you say an average appointment lasted . . .

Deleted: TIMES 2

CODE ONE ONLY

Deleted: TIMES 3

15 minutes or less, .............................................................................................. 1

Deleted: TIMES 4

16 to 30 minutes, ................................................................................................. 2
31 to 45 minutes, ................................................................................................. 3
46 to 60 minutes, or ............................................................................................ 4
More than 60 minutes? ....................................................................................... 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B58x. About how many individual appointments, if any, did you have over the phone? Would you
say . . .

0, ........................................................................................................................... 1

SKIP TO B59a

1, ........................................................................................................................... 2
2 or 3, .................................................................................................................... 3
4 or 5, or ............................................................................................................... 4
More than 5 individual appointments over the phone? .................................. 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

8-23-12 (v37).docx

33Cumulative changes made to WIA 15-Mo Follow-Up Survey between

Deleted: ¶
¶
B57. About how much time did you
spend working one-on-one with an
employment professional at (this/these)
place(s) during an average visit or phone
call?¶
| | | HOURS
SKIP TO B59¶
| | | MINUTES
SKIP TO B59¶
DON’T KNOW d¶
REFUSED r¶
¶
¶
IF B57 = d OR r¶
Deleted: you spent

CODE ONE ONLY

Prepared by Mathematica Policy Research

Deleted: talk one-on-one with any
employment professionals at (this/these)
place(s)
Deleted: or by phone?¶
| | | # TIMES
SKIP TO B57¶
DON’T KNOW d¶
REFUSED r¶

2 or 3, .................................................................................................................... 3

B58.

Deleted: ¶
¶
B55. Since [fill RA MO/YR DATE],

3-21-12 and

Deleted: 61 to 90 minutes, or 5¶
Deleted: 90

B58xx. And would you say an average appointment lasted . . .
CODE ONE ONLY
Deleted: ? 6

10 minutes or less, .............................................................................................. 1
11 to 20 minutes, ................................................................................................. 2
21 to 30 minutes, or ............................................................................................ 3
More than 30 minutes? ....................................................................................... 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SUPPORT SERVICES
B59a. Now let’s talk about financial assistance you may have received to help you with expenses, not
including tuition and fees, to look for or attend work, training or school. Please do not include
financial assistance you may have received from friends or family.
Since [fill RA MO/YR DATE], have you received any assistance in the form of cash, vouchers,
gift cards or reimbursement?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO C1

DON’T KNOW ....................................................................................................... d

SKIP TO C1

REFUSED ............................................................................................................. r

SKIP TO C1

B59b. Was this assistance meant to help you pay for . . .
CODE ONE PER ROW
YES

NO

DON’T
KNOW

REFUSED

a. Books? ................................................................................

1

0

d

r

b. Tools or other supplies? .....................................................

1

0

d

r

c.

Clothes or other uniforms? .................................................

1

0

d

r

d. Transportation (such as gas cards or bus passes)? ..........

1

0

d

r

e. Child care?..........................................................................

1

0

d

r

f.

1

0

d

r

Something else that I haven’t mentioned? (SPECIFY........

PROGRAMMER BOX
CATI: IF NO, DON’T KNOW, OR REFUSED TO ALL IN B59b, SKIP TO C1

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

34Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

Deleted: B59
Deleted: , I am interested in learning
Deleted: (
Deleted: )

B60.

Did you receive any of this financial assistance from a [fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)]?
PROBE:

Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: )] like it?

Include financial assistance you received from [fill LWIA ONE-STOP NAME].

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

B61.

SKIP TO B62

DON’T KNOW ....................................................................................................... d

SKIP TO B62

REFUSED ............................................................................................................. r

SKIP TO B62

Thinking about all of the financial assistance you received from a [fill LWIA SPECIFIC NAME (E.G.,
CAREER CENTER, JOB CENTER)] since [fill RA MO/YR], how much total assistance, in dollars,
did you receive? Do not include assistance you received for tuition or fees.
$|

|

|,|

|

|

|

Deleted: [fill LWIA ONE-STOP NAME] or
Deleted: like it
Deleted: |,|

| TOTAL ASSISTANCE

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B62.

Since [fill RA MO/YR DATE], did you receive any of this financial assistance from somewhere
other than a [fill LWIA SPECIFIC NAME (E.G., CAREER CENTER, JOB CENTER)]?
PROBE:

This would include other government agencies such as [fill STATE TANF NAME],
libraries, churches, community-based organizations such as United Way or Goodwill,
and community colleges, among other places.

PROBE:

Do not include financial assistance you may have received from friends or family.

Deleted: We are also interested in
learning about financial assistance you
may have received to help you with
expenses (not including tuition and fees)
to look for or attend work, training or
school at a place other than [fill LWIA
ONE-STOP NAME] or a [fill LWIA
SPECIFIC NAME (E.G., CAREER CENTER,
JOB CENTER)] like it.¶

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

SKIP TO C1

DON’T KNOW ....................................................................................................... d

SKIP TO C1

REFUSED ............................................................................................................. r

SKIP TO C1

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

35Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

Deleted: any place
Deleted: than a
Deleted: LWIA SPECIFIC
Deleted: (E.G., CAREER CENTER, JOB
CENTER)]? Please

B63.

From what other places did you receive financial assistance?
CODE ALL THAT APPLY
A GOVERNMENT AGENCY OTHER THAN [fill LWIA ONE-STOP
NAME] (FOR EXAMPLE, [fill STATE TANF NAME], SNAP, FOOD
STAMPS, VA) (SPECIFY)..................................................................................... 1

LIBRARIES ........................................................................................................... 2
CHURCHES .......................................................................................................... 3
Deleted: OTHER

COMMUNITY-BASED ORGANIZATIONS SUCH AS UNITED WAY OR
GOODWILL ........................................................................................................... 4
COMMUNITY COLLEGES.................................................................................... 5
ONLINE ................................................................................................................. 6
OTHER EDUCATIONAL OR TRAINING ENTITY ................................................ 7

Deleted: 8

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
B64.

Thinking about all of the financial assistance you received from (this/these) place(s) since [fill RA
MO/YR DATE], how much total assistance did you receive? Do not include assistance for tuition
or fees.
$|

|

|

|,|

|

|

| TOTAL ASSISTANCE

Deleted: |,|

REFUSED ............................................................................................................. r

8-23-12 (v37).docx

36Cumulative changes made to WIA 15-Mo Follow-Up Survey between

Deleted: other than a [fill LWIA SPECIFIC
NAME (E.G., CAREER CENTER, JOB
CENTER)]
Deleted: , in dollars,

DON’T KNOW ....................................................................................................... d

Prepared by Mathematica Policy Research

Deleted: any

3-21-12 and

SECTION C – TRAINING AND EDUCATION PROGRAMS: LEVEL OF PARTICIPATION, PAYMENT, AND
OUTCOMES
C1.

Now I’d like to ask you about education or training programs you may have participated in since
[fill RA MO/YR DATE] that we haven’t talked about yet. Please include training programs that
helped you learn job skills or prepare for an occupation. Also include general educational
programs, such as adult basic education or GED courses, ESL classes, college, or other types of
school.

Deleted: , school, and job

Since [fill RA MO/YR DATE], did you participate in any education or training programs?

Deleted: and

PROBE:

Include classes you may have attended to learn English (ESL classes) or improve your
reading skills.

Deleted: and courses

PROBE:

Include training provided by an employer, for self-employment, or on-the-job training
(OJT).

Deleted: and courses
Deleted: spoken

Deleted: Also
Deleted: Also

YES ....................................................................................................................... 1

C2.

NO ......................................................................................................................... 0

SKIP TO D0

DON’T KNOW ....................................................................................................... d

SKIP TO D0

REFUSED ............................................................................................................. r

SKIP TO D0

Deleted: D1
Deleted: D1
Deleted: D1

How many different education and training programs have you participated in since [fill RA MO/YR
DATE]?
IF MORE THAN ONE, PROBE:
INTERVIEWER:
|

|

Were these separate programs or different courses for the same
program?

DO NOT REPORT MULTIPLE COURSES THAT ARE PART OF ONE DEGREE
PROGRAM. ONLY REPORT THE NUMBER OF DEGREE PROGRAMS.

| NUMBER OF PROGRAMS

Deleted: |

|

|

SKIP TO C4

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
IF C2 = d or r
C3.

Deleted: only

Would you say you participated in . . .
CODE ONE ONLY
1 education or training program, ....................................................................... 1
2 or 3, .................................................................................................................... 2
4 or 5, or ............................................................................................................... 3

Deleted: CODE ONE ONLY¶
1 1¶
2 OR 3 2¶
4 OR 5 3¶
MORE THAN 5

More than 5 programs? ...................................................................................... 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

8-23-12 (v37).docx

37Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and

PROGRAMMER SKIP BOX
CATI: ALLOW FOR 5 PROGRAMS. ASK C4 ACROSS FIRST, FOLLOWED BY C5. THEN ASK C6-C37 FOR
EACH PROGRAM.
NOTE: SPACE FOR 3RD, 4TH, AND 5TH SCHOOL OR TRAINING WILL BE IN CATI PROGRAM.
#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

C4.

What (is/are) the name(s) of the
program(s) you attended since
[fill RA MO/YR DATE], starting with
the first one you attended?

(SPECIFY NAME OF THE TRAINING AND
EDUCATION PROGRAM(S))

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

(SPECIFY NAME OF THE TRAINING AND
EDUCATION PROGRAM(S))

What’s the next program you
attended?
C5.

Let me verify that since [fill RA
MO/YR DATE] you attended [fill C4
NAMES].
Is this correct, or are there any other
education or training programs you
may have attended?

CORRECT ................................................. 1

CORRECT ................................................. 1

NOT CORRECT ........................................ 0

NOT CORRECT ......................................... 0

DON’T KNOW ........................................... d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED.................................................. r

| | |/|
MONTH

| | |/|
MONTH

IF CORRECT, ENTER “1” AND
CONTINUE.
IF THIS IS NOT CORRECT, GO
BACK TO C4 AND C5 TO ENTER
CORRECT NUMBER AND NAMES
OF PROGRAMS ATTENDED.
C6.

When did you start attending
[fill PROGRAM]?

IF C6 = d OR r
C7. Do you recall what year you started
attending [fill PROGRAM/
THE FIRST/SECOND] program?
C8.

And when did you stop attending
that program?

| | |
YEAR

|

Prepared by Mathematica Policy Research

| | |
YEAR

|

SKIP TO C8

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED.................................................... r

|

|

|

|

|

| YEAR

|

|

|

| YEAR

DON’T KNOW ........................................... d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED.................................................. r

| | |/|
MONTH

| | |/|
MONTH

| | |
YEAR

|

STILL IN PROGRAM ............ 2

IF C8 = d OR r
C9. Do you recall what year you stopped
attending that program?

SKIP TO C8

SKIP TO C10
SKIP TO C10

| | |
YEAR

|

SKIP TO C10

STILL IN PROGRAM ........... 2

DON’T KNOW ......................d

DON’T KNOW ...................... d

REFUSED ............................r

REFUSED............................ r

|

|

|

|

|

| YEAR

|

|

|

SKIP TO C10

| YEAR

DON’T KNOW ........................................... d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED.................................................. r

36Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

C10. How many hours per week (did/do)
you attend that program?
PROBE: Do not include time
spent outside of class
studying or doing
homework. Only time
spent attending class
should be included.

|

|

| HOURS PER WEEK

SKIP TO C12

DON’T KNOW.............................................. d
REFUSED ................................................... r

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)
|

|

| HOURS PER WEEK SKIP TO C12

DOON’T KNOW
.................................................................... d
REFFUSED ................................................. r

IF RESPONDENT SAYS THEY
TOOK ONLINE CLASSES,
PROBE: Only include the time
you spent online actually
taking classes. Do not
include time spent
studying or doing
homework.
IF RESPONDENT SAYS THIS
WAS PART OF ON-THE-JOB
TRAINING,
PROBE: We are interested in how
much time you actually
spent, not only the
contractual time you
spent.
IF C10 = d OR r
C11. Would you say you attend(ed) the
program for . . .

C12. Now I am interested in what kind of
program this (is/was). (Is/Was) this
program meant to help you learn
job skills or prepare for an
occupation, or to provide general
education?
PROBE: General education
programs include adult
basic education or GED
courses, college, and
other types of school.

CODE ONE ONLY

CODE ONE ONLY

less than 1 hour per week, ......................... 1

less than 1 hour per week, ......................... 1

1 to 3 hours per week, ............................... 2

1 to 3 hours per week, ............................... 2

more than 3 but less than 5 hours per
week, or ..................................................... 3

more than 3 but less than 5 hours per
week, or ..................................................... 3

5 hours or more per week? ........................ 4

5 hours or more per week? ........................ 4

DON’T KNOW............................................ d

DON’T KNOW............................................ d

REFUSED ................................................. r

REFUSED ................................................. r

CODE ONE ONLY

CODE ONE ONLY

JOB SKILLS OR PREPARE FOR
OCCUPATION ........................................... 1

JOB SKILLS OR PREPARE FOR
OCCUPATION ........................................... 1

GENERAL EDUCATION ............................ 2

GENERAL EDUCATION ............................ 2

ENGLISH AS A SECOND LANGUAGE ..... 3

ENGLISH AS A SECOND LANGUAGE ..... 3

DON’T KNOW............................................ d

DON’T KNOW............................................ d

REFUSED ................................................. r

REFUSED ................................................. r

PROBE: (Is/Was) this program
meant to help you learn
English as a second
language (ESL)?

Prepared by Mathematica Policy Research

37Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

IF C12 = 1 (JOB SKILLS OR PREPARE
FOR AN OCCUPATION)
C13. (Is/Was) this program considered to
be “on-the-job” training??
PROBE: On-the-job training, also
called “OJT”, involves
getting on-the-jobexperience from a
particular employer.
IF C12 = 2 (GENERAL EDUCATION)
C14. What kind of general education
(are/were) you attending? (Is/Was)
it . . .
INTERVIEWER: READ
CATEGORIES.

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

YES ........................................................... 1

YES ........................................................... 1

NO ............................................................. 0

NO ............................................................. 0

DON’T KNOW ........................................... d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED.................................................. r

CODE ONE ONLY

CODE ONE ONLY

regular high school, ..................................... 1

regular high school, ...................................... 1

GED classes, ............................................... 2

GED classes, ............................................... 2

non-credit adult education, ........................... 3

non-credit adult education, ........................... 3

a two-year program at a community
college, ........................................................ 4

a two-year program at a community
college, ........................................................ 4

a four-year program at a college or
university, .................................................... 5

a four-year program at a college or
university, ..................................................... 5

a graduate or professional program, or ........ 6

a graduate or professional program, or......... 6

something else? (SPECIFY) ........................ 99

something else? (SPECIFY)......................... 99

ESL-English as a second language ............. 8

ESL-English as a second language .............. 8

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED.................................................... r

(SPECIFY JOB TRAINING)

(SPECIFY JOB TRAINING)

C15. What kind of job (are/were) you
being trained for or what (are/were)
you learning to do in that program?
PROBE FOR SPECIFICS.

Prepared by Mathematica Policy Research

38Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

SKIP C16 IF C13 = 1 (OJT)
C16. At what type of place
(do/did) you go to
participate in that program?
READ CHOICES IF
NECESSARY.

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

CODE ONE ONLY
COMMUNITY COLLEGE/2 YEAR
COLLEGE .................................................... 1
4 YEAR COLLEGE OR UNIVERSITY .......... 2
PRIVATE PROVIDER OF TRAINING
(SPECIFY) ................................................... 3

COMMUNITY BASED ORGANIZATION OR
OTHER NON-PROFIT PRIVATE AGENCY.. 4
ONLINE ....................................................... 5
VOCATIONAL INSTITUTE/
TRAINING CENTER .................................... 6

CODE ONE ONLY
COMMUNITY COLLEGE/2 YEAR COLLEGE .... 1
4 YEAR COLLEGE OR UNIVERSITY ................ 2
PRIVATE PROVIDER OF TRAINING
(SPECIFY) ......................................................... 3

COMMUNITY BASED ORGANIZATION OR
OTHER NON-PROFIT PRIVATE AGENCY ........ 4
ONLINE.............................................................. 5
VOCATIONAL INSTITUTE/
TRAINING CENTER .......................................... 6
ADULT ED/COMMUNITY SCHOOL/
ADULT HS/NIGHT SCHOOL.............................. 7

ADULT ED/COMMUNITY SCHOOL/
ADULT HS/NIGHT SCHOOL ....................... 7

EMPLOYER ....................................................... 8

EMPLOYER ................................................. 8

GOVERNMENT AGENCY/MILITARY................. 9

GOVERNMENT AGENCY/MILITARY .......... 9

[fill LWIA ONE-STOP NAME] or other
[fill LWIA SPECIFIC NAME (E.G.,
CAREER CENTER, JOB CENTER)] .................. 10

[fill LWIA ONE-STOP NAME] or other [fill
LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)] ............................ 10
STATE UNEMPLOYMENT OR
EMPLOYMENT OFFICE ..............................11

STATE UNEMPLOYMENT OR
EMPLOYMENT OFFICE .................................... 11
SOME PLACE ELSE (SPECIFY)........................ 99

SOME PLACE ELSE (SPECIFY) ................. 99
DON’T KNOW ..............................................d
DON’T KNOW .............................................. d

REFUSED ....................................................r

REFUSED.................................................... r

C17. How much (does/did) the
program cost? Please do
not include the cost of
books, uniforms, travel,
tools, or tests or
assessments.
PROBE: Please provide
the cost of
program
participation,
regardless of
who paid for it.
PROBE: Your best
estimate is fine.
IF C17 = d OR r
C18. Would you say the cost of
the program (is/was) . . .

$|

|

|, |

|

|

| SKIP TO C19

$|

|

|, |

|

|

| SKIP TO C19

DON’T KNOW ....................................... d

DON’T KNOW ....................................... d

REFUSED.............................................. r

REFUSED .............................................. r

CODE ONE ONLY
Less than $2,000,......................................... 1
$2,000 to $3,999, ......................................... 2
$4,000 to $5,999, ......................................... 3
$6,000 to $7,999, ......................................... 4
$8,000 to $9,999, or ..................................... 5
$10,000 or more? ......................................... 6

CODE ONE ONLY
Less than $2,000, ........................................ 1
$2,000 to $3,999, ......................................... 2
$4,000 to $5,999, ......................................... 3
$6,000 to $7,999, ......................................... 4
$8,000 to $9,999, or ..................................... 5
$10,000 or more? ......................................... 6

Prepared by Mathematica Policy Research

39Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

#2
(SECOND SCHOOL ORR TRAINING
PROGRAM AFTER RA DATE)

C19. Is this amount the total cost of
the program or the cost for
some other period of time?
PROBE: Is this amount the
cost per year, per
semester, per
quarter, or for
some other period
of time?

CODE ONE ONLY
TOTAL COST OF THE
PROGRAM........................... 1 SKIP TO C20
COST PER YEAR ................ 2
COST PER SEMESTER....... 3
COST PER QUARTER......... 4
COST PER MONTH ............. 5
COST FOR SOME OTHER
PERIOD OF TIME
(SPECIFY) ........................... 99

CODE ONE ONLY
TOTAL COST OF THE
PROGRAM ...........................1 SKIIP TO C20
COST PER YEAR................. 2
COST PER SEMESTER ....... 3
COST PER QUARTER ......... 4
COST PER MONTH ............. 5
COST FOR SOME
OTHER PERIOD OF
TIME (SPECIFY) .................. 99

C19a. How (many [fill UNIT OF
TIME FROM C19]s/long) is it
supposed to take to complete
this program?

| | | NUMBER
YEARS ......................................................... 1
SEMESTERS ............................................... 2
QUARTERS ................................................. 3
MONTHS...................................................... 4
SOME OTHER PERIOD
OF TIME (SPECIFY) .................................... 99

| | | NUMBER
YEARS .........................................................1
SEMESTERS ...............................................2
QUARTERS..................................................3
MONTHS ......................................................4
SOME OTHER PERIOD
OF TIME (SPECIFY) ....................................99

C20. (Do/Did) you or your family . . .

CODE ONE ONLY
pay for all,............................... 1 SKIP TO C24
some, or ................................. 2
none of this program?............. 3 SKIP TO C23
DON’T KNOW ........................ d SKIP TO C23
REFUSED .............................. r SKIP TO C23

CODE ONE ONLY
pay for all, ............................... 1 SKIP TO C24
some, or ................................. 2
none of this program? ............. 3 SKIP TO C23
DON’T KNOW ........................ d SKIP TO C23
REFUSED .............................. r SKIP TO C23

C21. How much, (do/did) you or
your family pay for this
program?

$| |,| | | |
DON’T KNOW ............................................. d
REFUSED ................................................... r

$| |,| | | |
DON’T KNOW ............................................. d
REFUSED ................................................... r

C22. Did this payment cover the
cost per year, per semester,
per quarter, or for some other
period of time?

CODE ONE ONLY
TOTAL COST OF THE PROGRAM .............. 1
COST PER YEAR ........................................ 2
COST PER SEMESTER............................... 3
COST PER QUARTER................................. 4
COST PER MONTH ..................................... 5
COST FOR SOME OTHER PERIOD OF
TIME (SPECIFY) .......................................... 99

CODE ONE ONLY
TOTAL COST OF THE PROGRAM ..............1
COST PER YEAR.........................................2
COST PER SEMESTER ...............................3
COST PER QUARTER .................................4
COST PER MONTH .....................................5
COST FOR SOME OTHER PERIOD OF
TIME (SPECIFY) ..........................................99

C23. Who (else) (pays/paid) for
this program? This may
include an organization or
grant.

CODE ALL THAT APPLY
ITA VOUCHER ............................................. 1
[fill LWIA ONE-STOP NAME] or other
[fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)] ............................ 2
STATE UNEMPLOYMENT/
EMPLOYMENT OFFICE .............................. 3
TRADE ADJUSTMENT ASSISTANCE (TAA
OR TRA) ...................................................... 4
VETERANS AFFAIRS (VA) .......................... 5
PELL GRANT ............................................... 6
OTHER GOVERNMENT AGENCY OR
ASSISTANCE............................................... 7
OTHER GRANT OR SCHOLARSHIP
FUND (LIKE [fill SITE SPECIFIC]) ................ 8
OTHER (SPECIFY) ...................................... 99

CODE ALL THAT APPLY
ITA VOUCHER .............................................1
[fill LWIA ONE-STOP NAME] or other
[fill LWIA SPECIFIC NAME (E.G., CAREER
CENTER, JOB CENTER)] ............................2
STATE UNEMPLOYMENT/
EMPLOYMENT OFFICE...............................3
TRADE ADJUSTMENT ASSISTANCE (TAA
OR TRA).......................................................4
VETERANS AFFAIRS (VA) ..........................5
PELL GRANT ...............................................6
OTHER GOVERNMENT AGENCY OR
ASSISTANCE ...............................................7
OTHER GRANT OR SCHOLARSHIP
FUND (LIKE [fill SITE SPECIFIC]) ................8
OTHER (SPECIFY) ......................................99

DON’T KNOW .............................................. d
REFUSED .................................................... r

DON’T KNOW ..............................................d
REFUSED ....................................................r

YES .......................................... 1

YES .......................................... 1

PROBE: Any other person
or organization?

C24. CATI: CHECK C8. DOES
C8=2 (STILL IN PROGRAM)?

NO ........................................... 0

Prepared by Mathematica Policy Research

GO TO C4
FOR
ANOTHER
PROGRAM
OR TO C27

GO TO C4
FOR
ANOTHER
PROGRAM OR
TO C27

NO ............................................ 0

40Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

C25. Did you complete the program?

YES ........................................1

PROBE: Did you receive a
certificate or degree?

NO ..........................................0

C26. What was the main reason that you
stopped attending that program?

SKIP TO C27

PROBE:

A professionall
certification or state or
industry license is not
considered to be a
diploma or degree. We
will talk about
certifications and licenses
next.

C28. Did you receive a diploma or degree
for completing that program?

Prepared by Mathematica Policy Research

SKIP TO C27

NO SPECIFIC
COMPLETION ........................3

SKIP TO C27

NO SPECIFIC
COMPLETION ....................... 3

SKIP TO C27

DON’T KNOW ........................d

SKIP TO C27

DON’T KNOW ........................ d

SKIP TO C27

REFUSED ..............................r

SKIP TO C27

REFUSED .............................. r

SKIP TO C27

CODE ONE ONLY

CODE ONE ONLY
FOUND JOB/REEMPLOYED ....................... 1

COULDN’T AFFORD TO CONTINUE .......... 2

COULDN’T AFFORD TO CONTINUE .......... 2

PERSONAL PROBLEMS............................. 3

PERSONAL PROBLEMS ............................. 3

NOT INTERESTED/DIDN’T LIKE
PROGRAM .................................................. 4

NOT INTERESTED/DIDN’T LIKE
PROGRAM .................................................. 4

DIDN’T THINK IT WOULD HELP TO
FIND JOB .................................................... 5

DIDN’T THINK IT WOULD HELP TO
FIND JOB .................................................... 5

STARTED (OTHER) SCHOOL/
TRAINING ................................................... 6

STARTED (OTHER) SCHOOL/
TRAINING.................................................... 6

DECIDED DIDN’T WANT JOB ..................... 7

DECIDED DIDN’T WANT JOB ..................... 7

ILLNESS/PREGNANCY .............................. 8

ILLNESS/PREGNANCY ............................... 8

CHILD CARE/FAMILY
TRANSPORTATION/LOGISTICAL
PROBLEMS................................................. 9

CHILD CARE/FAMILY
TRANSPORTATION/LOGISTICAL
PROBLEMS ................................................. 9

POOR GRADES .......................................... 10

POOR GRADES .......................................... 10

COURSES OR PROGRAM POORLY
TAUGHT ...................................................... 11

COURSES OR PROGRAM POORLY
TAUGHT ...................................................... 11

OTHER (SPECIFY) ..................................... 99

OTHER (SPECIFY) ...................................... 99

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED .................................................... r

SKIP TO C37a

PROBE: For example, a high
school diploma or GED or
a two- or four-year
degree.

YES ....................................... 1
NO ......................................... 0

FOUND JOB/REEMPLOYED ...................... 1

C27. (Is/Was) [fill PROGRAM NAME]
designedd to lead to a diploma or
degree?

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

SKIP TO C37a

YES ........................................1

YES ....................................... 1

NO ..........................................0

SKIP TO C30

NO ......................................... 0

DON’T KNOW ........................d

SKIP TO C30

DON’T KNOW ........................ d

SKIP TO C30

REFUSED ..............................r

SKIP TO C30

REFUSED .............................. r

SKIP TO C30

IF C8=2 (STILL IN PROGRAM),
SKIP TO C30 FOR ALL

YES ........................................1

SKIP TO C30

IF C8=2 (STILL IN PROGRAM),
SKIP TO C30 FOR ALL

YES ....................................... 1

NO ..........................................0

SKIP TO C30

NO ......................................... 0

DON’T KNOW ........................d

SKIP TO C30

DON’T KNOW ........................ d

SKIP TO C30

REFUSED ..............................r

SKIP TO C30

REFUSED .............................. r

SKIP TO C30

41Cumulative changes made to WIA 15-Mo Follow-Up Survey between

SKIP TO C30

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

C29. What specific degree did you
receive for completing that
program?

C30. (Is/Was) [fill PROGRAM NAME]
designed to lead to a professional
certification or a state or industry
license?

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

CODE ONE ONLY

CODE ONE ONLY

HIGH SCHOOL DIPLOMA OR GED ............ 1

HIGH SCHOOL DIPLOMA OR GED ............ 1

POST-SECONDARY DEGREE
(E.G., AA, BA, ETC.).................................... 2

POST-SECONDARY DEGREE
(E.G., AA, BA, ETC.) .................................... 2

OTHER (SPECIFY) ..................................... 99

OTHER (SPECIFY) ...................................... 99

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED .................................................... r

YES .................................... 1

YES ................................... 1

NO ...................................... 0

SKIP TO C37a

NO ..................................... 0

SKIP TO C37a

DON’T KNOW .................... d

SKIP TO C37a

DON’T KNOW .................... d

SKIP TO C37a

PROBE: A professional
certification or license
shows you are qualified to
perform a specific job and
includes things like
Licensed Realtor,
Certified Medical
Assistant, Certified
Construction Manager, a
Project Management
Professional or PMP
certification, or an IT
certification.

REFUSED .......................... r

SKIP TO C36x

REFUSED .......................... r

SKIP TO C37a

C31. Did you receive a certification or
license for completing that program?

YES .................................... 1

C32. Did you need to take any tests or
exams to get this certification or
license?

C33. How much (does/did) (this/these)
test(s) cost?
PROBE: Your best estimate is fine.

IF C8=2 (STILL IN PROGRAM),
SKIP TO C37a FOR ALL

YES ................................... 1

NO ...................................... 0

SKIP TO C37a

NO ..................................... 0

SKIP TO C37a

DON’T KNOW .................... d

SKIP TO C37a

DON’T KNOW .................... d

SKIP TO C37a

REFUSED .......................... r

SKIP TO C37a

REFUSED .......................... r

SKIP TO C37a

YES .................................... 1

YES ................................... 1

NO ...................................... 0

SKIP TO C37a

NO ..................................... 0

DON’T KNOW .................... d

SKIP TO C37a

DON’T KNOW .................... d

SKIP TO C37a

REFUSED .......................... r

SKIP TO C37a

REFUSED .......................... r

SKIP TO C37a

$|

|

|,|

|

|

| EXAM COST

|

|,|

|

|

| EXAM COST

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED .................................................... r

CODE ONE ONLY
pay for all, ........................... 1

SKIP TO C37a

some, or ............................. 2

Prepared by Mathematica Policy Research

$|

SKIP TO C37a

DON’T KNOW ............................................. d

C34. (Do/Did) you or your family . . .

C35. How much, (do/did) you or your
family pay for ((this/these) test(s)??

IF C8=2 (STILL IN PROGRAM),
SKIP TO C37a FOR ALL

CODE ONE ONLY
pay for all, .......................... 1

SKIP TO C37a

some, or ............................. 2

none of (this/these) tests? ... 3

SKIP TO C36

none of (this/these) tests? .. 3

DON’T KNOW .................... d

SKIP TO C36

DON’T KNOW .................... d

SKIP TO C36

REFUSED .......................... r

SKIP TO C36

REFUSED .......................... r

SKIP TO C36

$|

|

|,|

|

|

| EXAM COST

$|

|

|,|

|

|

SKIP TO C36

| EXAM COST

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED .................................................... r

42Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

#1
(FIRST SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

C36. Who (else) (pays/paid) for
(this/these) tests? This may include
an organization or grant.
PROBE: Any other person or
organization?

C37a. Have you had at least one job since
you started this program?

C37b. Do you think you got a job because
of the skills you learned in this
program?

CODE ALL THAT APPLY

CODE ALL THAT APPLY

ITA VOUCHER ............................................ 1

ITA VOUCHER ............................................ 1

[fill LWIA ONE-STOP NAME] or other
[fill LWIA SPECIFIC NAME (E.G.,
CAREER CENTER, JOB CENTER)] ............ 2

[fill LWIA ONE-STOP NAME] or other
[fill LWIA SPECIFIC NAME (E.G.,
CAREER CENTER, JOB CENTER)] ............ 2

STATE UNEMPLOYMENT/
EMPLOYMENT OFFICE .............................. 3

STATE UNEMPLOYMENT/
EMPLOYMENT OFFICE .............................. 3

TRADE ADJUSTMENT ASSISTANCE
(TAA or TRA) ............................................... 4

TRADE ADJUSTMENT ASSISTANCE
(TAA or TRA) ............................................... 4

VETERANS AFFAIRS (VA) ......................... 5

VETERANS AFFAIRS (VA) .......................... 5

PELL GRANT .............................................. 6

PELL GRANT............................................... 6

OTHER GOVERNMENT AGENCY OR
ASSISTANCE .............................................. 7

OTHER GOVERNMENT AGENCY OR
ASSISTANCE .............................................. 7

OTHER GRANT OR SCHOLARSHIP
FUND (LIKE [fill SITE SPECIFIC]) ............... 8

OTHER GRANT OR SCHOLARSHIP
FUND (LIKE [fill SITE SPECIFIC])................ 8

OTHER (SPECIFY) ..................................... 99

OTHER (SPECIFY) ...................................... 99

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED .................................................... r

YES ......................................1

GO TO C37b

YES ..................................... 1

GO TO C37b

NO ........................................0

SKIP TO D0

NO ....................................... 0

SKIP TO D0

DON’T KNOW ...................... d

GO TO C37b

DON’T KNOW ...................... d

GO TO C37b

REFUSED ............................r

GO TO C37

REFUSED ............................ r

GO TO C37

YES ............................................................. 1

YES ............................................................. 1

NO, DID NOT GET JOB BECAUSE
OF SKILLS .................................................. 2

NO, DID NOT GET JOB BECAUSE
OF SKILLS ................................................... 2

NO, HAVE NOT BEEN EMPLOYED
SINCE COMPLETED PROGRAM ............... 3

NO, HAVE NOT BEEN EMPLOYED
SINCE COMPLETED PROGRAM ................ 3

STILL IN PROGRAM ................................... 4

STILL IN PROGRAM.................................... 4

DON’T KNOW ............................................. d

DON’T KNOW .............................................. d

REFUSED ................................................... r

REFUSED .................................................... r

IF STILL IN PROGRAM,
GO TO C4 FOR NEXT PROGRAM
OR D0 IF NO OTHER PROGRAM

Prepared by Mathematica Policy Research

#2
(SECOND SCHOOL OR TRAINING
PROGRAM AFTER RA DATE)

IF STILL IN PROGRAM,
GO TO C4 FOR NEXT PROGRAM
OR D0 IF NO OTHER PROGRAM

43Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

SECTION D – EMPLOYMENT PATTERNS, JOB CHARACTERISTICS, AND EARNINGS

MOST RECENT JOB BEFORE RECEIVING ONE-STOP SERVICES

PROGRAMMER BOX
CATI: IF SRF17 = 1, GO TO D5, ELSE GO TO D0.
D0.

Now I’d like to ask you about your employment status before you sought services from the
[fill LWIA ONE-STOP NAME] in [fill RA MO/YR DATE]. Did you have at least one job
between [fill (RA MO/YR DATE – 5 years)] and [fill RA MO/YR DATE]?
YES ....................................................................................................................... 1

D1.

Deleted: at the time or
Deleted: on
Deleted: in the five
Deleted: prior to

NO ......................................................................................................................... 0

SKIP TO D21a

Deleted: D21

DON’T KNOW ....................................................................................................... d

SKIP TO D21a

Deleted: D21

REFUSED ............................................................................................................. r

SKIP TO D21a

Deleted: D21

I am interested in the job you had just prior to [fill RA MO/YR DATE]. If you had more than
one job just before you sought services, please give answers about your job with the most
hours.
What was the name of this company? Who was your employer?
COMPANY NAME (SPECIFY) .............................................................................. 1

SELF EMPLOYED ................................................................................................ 2
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
D2.

What kind of company is [fill COMPANY NAME]—what do they make, do, or sell?
PROBE:

What kind of business or industry is this?

KIND OF BUSINESS OR INDUSTRY (SPECIFY) ............................................... 1

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

44Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

D3.

What were your main duties at this company? Please be specific.
PROBE:

What did you do?

FOR EXAMPLE: TRY TO GET A VERB. TEACHING, DRIVING A TRACTOR TRAILER,
STOCKING INVENTORY.

Deleted: ELECTRICAL ENGINEER,
STOCK CLERK, CASHIER,

MAIN DUTIES (SPECIFY) .................................................................................... 1

Deleted: DRIVER, WAITRESS, AND
TEACHER

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
D4.

As of [fill RA MO/YR DATE], what was your most recent rate of pay, before taxes or
deductions, at that job?
PROBE: If your pay varied, provide an average amount.
ACCEPT MOST CONVENIENT PAY PERIOD.
$|

|

|

|,|

|

|

|.|

|

| RATE OF PAY

Deleted: |,|

SKIP TO D8

PER HOUR ........................................................................................................... 1

SKIP TO D8

PER WEEK ........................................................................................................... 2

SKIP TO D8

ONCE EVERY TWO WEEKS ............................................................................... 3

SKIP TO D8

TWICE A MONTH ................................................................................................. 4

SKIP TO D8

PER YEAR ............................................................................................................ 5

SKIP TO D8

OTHER (SPECIFY) ............................................................................................... 99

SKIP TO D8

|

|

|.|

Deleted: 6

___________________________________________________

D5.

DON’T KNOW ....................................................................................................... d

SKIP TO D8

REFUSED ............................................................................................................. r

SKIP TO D8

Now, I’d like to ask you about the job you had just before you sought services from the [fill
LWIA ONE-STOP NAME] in [fill RA MO/YR DATE]. My computer screen indicates that you
worked at [fill COMPANY NAME SRF20]. Is this correct?

Deleted: at the time or
Deleted: on

YES ....................................................................................................................... 1

D6.

NO ......................................................................................................................... 0

GO BACK TO D1

DON’T KNOW ....................................................................................................... d

GO BACK TO D1

REFUSED ............................................................................................................. r

GO BACK TO D1

What kind of company is [fill COMPANY NAME]—what do they make, do, or sell?
PROBE:

What kind of business or industry is this?

KIND OF BUSINESS OR INDUSTRY (SPECIFY) ............................................... 1

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

45Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

IF SRF21 valid
D7.

At the time you sought services from [fill LWIA ONE-STOP NAME] in [fill RA MO/YR DATE]
your main duties at [fill COMPANY NAME SRF20] were [fill SRF21]. Is this correct?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

GO BACK TO D3

DON’T KNOW ....................................................................................................... d

GO BACK TO D3

REFUSED ............................................................................................................. r

GO BACK TO D3

ALL
D8.

When did you start working for [fill COMPANY NAME]?
INTERVIEWER:

RECORD MONTH AND YEAR.
ENTER DATE IN MM/YYYY FORMAT

| | |/|
MONTH

| | |
YEAR

|

SKIP TO D10

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
IF D8 = d OR r
D9.

Deleted: for [fill COMPANY NAME]?

Do you recall what year you started working there?
|

|

|

|

| YEAR

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
D10.

When did that job end?
INTERVIEWER:

RECORD MONTH AND YEAR.
ENTER DATE IN MM/YYYY FORMAT.

| | |/|
MONTH

| | |
YEAR

|

SKIP TO D12a

STILL AT JOB ....................................................................................................... 2

Deleted: D12

SKIP TO D12a

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
IF D10 = d OR r
D11.

Do you recall what year that job ended?
|

|

|

|

| YEAR

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

46Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

D12a. Apart from vacations, holidays, or sick leave, would you say you worked for all or nearly
all of the time between when that job started and (when that job ended/now) or was there
some time that you were not working?
PROBE:

Deleted: D12

Between [fill (D8/D9 MO/YR)] and ([fill (D10/D11 MO/YR)]/now)

WORKED ALL OR NEARLY ALL OF THE TIME ................................................. 1

SKIP TO D13

SOME TIME NOT WORKING ............................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
D12b. About how many weeks would you say you worked during that time? Would you say . . .
PROBE:

Between [fill (D8/D9 MO/YR)] and ([fill (D10/D11 MO/YR)]/now)

Deleted: between (fill [D8/D9 MO/YR]) and
(fill [D10/D11 MO/YR])/now?

CODE ONE ONLY
Deleted: All or nearly all, 1¶

Most but not all, ................................................................................................... 1

Deleted: 2 SKIP TO D15

About half, ........................................................................................................... 2

Deleted: 3 SKIP TO D15

Less than half but more than a few, or ............................................................. 3

D13.

Deleted: 4 SKIP TO D15

Almost none? ...................................................................................................... 4

Deleted: 5 SKIP TO D15

DON’T KNOW ....................................................................................................... d

Deleted:

SKIP TO D15

REFUSED ............................................................................................................. r

Deleted:

SKIP TO D15

How many hours per week, including regular overtime hours, did you usually work on that
job?
|

|

| HOURS PER WEEK

SKIP TO D15

Deleted: D17

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
IF D13 = d OR r
D14.

Would you say you work(ed) . . .
CODE ONE ONLY
Less than 20 hours per week, ............................................................................ 1
Between 20 and 29 hours per week, ................................................................. 2
Between 30 and 39 hours per week, ................................................................. 3
Between 40 and 49 hours per week, or ............................................................. 4
50 or more hours per week? .............................................................................. 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

47Cumulative changes made to WIA 15-Mo Follow-Up Survey between

Deleted: CODE ONE ONLY¶
LESS THAN 20 HOURS PER
WEEK 1 SKIP TO D17¶
BETWEEN 20 AND 29 HOURS PER
WEEK 2 SKIP TO D17¶
BETWEEN 30 AND 39 HOURS PER
WEEK 3 SKIP TO D17¶
BETWEEN 40 AND 49 HOURS PER
WEEK 4 SKIP TO D17¶
50 OR MORE HOURS PER
WEEK 5 SKIP TO D17¶
Deleted:

SKIP TO D17

Deleted:

SKIP TO D17

3-21-12 and 8-23-12

D15.

How many days per week did you usually work?
PROBE:

How many days in an average week?

PROBE:

Just before you left.

|

Deleted:

| DAYS PER WEEK

|

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
NO D16 IN THIS VERSION.
PROGRAMMER BOX
CATI: IF D1 = 2 (SELF-EMPLOYED), SKIP TO D20.
D17.

Deleted:
Page Break
¶
D16. And how many hours per day did
you usually work? Please include regular
overtime hours.¶
PROBE: How many hours in an
average day?¶
PROBE: Just before you left.¶
| | | HOURS PER DAY¶
DON’T KNOW d¶
REFUSED r¶
¶
¶

Which of the following best describes your employment at that company? Were you
working . . .
CODE ONE ONLY
As a regular full-time or part-time employee, .................................................. 1
For a temporary help agency, ............................................................................ 2
For a company that contracts out you or your services, ................................ 3
As an independent contractor, independent consultant, free-lance
worker, or self-employed, .................................................................................. 4
As a day laborer, or............................................................................................. 5
As an on-call employee? .................................................................................... 6
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
PROBE:

A temporary help agency supplies workers to other companies on an as
needed basis.

PROBE:

Some companies provide employees or their services to others under contract.
A few examples of services that can be contracted out include security,
landscaping, or computer programming.

PROBE:

Independent contractors, independent consultants, and free-lance workers
obtain customers on their own to provide a product or service and can have
other employees working for them.

PROBE:

Day laborers are people who get work by waiting at a place where employers
pick up people to work for a day or by posting paper or electronic job wanted
ads and responding on a day-by-day basis.

PROBE:

On-call workers are in a pool of workers who are ONLY called to work as
needed, although they can be scheduled to work for several days or weeks in a
row, for example, substitute teachers, and construction workers supplied by a
union hiring hall.

Prepared by Mathematica Policy Research

48Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

D18.

Which of the following benefits were available to you on your job, even if you were not
receiving them (READ EACH ITEM) . . .
INTERVIEWER:

CODE “YES” IF AVAILABLE, BUT NOT USED.
CODE ONE PER ROW
YES

NO

DON’T
KNOW

REFUSED

a. Health insurance or membership in an HMO or
PPO plan? .............................................................

1

0

d

r

b. Paid vacation? .......................................................

1

0

d

r

c.

Paid holidays? .......................................................

1

0

d

r

d. Paid sick leave? .....................................................

1

0

d

r

e. Retirement or pension benefits?............................

1

0

d

r

f.

1

0

d

r

Tuition assistance/reimbursement? .......................

D19.

Did you belong to a union on this job?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
PROGRAMMER BOX
CATI: IF D10 = 2 (STILL AT JOB), d, OR r, SKIP TO D21b.

D20.

Deleted: —

Why did you stop working at that job?
PROBE:

Were you laid off, did you quit, did you retire, were you fired, or was there
some other reason?
CODE ONE ONLY

LAID OFF (INCLUDE JOB COMPLETED/TEMP. WORK/SEASONAL
WORK/WORK PERIOD ENDED/REORGANIZATION/DOWNSIZING/
COMPANY SOLD/COMPANY MOVED/COMPANY WENT OUT OF
BUSINESS/END OF TERM IN SERVICE/ENLISTMENT UP) ............................. 1
QUIT ...................................................................................................................... 2
RETIRED .............................................................................................................. 3
FIRED.................................................................................................................... 4
ILLNESS/PREGNANCY/LEAVE OF ABSENCE .................................................. 5
STRIKE ................................................................................................................. 6
INJURED ON JOB ................................................................................................ 7
OTHER (SPECIFY) ............................................................................................... 99

Deleted: INJURY
Deleted: 8

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

49Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

Prepared by Mathematica Policy Research

50Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

CURRENT JOB AND UP TO 5 JOBS BETWEEN NOW AND RA

PROGRAMMER BOX
CATI: IF D10 = 2 (STILL AT JOB), SKIP TO D21b.
D21a. (We are finished talking about the job you had at [IF SRF17 ~=1, fill D2 COMPANY NAME;
ELSE IF SRF17 = 1, fill COMPANY NAME SRF20].) Now I’d like to ask you about your
current employment status. Are you . . .
CODE ALL THAT APPLY
Currently employed for someone other than yourself, ................................... 1
Self-employed, ..................................................................................................... 2

Deleted: ¶
D21
Deleted: the time or just before you
sought services from the [
Deleted: LWIA ONE-STOP NAME
Deleted: working now, looking for work,
retired, keeping house,

Not employed, ..................................................................................................... 3
Not employed outside the home, ...................................................................... 4
Retired, ................................................................................................................. 5
A student, or .......................................................................................................... 6
Something else? (SPECIFY) ................................................................................ 99
ONLY TEMPORARILY LAID OFF, SICK, OR MATERNITY LEAVE .................... 7
DISABLED, PERMANENTLY OR TEMPORARILY .............................................. 8
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Deleted:
CODE ONE ONLY¶
WORKING NOW 1¶
LOOKING FOR WORK,
UNEMPLOYED 2¶
RETIRED 3¶
KEEPING HOUSE 4¶
STUDENT 5¶
Deleted: 6

D21b. Are you currently looking for work?

Deleted: 7

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

Deleted: SOMETHING ELSE
(SPECIFY) 8¶
¶

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

51Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

D22.

Including any current job(s), how many different paid jobs have you had since
[fill RA MO/YR DATE]?
PROBE:

How many different full-time or part-time jobs have you had since you sought
services from [fill LWIA ONE-STOP NAME]?

INTERVIEWER:

|

|

TREAT A JOB INTERRUPTED BY TWO OR MORE UNPAID WEEKS AS
SEPARATE JOBS, EVEN IF IT IS WITH THE SAME EMPLOYER. IF
SEPARATION IS LESS THAN TWO WEEKS, TREAT AS ONE JOB.
Deleted: #

| NUMBER OF JOBS

ZERO .................................................................................................................... 00

SKIP TO E1

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

52Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

PROGRAMMER BOX
CATI: ALLOW FOR 5 JOBS. ASK D23 ACROSS FIRST, FOLLOWED BY D24. THEN
ASK D25-D39 FOR EACH JOB.

NOTE: SPACE FOR 3RD, 4TH, AND 5TH JOB WILL BE IN CATI PROGRAM.
JOB 1

D23. Please tell me the name of the
companies, organizations, or people
you’ve worked for. Start with your
current job or jobs, then the most
recent jobs that you had.
PROBE: What was the job before
that?
D24. It is important that we get
information on every job you have
had since [fill RA MO/YR DATE]. Let
me verify that since [fill RA MO/YR
DATE] you worked at [fill D23
NAMES]. Is this correct, or are there
any other jobs you may have had,
including your current job?

JOB 2

COMPANY NAME (SPECIFY) ....................... 1

COMPANY NAME (SPECIFY)........................ 1

SELF-EMPLOYED ......................................... 2

SELF-EMPLOYED ......................................... 2

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

CORRECT ..................................................... 1

CORRECT ..................................................... 1

NOT CORRECT ............................................ 0

NOT CORRECT ............................................. 0

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

| | |/|
MONTH

| | |/|
MONTH

INTERVIEWER: IF CORRECT,
ENTER “1” AND CONTINUE.
IF IT IS NOT CORRECT, ENTER
“0”; GO BACK TO D23 AND D24 TO
ENTER CORRECT NAMES AND
NUMBER OF JOBS HELD.
D25. When did you start working for
[fill D23_JOB_1 – D23_JOB_5]?
INTERVIEWER: RECORD MONTH
AND YEAR.
IF D25= d OR r
D26. Do you recall what year you started
working there?

|

| |
YEAR

|

SKIP TO D27

|

| |
YEAR

|

SKIP TO D27

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

|

|

|

|

|

| YEAR

|

|

|

| YEAR

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

| | |/|
MONTH

| | |/|
MONTH

D27. When did that job end?
INTERVIEWER: RECORD MONTH
AND YEAR.

IF D27= d OR r
D28. Do you recall what year that job
ended?

Prepared by Mathematica Policy Research

(v37).docx

|

| |
YEAR

|

SKIP TO D29a

|

| |
YEAR

|

SKIP TO D29a

STILL AT JOB.........................2 SKIP TO D29a

STILL AT JOB ........................ 2 SKIP TO D29a

DON’T KNOW.........................d

DON’T KNOW ........................ d

REFUSED ..............................r

REFUSED .............................. r

|

|

|

|

|

| YEAR

|

|

|

| YEAR

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

52Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

JOB 1

D29a. Apart from vacations, holidays, or
sick leave, would you say you
worked for all or nearly all of the
time between when that job started
and (when that job ended/now) orr
was there somme time that you
were not working?

JOB 2

CODE ONE ONLY
WORKED ALL OR NEARRLY
ALL OF THE TIME .....................1 SKIP TO D30

CODE ONE ONLY
WORKED ALL OR NEARLY
ALL OF THE TIME ..................... 1 SKIP TO D30

SOME TIME NOT WORKING .....2

SOME TIME NOT WORKING .... 2

DON’T KNOW.............................d

DON’T KNOW ............................ d

REFUSED ..................................r

REFUSED .................................. r

PROBE: Between [fill (D25/D26
MO/YR)] and [fill D27/
D28 MO/YR)]/now.
D29b. About how many weeks would you
say you worked during that time?
PROBE: Between [fill (D25/D26
MO/YR)] and [fill D27/
D28 MO/YR)]/now.

IF D29a =1
D30. How many hours per week,
including regular overtime hours
(do/did) you usually work at
[fill D23_JOB_1 – D23_JOB_5]?
IF D30 =d OR r
D31. Would you say you work(ed) . . .

D32. How many days per week (do/did)
you usually work?
PROBE: How many days in an
average week?

CODE ONE ONLY
Most but not all, ............................................... 1

CODE ONE ONLY
Most but not all, ................................................ 1

About half, ....................................................... 2

About half, ........................................................ 2

Less than half but more than a few, or ............. 3

Less than half but more than a few, or .............. 3

Almost none? ................................................... 4

Almost none? ................................................... 4

DON’T KNOW.................................................. d

DON’T KNOW .................................................. d

REFUSED ....................................................... r

REFUSED ........................................................ r

|

|

|

| HOURS PER WEEK SKIP TO D32

|

| HOURS PER WEEK

SKIP TO D32

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

CODE ONE ONLY

CODE ONE ONLY

Less than 20 hours per week, .......................... 1

Less than 20 hours per week,........................... 1

Between 20 and 29 hours per week, ................ 2

Between 20 and 29 hours per week, ................ 2

Between 30 and 39 hours per week, ................ 3

Between 30 and 39 hours per week, ................ 3

Between 40 and 49 hours per week, or ............ 4

Between 40 and 49 hours per week, or ............ 4

50 or more hours per week? ............................ 5

50 or more hours per week? ............................. 5

DON’T KNOW.................................................. d

DON’T KNOW .................................................. d

REFUSED ....................................................... r

REFUSED ........................................................ r

|

|

|

| DAYS PER WEEK

|

| DAYS PER WEEK

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

KIND OF BUSINESS OR INDUSTRY
(SPECIFY) ..................................................... 1

KIND OF BUSINESS OR INDUSTRY
(SPECIFY) ..................................................... 1

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

PROBE: Just before you left.
NO D33 IN THIS VERSION.
D34. What kind of company is
[fill D23_JOB_1 – D23_JOB_5]—
what do they make, do, or sell?
PROBE: What kind of business or
industry is this?
INTERVIEWER: IF RESPONDENT
RETURNED TO JOB, SAY: You
may have told me this information
about when you worked for
[fill COMPANY NAME] before.

Prepared by Mathematica Policy Research

(v37).docx

53Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

JOB 1

JOB 2

D35. What (do/did) you do there—what
(is/was) your job?

JOB DUTIES (SPECIFY) ............................... 1

JOB DUTIES (SPECIFY) ................................ 1

PROBE: What were your most
important duties at that
job?

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

INTERVIEWER: TRY TO GET A
VERB.
IF D23 = 2, SKIP D36
D36. Which of the following best
describes your employment at
[fill D23_JJOB_1 – D23_JOBB_5]?
(Are/Were) you working . . .

D37. What (was/is) your (most recent/
current) rate of pay, before taxes at
deductions, at that job?
PROBE: If your pay (varies/varied),
please provide an
average amount.
ACCEPT MOST CONVENIENT
PAY PERIOD.

IF D23 = 2, SKIP D38
D38. Which of the following benefits
(are/were) available to you on your
job, even if you (are/were) not
receiving them (READ EACH
ITEM) . . .
SELECT IF AVAILABLE, BUT NOT
USED.

IF D23 = 2, SKIP D39.
D39. (Do/Did) you belong to a union on
this job?

Prepared by Mathematica Policy Research

(v37).docx

CODE ONE ONLY

CODE ONE ONLY

as a regular full-time or part-time
employee, ...................................................... 1

as a regular full-time or part-time
employee, ...................................................... 1

for a temporary help agency,.......................... 2

for a temporary help agency, .......................... 2

for a company that contracts out you or
your services,................................................. 3

for a company that contracts out you or
your services, ................................................. 3

as an independent contractor,
independent consultant, free-lance
worker, or self-employed, ............................... 4

as an independent contractor,
independent consultant, free-lance
worker, or self-employed, ............................... 4

as aa day laborer, or ..................................... 5

as a day laborer, or ........................................ 5

as an on-call employee? ................................ 6

as an on-call employee? ................................. 6

DON’T KNOW................................................ d

DON’T KNOW ................................................ d

REFUSED ..................................................... r

REFUSED ...................................................... r

$|

|

|

|,|

|

|

|.|

|

| AVERAGE
AMOUNT

$|

|

|

|,|

|

|

|.|

|

| AVERAGE
AMOUNT

PER HOUR................................................ 1

PER HOUR ................................................ 1

PER WEEK ................................................ 2

PER WEEK ................................................ 2

ONCE EVERY TWO WEEKS .................... 3

ONCE EVERY TWO WEEKS ..................... 3

TWICE A MONTH ...................................... 4

TWICE A MONTH ...................................... 4

PER YEAR ................................................ 5

PER YEAR ................................................. 5

OTHER (SPECIFY).................................... 99

OTHER (SPECIFY) .................................... 99

DON’T KNOW............................................ d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED .................................................. r

CODE ALL THAT APPLY
Health insurance or membership in an
HMO or PPO plan? .................................... 1

CODE ALL THAT APPLY
Health insurance or membership in an
HMO or PPO plan? .................................... 1

Paid vacation? .......................................... 2

Paid vacation? ............................................ 2

Paid holidays? ........................................... 3

Paid holidays? ............................................ 3

Paid sick leave? ......................................... 4

Paid sick leave? ......................................... 4

Retirement or pension benefits? ................ 5

Retirement or pension benefits? ................. 5

Tuition assistance/reimbursement? ............ 6

Tuition assistance/reimbursement? ............ 6

DON’T KNOW............................................ d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED .................................................. r

YES ........................................................... 1

YES ............................................................ 1

NO ............................................................. 0

NO ............................................................. 0

DON’T KNOW............................................ d

DON’T KNOW ............................................ d

REFUSED ................................................. r

REFUSED .................................................. r

54Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-12 and 8-23-12

SECTION E – INCOME SOURCES AND HOUSEHOLD CHARACTERISTICS
The next questions are about sources of income and support other than unemployment benefits
that you may have received during the most recent calendar year, that is, between [fill January 1,
MOST RECENT CALENDAR YEAR (CY) and December 31, CY]. These questions will go very
quickly.
E1.

Did you or anyone in your household receive assistance from any of the following
programs during [fill CY]?
CODE ONE PER ROW
YES

NO

DON’T
KNOW

REFUSED

a. SNAP/food stamps .........................................

1

0

d

r

b. WIC .................................................................

1

0

d

r

Cash assistance from [fill STATE TANF
NAME] or welfare, Supplemental Security
Income (SSI), Social Security Retirement,
Disability, or Survivors Benefits (SSA) or
General Assistance (GA) ................................

1

0

d

r

d. Any other assistance that I haven’t
mentioned? (SPECIFY) ..................................

1

0

d

r

c.

PROGRAMMER BOX
IF E1a – E1b = NO, GO TO E4.
CATI: ASK E2 AND E3 FOR EACH YES IN E1 (WITH THE EXCEPTION
OF E1b (WIC)).
SNAP (FOOD STAMPS)

E2.

E3.

For approximately how many
months did you or anyone else
in your household receive [fill
(food stamps) (cash
assistance) (other
assistance)]?
PROBE: If you did not
receive assistance
in some months,
please tell us for
how many months
you did receive
assistance.
And approximately how much
assistance was received each
month?
IF VARIED, PROBE: Please
tell me the average amount
received.

|

| MONTHS

|

|

| MONTHS

DON’T KNOW .................................... d

DON’T KNOW .................................... d

REFUSED .......................................... r

REFUSED .......................................... r

$|

|

|

,|

|

|

|

$|

|

|

,|

|

|

|

DON’T KNOW .................................... d

DON’T KNOW .................................... d

REFUSED .......................................... r

REFUSED .......................................... r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

|

CASH ASSISTANCE

55Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

Deleted: )].

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

56Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

E4.

What was the total income for you and all the members of your household, before taxes
and other deductions in [fill CY]? Please include all of the sources of income we’ve talked
about, plus any others you may have had.
PROBE, IF NEEDED: Include sources such as self-employment, regular jobs, and
earnings from odd side jobs, under-the-table jobs, and other
activities, social security, pensions, rent, interest and dividends,
unemployment compensation, welfare, other public assistance, food
stamps, child support, and money from any other sources. Your best
estimate is fine.
INTERVIEWER:

$|

|

|

|,|

ACCEPT A “DON’T KNOW” ANSWER WITHOUT PRESSING
RESPONDENT FOR AN ANSWER. GO TO RANGES IN E5 TO
GET INCOME AMOUNT.
|

|

|

SKIP TO E8

Deleted: |,|

PER MONTH ......................................................................................................... 1
PER YEAR ............................................................................................................ 2

E5.

DON’T KNOW ....................................................................................................... d

SKIP TO E8

REFUSED ............................................................................................................. r

SKIP TO E8

Your best estimate is fine.

INTERVIEWER:

IF RESPONDENT STILL SAYS “DON’T KNOW,” RECORD DON’T KNOW
AS THEIR ANSWER AND MOVE ON WITHOUT PRESSING
RESPONDENT FURTHER.
CODE ONE ONLY

Less than $30,000, or .......................................................................................... 1

SKIP TO E7

$30,000 or more? ................................................................................................. 2

E6.

DON’T KNOW ....................................................................................................... d

SKIP TO E8

REFUSED ............................................................................................................. r

SKIP TO E8

Would you say it was . . .
CODE ONE ONLY
$30,000 to under $45,000, ................................................................................... 1
$45,000 to under $60,000, ................................................................................... 2
$60,000 to under $75,000, ................................................................................... 3
$75,000 to under $90,000, ................................................................................... 4
$90,000 to under $105,000, or ............................................................................ 5
$105,000 or more? ............................................................................................... 6
DON’T KNOW ....................................................................................................... d

SKIP TO E8

REFUSED ............................................................................................................. r

SKIP TO E8

SKIP TO E8

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

Deleted:

SKIP TO E5

Deleted: less than $30,000 or $30,000 or
more?

Would you say your household income in [fill CY] was . . .
PROBE:

Deleted: E5

57Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

E7.

Would you say it was . . .
CODE ONE ONLY
Less than $5,000, ................................................................................................ 1
$5,000 to under $10,000, ..................................................................................... 2
$10,000 to under $15,000, ................................................................................... 3
$15,000 to under $20,000, ................................................................................... 4
$20,000 to under $25,000, or .............................................................................. 5
$25,000 to under $30,000? ................................................................................. 6
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

E8.

INCLUDING YOURSELF, how many people currently live with you? Please include babies,
small children, people who are not related to you, and people who are temporarily away.
|

|

Deleted: #

| NUMBER OF PEOPLE LIVING WITH, INCLUDING RESPONDENT

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
PROGRAMMER BOX
IF E8 = 1, SKIP TO F1.
E9.

How many of these people are children under 18 who are financially dependent on you?
|

|

Deleted: #

| NUMBER CHILDREN UNDER 18 LIVING WITH AND WHO
ARE FINANCIALLY DEPENDENT UPON RESPONDENT

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

58Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

SECTION F – HEALTH INSURANCE AND DEMOGRAPHICS

PROGRAMMER BOX
CATI: IF SRF16 MISSING, START WITH F1, ELSE START WITH F2.
F1.

We’re almost done. Thank you for your patience.
At the time you sought services from [fill LWIA ONE-STOP NAME] in [fill RA MO/YR DATE],
did you have any health problems—mental, physical, or emotional—or substance abuse
problems that limited the kind or amount of work or training that you could do?
INTERVIEWER:

Deleted: around

Deleted: PROBE

COVERS DISABILITY.

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
F2.

Were you covered by health insurance during the year leading up to the time you sought
services at [fill LWIA ONE-STOP NAME], that is from [fill (RA MO/YR DATE – 1 year)] to
[fill RA MO/YR DATE]?
INTERVIEWER:

Deleted: ] around [fill

IF RESPONDENT STATES THAT THEIR COVERAGE WAS
INTERRUPTED DURING THIS YEAR AND THEY HAD COVERAGE FOR
PART OF THE YEAR, BUT NOT THE ENTIRE YEAR, ASK: “Did you have
coverage for the majority of the year, that is, 6 months or more?”
IF SO, CODE THE RESPONSE AS “YES,” IF NOT CODE AS “NO.”

YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
F3.

Have you been covered by health insurance at any time since [fill RA MO/YR DATE]?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

F4.

SKIP TO F6

DON’T KNOW ....................................................................................................... d

SKIP TO F6

REFUSED ............................................................................................................. r

SKIP TO F6

Were you covered by health insurance for the entire period since [fill RA MO/YR DATE]?
PROBE:

Deleted: you

If there were only very brief periods totaling less than one month that you did
not have health insurance, please say “yes.”

YES ....................................................................................................................... 1

SKIP TO F5a

NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

59Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

Deleted: F6

F5.

For approximately how many months were you covered by health insurance?

Deleted: Since [fill RA MO/YR DATE],

PROBE:

Deleted: |

|

|

Since [fill RA MO/YR DATE].

|

|

|

|

| NUMBER OF MONTHS

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
F5x.

And what was the main type of health insurance or health coverage that you had during
that time?
PROBE:

For example, a plan from your current employer, a plan you bought on your
own, or a play from the government, like Medicare or Medicaid. We are not
looking for the name of your insurance carrier.

PROBE:

Since [fill RA MO/YR DATE].

INTERVIEWER:

Deleted: ¶
F5a. Since [fill RA MO/YR],
Deleted: ?

READ IF NECESSARY.
IF SAMPLE MEMBER GIVES MORE THAN ONE, PROBE: “Out of those,
what was the primary coverage you had?”
IF SAMPLE MEMBER TELLS YOU THE NAME OF THEIR HEALTH
INSURANCE PLAN, READ ANSWER CHOICES AND STRESS THAT THE
QUESTION IS ASKING WHAT TYPE OF HEALTH INSURANCE THEY
HAD, NOT THE NAME OF THEIR INSURANCE CARRIER.
CODE ONE ONLY

A HEALTH INSURANCE PLAN FROM YOUR CURRENT OR FORMER
EMPLOYER, UNION, OR SCHOOL ..................................................................... 1

Deleted: ,

A HEALTH INSURANCE PLAN FROM YOUR SPOUSE’S CURRENT OR
FORMER EMPLOYER, UNION, OR SCHOOL .................................................... 2

Deleted: ,

A HEALTH INSURANCE PLAN BOUGHT ON YOUR OWN, INCLUDING
THOSE FROM PROFESSIONAL ASSOCIATIONS ............................................. 3

Deleted: ,

A HEALTH INSURANCE PLAN PROVIDED BY SOMEONE WHO DOES
NOT LIVE IN YOUR HOUSEHOLD ...................................................................... 4

Deleted: ,

MEDICARE, THE HEALTH INSURANCE PLAN FOR PEOPLE 65 YEARS
OLD AND OLDER OR PERSONS WITH CERTAIN DISABILITIES..................... 5

Deleted: ,

MEDICAID, THE GOVERNMENT ASSISTANCE PROGRAM THAT PAYS
FOR HEALTH CARE ............................................................................................ 6

Deleted: ,

ANOTHER STATE SPECIFIC PLAN .................................................................... 7

Deleted: ,

VA, CHAMPUS, CHAMP-VA, TRICARE, OR SOME OTHER MILITARY
CARE .................................................................................................................... 8

Deleted: , OR

INDIAN HEALTH SERVICE .................................................................................. 9

Deleted: ?
Deleted: 10

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

60Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

Now I have some general questions.
IF SRF6 MISSING
F6.

Deleted: F6. RECORD SEX OF
RESPONDENT.¶

CODE WITHOUT ASKING IF KNOWN: What is your gender?
CODE ONE ONLY
MALE..................................................................................................................... 1
FEMALE ................................................................................................................ 2
OTHER (SPECIFY) ............................................................................................... 99
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

IF SRF10 MISSING
F7.

Are you of Hispanic, Latino, or Spanish origin?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

IF SRF11 MISSING
F8.

What is your race? You may choose more than one.
CODE ALL THAT APPLY
White,.................................................................................................................... 1
Black or African American, ................................................................................ 2
American Indian or Alaska Native, .................................................................... 3
Asian, or ............................................................................................................... 4
Native Hawaiian or other Pacific Islander? ...................................................... 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

IF SRF13 MISSING
F9.

At the time you sought services from [fill LWIA ONE-STOP NAME] in [fill RA MO/YR DATE],
what was your marital status? Were you . . .
CODE ONE ONLY
Married, ................................................................................................................ 1
Separated, ............................................................................................................ 2
Divorced, .............................................................................................................. 3
Widowed, or ......................................................................................................... 4
Never married? .................................................................................................... 5
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

61Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

Deleted: around

IF SRF15 MISSING
F10.

At the time you sought services from [fill LWIA ONE-STOP NAME] in [fill RA MO/YR DATE],
what was the highest diploma or degree you had received?

Deleted: around

CODE ONE ONLY
NONE .................................................................................................................... 1
ELEMENTARY, MIDDLE, OR JUNIOR HIGH DIPLOMA ..................................... 2
Deleted: GRADUATE

HIGH SCHOOL DIPLOMA .................................................................................... 3
ADULT BASIC EDUCATION (ABE) CERTIFICATE ............................................. 4
GENERAL EDUCATIONAL DEVELOPMENT (GED)........................................... 5
VOCATIONAL/TECHNICAL DEGREE OR CERTIFICATE .................................. 6
ASSOCIATE’S DEGREE (AA; 2 YEARS)............................................................. 7
BACHELOR’S DEGREE OR EQUIVALENT (BA/BS; 4 YEARS) ......................... 8
MASTER’S DEGREE OR EQUIVALENT (MA/MS) .............................................. 9
DOCTORATE/Ph.D. (MD, PHD) ........................................................................... 10
OTHER PROFESSIONAL DEGREE/CERTIFICATE ........................................... 11

Deleted: 12

OTHER (SPECIFY) ............................................................................................... 99
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
ALL
F11.

What is the highest diploma or degree you currently have?
CODE ONE ONLY
NONE .................................................................................................................... 1
ELEMENTARY, MIDDLE, OR JUNIOR HIGH DIPLOMA ..................................... 2
Deleted: GRADUATE

HIGH SCHOOL DIPLOMA .................................................................................... 3
ADULT BASIC EDUCATION (ABE) CERTIFICATE ............................................. 4
GENERAL EDUCATIONAL DEVELOPMENT (GED)........................................... 5
VOCATIONAL/TECHNICAL DEGREE OR CERTIFICATE .................................. 6
ASSOCIATE’S DEGREE (AA; 2 YEARS)............................................................. 7
BACHELOR’S DEGREE OR EQUIVALENT (BA/BS; 4 YEARS) ......................... 8
MASTER’S DEGREE OR EQUIVALENT (MA/MS) .............................................. 9
DOCTORATE/Ph.D. (MD, PHD) ........................................................................... 10
OTHER PROFESSIONAL DEGREE/CERTIFICATE ........................................... 11

Deleted: 12

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

62Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

F12a.

Have you ever been arrested?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0

F12b.

SKIP TO G1

DON’T KNOW ....................................................................................................... d

SKIP TO G1

REFUSED ............................................................................................................. r

SKIP TO G1

Was this before [fill RA MO/YR DATE], after [fill RA MO/YR DATE] or both before and after?
CODE ONE ONLY
BEFORE ............................................................................................................... 1
AFTER................................................................................................................... 2
BOTH BEFORE AND AFTER ............................................................................... 3
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

F13a.

Deleted: F12. At the time you sought
services from [fill LWIA ONE-STOP NAME]
around [fill RA MO/YR DATE], had

Have you ever been convicted of a felony?
YES ....................................................................................................................... 1

F13b.

NO ......................................................................................................................... 0

SKIP TO G1

DON’T KNOW ....................................................................................................... d

SKIP TO G1

REFUSED ............................................................................................................. r

SKIP TO G1

Was this before [fill RA MO/YR DATE], after [fill RA MO/YR DATE] or both before and after?
CODE ONE ONLY

Deleted: have you been convicted of a
felony

BEFORE ............................................................................................................... 1
AFTER................................................................................................................... 2

Deleted: YES

BOTH BEFORE AND AFTER ............................................................................... 3

Deleted: NO 0¶

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

63Cumulative changes made to WIA 15-Mo Follow-Up Survey between

Deleted: ¶
¶
F13. Since

3-21-

SECTION G – FOLLOW-UP INFORMATION
G1.

Thank you for participating in the survey. We may contact you again in the future and I
need to know how to get in touch with you.

G2.

(What is/Is [fill TELEPHONE NUMBER]) your telephone number?
TELEPHONE NUMBER SAME AS SAMPLE INFORMATION............................. 1
NEW TELEPHONE NUMBER .............................................................................. 2
|

|

|

|-|

|

|

|-|

|

|

|

|

NO TELEPHONE .................................................................................................. 0

G3.

SKIP TO G7

DON’T KNOW ....................................................................................................... d

SKIP TO G7

REFUSED ............................................................................................................. r

SKIP TO G7

Is that number listed in your name or is it in someone else’s?
SAMPLE MEMBER ............................................................................................... 1

SKIP TO G7

OTHER .................................................................................................................. 2

G4.

DON’T KNOW ....................................................................................................... d

SKIP TO G7

REFUSED ............................................................................................................. r

SKIP TO G7

Could you spell the first name for me please?
Could you spell their last name for me please?
CONFIRM NAME WITH RESPONDENT THEN PRESS ENTER.
___________________________________________________
FIRST NAME
___________________________________________________
LAST NAME
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

Prepared by Mathematica Policy Research

12 and 8-23-12 (v37).docx

64Cumulative changes made to WIA 15-Mo Follow-Up Survey between

3-21-

G5.

What is (his/her/their) address?
___________________________________________________
STREET 1
___________________________________________________
STREET 2
___________________________________________________
STREET 3
___________________________________________________
CITY
___________________________________________________
STATE
___________________________________________________
ZIP
SAME AS SAMPLE MEMBER’S .......................................................................... 1
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

G6.

What is (his/her/their) relationship to you?
CODE ONE ONLY
SPOUSE/PARTNER ............................................................................................. 1
MOTHER ............................................................................................................... 2
FATHER ................................................................................................................ 3
SISTER ................................................................................................................. 4
BROTHER ............................................................................................................. 5
GRANDMOTHER.................................................................................................. 6
GRANDFATHER ................................................................................................... 7
AUNT..................................................................................................................... 8
UNCLE .................................................................................................................. 9
FRIEND ................................................................................................................. 10
DAUGHTER .......................................................................................................... 11
SON....................................................................................................................... 12
Deleted: 13

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SKIP TO G11

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G7.

Can you give me a different phone number where you can be reached, perhaps a cell
phone number?
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
Please give me the telephone number, area code first.
NEW TELEPHONE
NUMBER: |

|

|

|-|

|

|

|-|

|

|

|

|

NO TELEPHONE .................................................................................................. 0

SKIP TO G11

DON’T KNOW ....................................................................................................... d

SKIP TO G11

REFUSED ............................................................................................................. r

SKIP TO G11

NEW SCREEN:
PHONE
NUMBER: |

|

|

|-|

|

|

|-|

|

|

|

|

CONFIRM THE INFO ABOVE WITH RESPONDENT THEN PRESS ENTER.
G8.

Whose telephone is that?
___________________________________________________
NAME
SAMPLE MEMBER ............................................................................................... 1

SKIP TO G11

DON’T KNOW ....................................................................................................... d

SKIP TO G11

REFUSED ............................................................................................................. r

SKIP TO G11

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G9.

What is (his/her/their) address?
___________________________________________________
STREET 1
___________________________________________________
STREET 2
___________________________________________________
APT. #
___________________________________________________
CITY
___________________________________________________
STATE
___________________________________________________
ZIP
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

G10.

What is (his/her/their) relationship to you?
CODE ONE ONLY
SPOUSE/PARTNER ............................................................................................. 1
MOTHER ............................................................................................................... 2
FATHER ................................................................................................................ 3
SISTER ................................................................................................................. 4
BROTHER ............................................................................................................. 5
GRANDMOTHER.................................................................................................. 6
GRANDFATHER ................................................................................................... 7
AUNT..................................................................................................................... 8
UNCLE .................................................................................................................. 9
FRIEND ................................................................................................................. 10
DAUGHTER .......................................................................................................... 11
SON....................................................................................................................... 12
Deleted: 13

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

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G11.

As part of our study, we may be contacting you in a few years to see how things are going
for you. In case you move, we would like to have the name, address, and phone number of
one person who does not live with you who will know how to reach you. We would only
contact this person if we have trouble getting in touch with you directly.
PROGRAMMER SKIP BOXG11
CATI INSTRUCTION: FOR ALL CONTACT INFORMATION, A “DON’T KNOW”
RESPONSE CAN BE ACCEPTED IN ANY ADDRESS FIELD TO ALLOW FOR PARTIAL
ADDRESSES, I.E. THE RESPONDENT KNOWS IN WHICH CITY THE CONTACT
LIVES, BUT NOT THE EXACT STREET ADDRESS. IF A “DON’T KNOW” RESPONSE IS
ENTERED IN ANY “NAME” FIELD, IN THE CONTACT SECTION, THE INTERVIEWER
SHOULD BE TAKEN DIRECTLY TO THE CLOSING “THANK YOU.”

OTHER RELATIVE’S NAME, ADDRESS, AND TELEPHONE NUMBER
G12.

What is the name of the person who would always know how to get in touch with you?
PROBE FOR FULL NAMES, INCLUDING MIDDLE INITIALS.
PROBE FOR CORRECT SPELLING.
Could you spell their first and last name for me please?
CONFIRM THE NAME ABOVE WITH RESPONDENT THEN PRESS ENTER.
___________________________________________________
FIRST NAME (OTHER RELATIVE’S FULL NAME)
___________________________________________________
LAST NAME
DON’T KNOW ....................................................................................................... d

SKIP TO G11

REFUSED ............................................................................................................. r

SKIP TO G11

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G13.

What is their relationship to you?
CODE ONE ONLY
SPOUSE/PARTNER ............................................................................................. 1
MOTHER ............................................................................................................... 2
FATHER ................................................................................................................ 3
SISTER ................................................................................................................. 4
BROTHER ............................................................................................................. 5
GRANDMOTHER.................................................................................................. 6
GRANDFATHER ................................................................................................... 7
AUNT..................................................................................................................... 8
UNCLE .................................................................................................................. 9
FRIEND ................................................................................................................. 10
DAUGHTER .......................................................................................................... 11
SON....................................................................................................................... 12
Deleted: 13

OTHER (SPECIFY) ............................................................................................... 99

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

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G14.

What is their full address and home telephone number?
PROBE:

Can you spell the street name for me please?

Is there an apartment number?
Besides the PO Box do you have a street address?
CONFIRM INFO.
___________________________________________________
STREET 1
___________________________________________________
STREET 2
___________________________________________________
APT. #
___________________________________________________
CITY
___________________________________________________
STATE
___________________________________________________
ZIP
NUMBER: |

|

|

|-|

|

|

|-|

|

|

|

|

DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
G15.

In whose name is that phone listed?
___________________________________________________
NAME
Deleted: DOES NOT HAVE OTHER
RELATIVES 0¶
SAME AS

CODE ONE ONLY
SAMPLE MEMBER ............................................................................................... 1
DON’T KNOW ....................................................................................................... d

Deleted: MEMBER’S s

REFUSED ............................................................................................................. r

Deleted: NO OTHER CONTACTS n¶

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G16.

We will be mailing you a check in a couple of weeks and I would like to confirm the name
and address where we should send the payment. Is it . . .
INTERVIEWER:

VERIFY SPELLING OF NAME.
PROGRAMMER BOX
CATI: ALLOW FOR NAME CHANGES

___________________________________________________
STREET 1
___________________________________________________
STREET 2
___________________________________________________
APT. #
___________________________________________________
CITY
___________________________________________________
STATE
___________________________________________________
ZIP
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
G17.

I just have two final questions for you about your overall experience with [fill LWIA ONESTOP NAME]. First, how satisfied or dissatisfied are you with your experience? Would you
say you are . . .
CODE ONE ONLY
Very satisfied, ...................................................................................................... 1
Somewhat satisfied,............................................................................................ 2
Somewhat dissatisfied, or .................................................................................. 3
Very dissatisfied,................................................................................................. 4
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r

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Deleted: G13

G18.

And do you have any further comments about your experience with the [fill LWIA
ONE-STOP NAME]? If yes, I can write them down now.
YES ....................................................................................................................... 1
NO ......................................................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
PROGRAMMER BOX
IF G18 = 1, TAKE TO SCREEN FOR INTERVIEWER TO TYPE
COMMENTS.
IF G18 = 0, d, OR r, TAKE TO THANK YOU SCREEN.

Thank you for your cooperation. This completes the survey! Thank you again.

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