Interviewer-Admini Interviewer-Administered Survey Questions

Round 2: Weeks Worked and Income Questions – Latest Revision 9/28/16

American Community Survey

Cognitive Test

Interviewer-administered Survey

Round 2: Weeks Worked and Income

September 28, 2016

Participant ID #: |___|___|___|___|___|___|___|___|___|___|

DETAILED QUESTIONS—PERSON 1

		NAME ____________________
29a. Now, I am going to ask a series of questions about employment… LAST WEEK, did you work for pay at a job or business? (Include any work even if you worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or were on active duty in the Armed Forces.)		 Yes  go to 31  No
29b. LAST WEEK, did you do ANY work for pay, even for as little as one hour?		 Yes  No  go to 35a
31. LAST WEEK, how did you USUALLY get to work? (If you usually used more than one method of transportation during the trip, report the one used for most of the distance.)		 Car, truck, or van  Bus or trolly bus Streetcar or trolley car  Subway or elevated Railroad  Ferryboat  Taxicab  Motorcycle  Bicycle  Walked  Worked at home  go to 39  Other method
INSTRUCTION M IF RESPONSE TO QUESTION 31 IS “CAR, TRUCK, OR VAN”, GO TO QUESTION 32. OTHERWISE GO TO QUESTION 33.
32. LAST WEEK, how many people including yourself usually rode to work together?		____
33. LAST WEEK, what time did you usually leave for work? (What hour?) (How many minutes past the hour?) (Was that AM or PM?)		Hour Minute __ : __ a.m.  p.m.
34. LAST WEEK, how many minutes did it usually take you to get from home to work? Enter a ONE-WAY commute time for the person’s usual DAILY commute from home to work last week.		___ Minutes
INSTRUCTION N IF RESPONSE TO QUESTION 29B IS “NO” ASK QUESTION 35A. OTHERWISE, GO TO QUESTION 39.
35a. LAST WEEK, were you on layoff from a job?		 Yes  go to 35c  No
35b. LAST WEEK, were you TEMPORARILY absent from a job or business because of vacation, temporary illness, maternity leave, other family or personal reasons, bad weather, etc.?		 Yes  go to 38  No  go to 36
35c. Have you been informed that you will be recalled to work within the next 6 months OR been given a date to return to work?		 Yes  go to 37a  No
36. During the LAST 4 WEEKS, have you been ACTIVELY looking for work?		 Yes  No  go to 38
37a. LAST WEEK, could you have started a job if offered one (or returned to work if recalled)?		 Yes  go to 38  No
37b. Why was that?		Own temporary illness Going to school or some other reason
38. When did you last work, even for a few days?		 Within the past 12 months  Between 1 and 5 years ago Over 5 years ago or never worked  go to 47e
(WEEKS WORKED AND HOURS WORKED: 39 – 40c) *39. During the 52 weeks covering 2015, that is from January 1, 2015 to December 31, 2015, in the weeks you worked, how many hours did you usually work each week?		Usual hours each week
*40a. During the 52 weeks covering 2015, did you work EVERY week? Count paid vacation, paid sick leave, and military service as work.		 Yes go to 41a  No
*40b. During the 52 weeks covering 2015, how many WEEKS did you work? Include paid time off and include weeks when you only worked for a few hours. If you would rather give your answer in months, please say so.		Weeks = go to 41a Would rather answer in months
*40c. How many months did you work in 2015?		Months
41a. The next series of questions are about the type of business you worked for and the type of work that you did last. If you had more than one job, describe the one at which the most hours were worked. Let’s start with the first question. I am going to read 5 categories. Please pick the one that best describes who you worked for - a private organization or company, government, U.S. Armed Forces (active duty), self-employed, or working without pay in a family business.		Private organization or company  Government  go to 41c  U.S. Armed Forces (active duty)  go to 42b  Self-employed  go to 41d  Working without pay in a family business  go to 42a
41b. Was this a non-profit organization or for-profit company?		 Non-profit organization  go to 42a For profit company  go to 42a
41c. Was this for local, state, or the federal government?		 Local  go to 42a  State  go to 42a  Federal  go to 42a
41d. Was this self-employment incorporated or not incorporated?		 Incorporated  Not incorporated
42a. What was the name of your company, business or other employer?		_____________________  go to 43
42b. Which branch of the Armed Forces do you work for?	U.S. Army  go to 45  U.S. Navy  go to 45  U.S. Air Force  go to 45  U.S. Marine Corps  go to 45  U.S. Coast Guard  go to 45
43. What kind of business or industry was this? For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank.	_____________________
44. Is this business mainly -- manufacturing, wholesale trade, retail trade or some other kind of business?	 Manufacturing Wholesale trade  Retail trade Other (agriculture, construction, service, government, etc.)
45. What kind of work were you doing at this job? For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant.	_________________________
46. What were your most important activities or duties at this job? For example, patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records.	__________________________ __________________________ __________________________
(INCOME: 46a - 47) The next few questions are about income received in 2015, that is from January 1, 2015 to December 31, 2015… *47a. Did you receive any wages or salary?	 Yes  No
If “yes” to 47a, read: *47b. Did you receive any additional tips, bonuses or commissions in 2015? If “No” to 47a, read: *47b. Did you receive any tips, bonuses or commissions in 2015?	 Yes  No
*47c. Did you receive any self-employment income in 2015? Consider income from own businesses (farm or non-farm) including proprietorships and partnerships.	 Yes  No  go to 47e
*47d. Was this income a loss?	 Yes  No
*47e. if “OVER 5 YEARS AGO OR NEVER WORKED” TO 38 READ: The next few questions are about income received in 2015, that is from January 1, 2015 to December 31, 2015… Did you receive any interest or dividends? Consider even small amounts credited to an account. Otherwise, READ: Did you receive any interest or dividends in 2015? Consider even small amounts credited to an account.	 Yes  No
*47f. Did you receive any net rental income in 2015?	 Yes  No go to 47h
*47g. Was this income a loss?	 Yes  No
*47h. Did you receive any royalty income or income from estates and trusts in 2015?	 Yes  No
*47i. Did you receive any Social Security or Railroad Retirement benefits in 2015?	 Yes  No
*47j. Did you receive any Supplemental Security Income (SSI) payments in 2015?	 Yes  No
*47k. Did you receive any public assistance or public welfare payments from the state or local welfare office in 2015?	 Yes  No
*47l . Did you receive any retirement, survivor, or disability pensions in 2015?	 Yes  No
*47m. Did you receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support or alimony in 2015?	 Yes  No
*48. If “Yes” to 47A or 47b, READ: What was your TOTAL income in 2015 from all sources? Include amount from all jobs before taxes and other deductions. If “Yes” to 46c, Read: What was your TOTAL income in 2015 from all sources? For self-employment income, include net income after operating expenses. Report earnings as a tenant farmer or sharecropper. If “YES” TO (47A or 47B) AND 46C, READ: What was your TOTAL income in 2015 from all sources? Include amount from all jobs before taxes and other deductions. For self-employment income, include net income after operating expenses. Report earnings as a tenant farmer or sharecropper. Otherwise, READ: What was your TOTAL income in 2015 from all sources?	$___________________________ Total Income If net income was a loss precede amount with a '-'

DETAILED QUESTIONS—PERSON 2

		NAME ____________________
29a. Now, I am going to ask a series of questions about <Name’s> employment… LAST WEEK, did <Name> work for pay at a job or business? (Include any work even if <Name> worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or were on active duty in the Armed Forces.)		 Yes  go to 31  No
29b. LAST WEEK, did <Name> do ANY work for pay, even for as little as one hour?		 Yes  No  go to 35a
31. LAST WEEK, how did <Name> USUALLY get to work? (If <Name> usually used more than one method of transportation during the trip, report the one used for most of the distance.)		 Car, truck, or van  Bus or trolly bus Streetcar or trolley car  Subway or elevated Railroad  Ferryboat  Taxicab  Motorcycle  Bicycle  Walked  Worked at home  go to 39  Other method
INSTRUCTION M IF RESPONSE TO QUESTION 31 IS “CAR, TRUCK, OR VAN”, GO TO QUESTION 32. OTHERWISE GO TO QUESTION 33.
32. LAST WEEK, how many people including <Name> usually rode to work together?		____
33. LAST WEEK, what time did <Name> usually leave for work? (What hour?) (How many minutes past the hour?) (Was that AM or PM?)		Hour Minute __ : __ a.m.  p.m.
34. LAST WEEK, how many minutes did it usually take <Name> to get from home to work? Enter a ONE-WAY commute time for the person’s usual DAILY commute from home to work last week.		___ Minutes
INSTRUCTION N IF RESPONSE TO QUESTION 29B IS “NO” ASK QUESTION 35A. OTHERWISE, GO TO QUESTION 39.
35a. LAST WEEK, was <Name> on layoff from a job?		 Yes  go to 35c  No
35b. LAST WEEK, was <Name> TEMPORARILY absent from a job or business because of vacation, temporary illness, maternity leave, other family or personal reasons, bad weather, etc.?		 Yes  go to 38  No  go to 36
35c. Has <Name> been informed that she/he will be recalled to work within the next 6 months OR been given a date to return to work?		 Yes  go to 37a  No
36. During the LAST 4 WEEKS, has <Name> been ACTIVELY looking for work?		 Yes  No  go to 38
37a. LAST WEEK, could <Name> have started a job if offered one (or returned to work if recalled)?		 Yes  go to 38  No
37b. Why was that?		Own temporary illness Going to school or some other reason
38. When did <Name> last work, even for a few days?		 Within the past 12 months  Between 1 and 5 years ago Over 5 years ago or never worked  go to 47e
(WEEKS WORKED AND HOURS WORKED: 39 – 40c) *39. During the 52 weeks covering 2015, that is from January 1, 2015 to December 31, 2015, in the weeks <Name> worked, how many hours did <Name> usually work each week?		Usual hours each week
*40a. During the 52 weeks covering 2015, did <Name> work EVERY week? Count paid vacation, paid sick leave, and military service as work.		 Yes go to 41a  No
*40b. During the 52 weeks covering 2015, how many WEEKS did <Name> work? Include paid time off and include weeks when <Name> only worked for a few hours. If you would rather give your answer in months, please say so.		Weeks = go to 41a Would rather answer in months
*40c. How many months did <Name> work in 2015?		Months
41a. The next series of questions are about the type of business <Name> worked for and the type of work that <Name> did last. If <Name> had more than one job, describe the one at which the most hours were worked. Let’s start with the first question. I am going to read 5 categories. Please pick the one that best describes who <Name> worked for - a private organization or company, government, U.S. Armed Forces (active duty), self-employed, or working without pay in a family business.		Private organization or company  Government  go to 41c  U.S. Armed Forces (active duty)  go to 42b  Self-employed  go to 41d  Working without pay in a family business  go to 42a
41b. Was this a non-profit organization or for-profit company?		 Non-profit organization  go to 42a For profit company  go to 42a
41c. Was this for local, state, or the federal government?		 Local  go to 42a  State  go to 42a  Federal  go to 42a
41d. Was this self-employment incorporated or not incorporated?		 Incorporated  Not incorporated
42a. What was the name of <Name’s> company, business or other employer?		_____________________  go to 43
42b. Which branch of the Armed Forces does <Name> work for?	U.S. Army  go to 45  U.S. Navy  go to 45  U.S. Air Force  go to 45  U.S. Marine Corps  go to 45  U.S. Coast Guard  go to 45
43. What kind of business or industry was this? For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank.	_____________________
44. Is this business mainly -- manufacturing, wholesale trade, retail trade or some other kind of business?	 Manufacturing Wholesale trade  Retail trade Other (agriculture, construction, service, government, etc.)
45. What kind of work was <Name> doing at this job? For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant.	_________________________
46. What was <Name’s> most important activities or duties at this job? For example, patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records.	__________________________ __________________________ __________________________
(INCOME: 46a - 47) The next few questions are about income received in 2015, that is from January 1, 2015 to December 31, 2015… *47a. Did <Name> receive any wages or salary?	 Yes  No
If “yes” to 47a, read: *47b. Did <Name> receive any additional tips, bonuses or commissions in 2015? If “No” to 47a, read: *47b. Did <Name> receive any tips, bonuses or commissions in 2015?	 Yes  No
*47c. Did <Name> receive any self-employment income in 2015? Consider income from own businesses (farm or non-farm) including proprietorships and partnerships.	 Yes  No  go to 47e
*47d. Was this income a loss?	 Yes  No
*47e. if “OVER 5 YEARS AGO OR NEVER WORKED” TO 38 READ: The next few questions are about income received in 2015, that is from January 1, 2015 to December 31, 2015… Did <Name> receive any interest or dividends? Consider even small amounts credited to an account. Otherwise, READ: Did <Name> receive any interest or dividends in 2015? Consider even small amounts credited to an account.	 Yes  No
*47f. Did <Name> receive any net rental income in 2015?	 Yes  No go to 47h
*47g. Was this income a loss?	 Yes  No
*47h. Did <Name> receive any royalty income or income from estates and trusts in 2015?	 Yes  No
*47i. Did <Name> receive any Social Security or Railroad Retirement benefits in 2015?	 Yes  No
*47j. Did <Name> receive any Supplemental Security Income (SSI) payments in 2015?	 Yes  No
*47k. Did <Name> receive any public assistance or public welfare payments from the state or local welfare office in 2015?	 Yes  No
*47l . Did <Name> receive any retirement, survivor, or disability pensions in 2015?	 Yes  No
*47m. Did <Name> receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support or alimony in 2015?	 Yes  No
*48. If “Yes” to 47A or 47b, READ: What was <Name’s> TOTAL income in 2015 from all sources? Include amount from all jobs before taxes and other deductions. If “Yes” to 46c, Read: What was <Name’s> TOTAL income in 2015 from all sources? For self-employment income, include net income after operating expenses. Report earnings as a tenant farmer or sharecropper. If “YES” TO (47A or 47B) AND 46C, READ: What was <Name’s> TOTAL income in 2015 from all sources? Include amount from all jobs before taxes and other deductions. For self-employment income, include net income after operating expenses. Report earnings as a tenant farmer or sharecropper. Otherwise, READ: What was <Name’s> TOTAL income in 2015 from all sources?	$___________________________ Total Income If net income was a loss precede amount with a '-'

DETAILED QUESTIONS—PERSON 3

		NAME ____________________
29a. Now, I am going to ask a series of questions about <Name’s> employment… LAST WEEK, did <Name> work for pay at a job or business? (Include any work even if <Name> worked only 1 hour, or helped without pay in a family business or farm for 15 hours or more, or were on active duty in the Armed Forces.)		 Yes  go to 31  No
29b. LAST WEEK, did <Name> do ANY work for pay, even for as little as one hour?		 Yes  No  go to 35a
31. LAST WEEK, how did <Name> USUALLY get to work? (If <Name> usually used more than one method of transportation during the trip, report the one used for most of the distance.)		 Car, truck, or van  Bus or trolly bus Streetcar or trolley car  Subway or elevated Railroad  Ferryboat  Taxicab  Motorcycle  Bicycle  Walked  Worked at home  go to 39  Other method
INSTRUCTION M IF RESPONSE TO QUESTION 31 IS “CAR, TRUCK, OR VAN”, GO TO QUESTION 32. OTHERWISE GO TO QUESTION 33.
32. LAST WEEK, how many people including <Name> usually rode to work together?		____
33. LAST WEEK, what time did <Name> usually leave for work? (What hour?) (How many minutes past the hour?) (Was that AM or PM?)		Hour Minute __ : __ a.m.  p.m.
34. LAST WEEK, how many minutes did it usually take <Name> to get from home to work? Enter a ONE-WAY commute time for the person’s usual DAILY commute from home to work last week.		___ Minutes
INSTRUCTION N IF RESPONSE TO QUESTION 29B IS “NO” ASK QUESTION 35A. OTHERWISE, GO TO QUESTION 39.
35a. LAST WEEK, was <Name> on layoff from a job?		 Yes  go to 35c  No
35b. LAST WEEK, was <Name> TEMPORARILY absent from a job or business because of vacation, temporary illness, maternity leave, other family or personal reasons, bad weather, etc.?		 Yes  go to 38  No  go to 36
35c. Has <Name> been informed that she/he will be recalled to work within the next 6 months OR been given a date to return to work?		 Yes  go to 37a  No
36. During the LAST 4 WEEKS, has <Name> been ACTIVELY looking for work?		 Yes  No  go to 38
37a. LAST WEEK, could <Name> have started a job if offered one (or returned to work if recalled)?		 Yes  go to 38  No
37b. Why was that?		Own temporary illness Going to school or some other reason
38. When did <Name> last work, even for a few days?		 Within the past 12 months  Between 1 and 5 years ago Over 5 years ago or never worked  go to 47e
(WEEKS WORKED AND HOURS WORKED: 39 – 40c) *39. During the 52 weeks covering 2015, that is from January 1, 2015 to December 31, 2015, in the weeks <Name> worked, how many hours did <Name> usually work each week?		Usual hours each week
*40a. During the 52 weeks covering 2015, did <Name> work EVERY week? Count paid vacation, paid sick leave, and military service as work.		 Yes go to 41a  No
*40b. During the 52 weeks covering 2015, how many WEEKS did <Name> work? Include paid time off and include weeks when <Name> only worked for a few hours. If you would rather give your answer in months, please say so.		Weeks = go to 41a Would rather answer in months
*40c. How many months did <Name> work in 2015?		Months
41a. The next series of questions are about the type of business <Name> worked for and the type of work that <Name> did last. If <Name> had more than one job, describe the one at which the most hours were worked. Let’s start with the first question. I am going to read 5 categories. Please pick the one that best describes who <Name> worked for - a private organization or company, government, U.S. Armed Forces (active duty), self-employed, or working without pay in a family business.		Private organization or company  Government  go to 41c  U.S. Armed Forces (active duty)  go to 42b  Self-employed  go to 41d  Working without pay in a family business  go to 42a
41b. Was this a non-profit organization or for-profit company?		 Non-profit organization  go to 42a For profit company  go to 42a
41c. Was this for local, state, or the federal government?		 Local  go to 42a  State  go to 42a  Federal  go to 42a
41d. Was this self-employment incorporated or not incorporated?		 Incorporated  Not incorporated
42a. What was the name of <Name’s> company, business or other employer?		_____________________  go to 43
42b. Which branch of the Armed Forces does <Name> work for?	U.S. Army  go to 45  U.S. Navy  go to 45  U.S. Air Force  go to 45  U.S. Marine Corps  go to 45  U.S. Coast Guard  go to 45
43. What kind of business or industry was this? For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank.	_____________________
44. Is this business mainly -- manufacturing, wholesale trade, retail trade or some other kind of business?	 Manufacturing Wholesale trade  Retail trade Other (agriculture, construction, service, government, etc.)
45. What kind of work was <Name> doing at this job? For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant.	_________________________
46. What was <Name’s> most important activities or duties at this job? For example, patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records.	__________________________ __________________________ __________________________
(INCOME: 46a - 47) The next few questions are about income received in 2015, that is from January 1, 2015 to December 31, 2015… *47a. Did <Name> receive any wages or salary?	 Yes  No
If “yes” to 47a, read: *47b. Did <Name> receive any additional tips, bonuses or commissions in 2015? If “No” to 47a, read: *47b. Did <Name> receive any tips, bonuses or commissions in 2015?	 Yes  No
*47c. Did <Name> receive any self-employment income in 2015? Consider income from own businesses (farm or non-farm) including proprietorships and partnerships.	 Yes  No  go to 47e
*47d. Was this income a loss?	 Yes  No
*47e. if “OVER 5 YEARS AGO OR NEVER WORKED” TO 38 READ: The next few questions are about income received in 2015, that is from January 1, 2015 to December 31, 2015… Did <Name> receive any interest or dividends? Consider even small amounts credited to an account. Otherwise, READ: Did <Name> receive any interest or dividends in 2015? Consider even small amounts credited to an account.	 Yes  No
*47f. Did <Name> receive any net rental income in 2015?	 Yes  No go to 47h
*47g. Was this income a loss?	 Yes  No
*47h. Did <Name> receive any royalty income or income from estates and trusts in 2015?	 Yes  No
*47i. Did <Name> receive any Social Security or Railroad Retirement benefits in 2015?	 Yes  No
*47j. Did <Name> receive any Supplemental Security Income (SSI) payments in 2015?	 Yes  No
*47k. Did <Name> receive any public assistance or public welfare payments from the state or local welfare office in 2015?	 Yes  No
*47l . Did <Name> receive any retirement, survivor, or disability pensions in 2015?	 Yes  No
*47m. Did <Name> receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support or alimony in 2015?	 Yes  No
*48. If “Yes” to 47A or 47b, READ: What was <Name’s> TOTAL income in 2015 from all sources? Include amount from all jobs before taxes and other deductions. If “Yes” to 46c, Read: What was <Name’s> TOTAL income in 2015 from all sources? For self-employment income, include net income after operating expenses. Report earnings as a tenant farmer or sharecropper. If “YES” TO (47A or 47B) AND 46C, READ: What was <Name’s> TOTAL income in 2015 from all sources? Include amount from all jobs before taxes and other deductions. For self-employment income, include net income after operating expenses. Report earnings as a tenant farmer or sharecropper. Otherwise, READ: What was <Name’s> TOTAL income in 2015 from all sources?	$___________________________ Total Income If net income was a loss precede amount with a '-'

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