NBS-General Waves Instrument Round 1 - Administration Year

ATTACHMENT A
NBS-GENERAL WAVES INSTRUMENT

OMB No. 0960-0800
Expiration Date: xx/xx/xxxx

NATIONAL BENEFICIARY SURVEY
March 25, 2016
General Waves Round 2
Representative Beneficiary and Successful Worker Combined Questionnaire

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is 0960-0800. The time required to complete this information collection is estimated to average 50 to 70 minutes per
response.

NATIONAL BENEFICIARY SURVEY
- TABLE OF CONTENTS Section

Page

A.

Screener ...................................................................................... A-1

B.

Disability and Current Work Status .............................................. B-1

C.

Current Employment .................................................................... C-1

C_B.

Employment in Past 6 Months ................................................ C_B-1

D.

Jobs/Other Jobs During 2016 ...................................................... D-1

E.

Awareness of SSA Work Incentive Programs .............................. E-1

G.

Employment-Related Services and Supports ..............................G-1

I.

Health and Functional Status ........................................................ I-1

J.

Health Insurance ...........................................................................J-1

K.

Income and Other Assistance ...................................................... K-1

L.

Sociodemographic Information .................................................... L-1

M.

Closing Information and Observations ........................................ M-1

SECTION A UNIVERSE: ALL

SECTION A: SCREENER
PRELOADED INFORMATION
S1

(A01_a)

CLUSTERED SAMPLE
YES = 01
NO = 02

S9

(A04_b)

FIRSTNAME (original – may be updated in another block: Current First Name)—CREATE NAME
USING FIRSTNAME AND LASTNAME

S10

(A04_c)

LASTNAME (original – may be updated in another block: Current Last Name)

S11

(A04_d)

BIRTHDATE (original – may be updated in another block: Current Birth Date)

S13

(A04_f)

BSTATUS (Benefit Type)
BSTATUS = 01 – SSI ONLY BENEFITS
BSTATUS = 02 – SSDI ONLY BENEFITS
BSTATUS = 03 – CONCURRENT (BOTH SSI AND SSDI) BENEFITS

S14

(A04_g) SSIAGE (from SSI records –age first received SSI benefits)—CREATE SSIAGE FROM DATE OF
BIRTH AND DATE FIRST RECEIVED SSI

S18

(A04_k)

STATE MED (STATE NAME FOR MEDICAID) (based on state of residence at A67a)

S19

(A04_l)

VRNAME (STATE NAME FOR VRA) (based on state of residence at A67a)

S20

(A04_m)

Sample Member’s Address at time sample was drawn (may be updated in Section A)

S21

(A04_n)

Sample Member’s Phone Number at time sample was drawn

SampGrp

Sample Group (Sample Group Type)
SampGrp=01– Representative Beneficiary Sample
SampGrp=02 – Successful Worker Sample

A-1

SECTION A UNIVERSE: ALL

RTYPE: Set at A110 or A110a.
PROGRAMMER: INSTITUTE A PARALLEL BLOCK THAT ALLOWS THE INTERVIEWER TO SWITCH
RESPONDENT FROM SAMPLE MEMBER TO PROXY OR FROM PROXY TO SAMPLE
MEMBER AT ANY POINT IN THE INTERVIEW. UPDATE RTYPE BASED ON THE PARALLEL
BLOCK.
PROGRAMMER: A CURRENT CONTACT BLOCK WILL STORE ANY UPDATES TO S8, S9, S10, S11, S20, and
S21. UPDATES TO THE OTHER CURRENT CONTACT BLOCK CAN COME FROM THE
SCREENER OR LOCATING.
PROGRAMMER: STORE UPDATED NAME, ADDRESS, AGE, PROXY, ETC. INFORMATION IN ADDRESS
UPDATE BLOCK OR NAME UPDATE BLOCK.
(All)
A0.

CALL SCREEN. PROGRAMMER, DISPLAY: INTERVIEWER: YOU ARE CALLING…(ONE ONLY) NOTE:
01, 04, 07 THROUGH 15 ARE SET IN OVERNIGHT PROCESSING. 02, 03, 05 AND 06 WOULD BE IN
THE FRONT END FOR THE INTERVIEWER TO SELECT.
SITUATION

A-2

DISPLAY, CALLING FOR

GO TO

01

NEW SCREENER FOR NAME

CALL TO {NAME}

A1

02

CATI CALL-IN

{NAME} CALLING IN

A11

03

CAPI INTERVIEW

{NAME – CAPI}

A64

04

CALL NAME AFTER REMAIL

{NAME , AFTER REMAIL}

A1

05

RELAY CALL IN

{NAME} CALLING IN – RELAY

A11

06

TTY CALL IN

{NAME} CALLING IN – TTY

A11

07

CALL NAME USING RELAY

{NAME} – RELAY

A10

08

CALL NAME USING TTY

{NAME} – TTY

A10

09

CALL NAME USING AMPLIFIER

{NAME} – AMPLIFIER

A1

10

CALL TO IDENTIFIED PROXY

PROXY NAME

A56

11

CALLBACK TO PROXY AFTER REMAIL

PROXY NAME

A56

12

INFORMANT/PROXY CALL IN

13

CALL TO NEW PROXY

PROXY NAME

A56

14

CALL INTERPRETER

INTERPRETER NAME

A8

15

CALL TO NEW / UNNAMED
INTERPRETER

INTERPRETER NAME

A4b

A11

SECTION A UNIVERSE: ALL

CALL TO RESPONDENT
(A0 = 01, 04, OR 09)
A1.
Hello, my name is _________. I’m calling on behalf of the Social Security Administration. May I please
speak with {NAME}?
INTERVIEWER: We are not selling anything or asking for money.
SPEAKING .........................................................................
WANTS MORE INFORMATION .........................................
{NAME} COMES TO PHONE .............................................
CALL BACK LATER ...........................................................
{NAME} MOVED.................................................................
POSSIBLE PARTICIPATION PROBLEM ...........................
HOSPITALIZED..................................................................
{NAME} DECEASED ..........................................................
{NAME} INCARCERATED .................................................
LANGUAGE BARRIER (NOT SPANISH) ...........................
INSTITUTIONALIZED ........................................................
MILITARY DUTY ................................................................
SWITCH TO AMPLIFIER / CONTINUE ..............................
NO SUCH PERSON AT THIS NUMBER ............................
OTHER: SUPERVISOR REVIEW NEEDED......................
HUNG UP DURING INTRODUCTION ...............................
UNAVAILABLE DURING FIELD PERIOD ..........................
LIVING OUTSIDE USA ......................................................
REFUSED ..........................................................................

A-1

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
r

(A10)
(A10)
SET A100 = 01 (A100)
(A30)
(A13)
(A27a)
(A103a)
SET A103 = 01(A103)
(A3)
(A27a)
SET A103 = 02 (A103)
(A10)
SET A102 = 01 (A102)
SET A106 = 05 (A106)
SET STATUS = 640 (END)
SET A104 = 06 (A104)
SET A103 = 03 (A103)
SET A105 = 02 (A105)

SECTION A UNIVERSE: ALL

REQUESTS INFORMATION
(A1=02)
A2.
Social Security just sent {NAME} a letter about an important national health study. I work for Mathematica
Policy Research, a well-known research company based in Princeton, New Jersey. We were hired by Social
Security to conduct this survey. This is a scientific study. We are not selling anything or asking for money.
PROBE:

(IF PREPAY=1): Social Security sent a letter with a $5 gift card as a thank you. We will send
you a $15 gift card after you complete the survey.

INTERVIEWER INSTRUCTION (PRE-PAY=1): IF SAMPLE MEMBER SAYS HE/SHE DID NOT RECEIVE
GIFT CARD AND WILL NOT COMPLETE THE INTERVIEW UNTIL WE SEND A GIFT CARD, SCHEDULE
APPOINTMENT TO CALL BACK.

{NAME} SPEAKING ...........................................................
{NAME} COMES TO PHONE .............................................
CALL BACK LATER ...........................................................
{NAME} MOVED.................................................................
POSSIBLE PARTICIPATION PROBLEM ...........................
HOSPITALIZED..................................................................
{NAME} DECEASED ..........................................................
{NAME} INCARCERATED .................................................
LANGUAGE BARRIER (NOT SPANISH) ...........................
INSTITUTIONALIZED ........................................................
MILITARY DUTY ................................................................
SWITCH TO AMPLIFIER / CONTINUE ..............................
NO SUCH PERSON AT THIS NUMBER ............................
OTHER: SUPERVISOR REVIEW NEEDED......................
HUNG UP DURING INTRODUCTION ...............................
UNAVAILABLE DURING FIELD PERIOD ..........................
LIVING OUTSIDE USA ......................................................
DID NOT RECEIVE LETTER .............................................
REFUSED ..........................................................................

01
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
r

(A10)
(A10)
SET A100 = 01 (A100)
(A30)
(A13)
(A27a)
(A103a)
SET A103 = 01 (A103)
(A27a)
SET A103 = 02 (A103)
(A10)
SET A102 = 01 (A102)
SET A106 = 05 (A106)
SET STATUS = 640 (END)
SET A104 = 06 (A104)
SET A103 = 03 (A103)
A22
SET A105 = 02 (A105)

LANGUAGE BARRIER
(A1 = 10) OR (A2 = 10)
A3.
Can someone there speak English?
PERSON COMES TO PHONE........................................... 01
CALL BACK LATER ........................................................... 02 SET A100 = 09 (A100)
NO ONE SPEAKS ENGLISH ............................................. 03 SET A106 = 01 (A106)
REFUSED/HUNG UP .........................................................
r SET A106 = 01 (A106)
POSSIBLE INTERPRETER COMES TO PHONE
(A3 = 01)
A4.
Hello, my name is _____________. I’m calling on behalf of the Social Security Administration. Social
Security just sent {NAME} a letter about an important national health survey. I work for Mathematica Policy
Research, a well-known research company based in Princeton, New Jersey. We were hired by Social
Security to conduct this survey. We are looking for someone who is 18 years or older to help {him/her} by
interpreting the survey for us. Are you 18 years of age or older?
YES .................................................................................... 01 (A4b)
NO ...................................................................................... 00
REFUSED/HUNG UP .........................................................
r SET A106 = 01 (A106)

A-2

SECTION A UNIVERSE: ALL

PROBE (PREPAY=1): Social Security recently sent a letter with a $5 gift card as thank you. We will send
you a $15 gift card after you complete the survey.
(A4 = 00)
A4a.
Is there someone else who is 18 years or older who could come to the phone and help with the survey?
YES, PERSON COMES TO PHONE ................................. 01
CALL BACK LATER ........................................................... 02 (A6)
NO ONE SPEAKS ENGLISH ............................................. 03 SET A106 = 01 (A106)
REFUSED/HUNG UP .........................................................
r SET A106 = 01 (A106)
(A0 = 15) OR (A4 = 01) OR (A4a = 01)
A4b.
IF (A0=15) or (A4a=01) FILL {Hello, my name is _____________. I’m calling on behalf of the Social Security
Administration. Social Security just sent {NAME} a letter about an important national health study. I work for
Mathematica Policy Research, a well-known research company based in Princeton, New Jersey. We were
hired by Social Security to conduct this survey. We are looking for an interpreter who is 18 years or older to
help {him/her} with the survey.} Would you be able to help {NAME} by interpreting the questions?
PROBE: We are not selling anything or asking for money.
PROBE (PREPAY=1): Social Security sent a letter with a $5 gift card as a thank you. We will send you a
$15 gift card after you complete the survey.
YES ....................................................................................
CALL BACK LATER ...........................................................
NO ONE +18 SPEAKS ENGLISH ......................................
{NAME} MOVED.................................................................
POSSIBLE PARTICIPATION PROBLEM ...........................
HOSPITALIZED..................................................................
{NAME} DECEASED ..........................................................
{NAME} INCARCERATED .................................................
INSTITUTIONALIZED ........................................................
MILITARY DUTY ................................................................
NO SUCH PERSON AT THIS NUMBER ............................
OTHER: SUPERVISOR REVIEW NEEDED......................
UNAVAILABLE DURING FIELD PERIOD ..........................
LIVING OUTSIDE USA ......................................................
REQUESTS IN-PERSON INTERVIEW ..............................
REFUSED ..........................................................................

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
r

(A6)
SET A106 = 01 (A106)
(A30)
(A13)
(A27a)
(A103a)
SET A103 = 01 (A103)
(A27a)
SET A103 = 02 (A103)
SET A102 = 01 (A102)
SET A106 = 05 (A106)
SET A104 = 06 (A104)
SET A103 = 03 (A103)
(A39)
SET A105 = 02 (A105)

(A4b = 01)
A5.
If {NAME} is available and you are ready to interpret, we can begin now. If you or {NAME} get tired or need a
break at any time, please tell me, and we will call back later to finish.
CONTINUE ......................................................................... 01
CALL BACK LATER ........................................................... 02
INTERPRETER REFUSED ................................................
r SET A105 = 02 (A105)
(A4a = 02) OR (A4b = 02) OR (A5 = 01 OR 02)
A6.
{IF A5 = 01 DISPLAY Before we begin, please tell me your name.}
{IF A4a = 02 DISPLAY Please tell me that person’s name so we can ask for them when we call back later /
IF A5 = 02 OR A4b = 02 DISPLAY: Please tell me your name so we can ask for you when we call back later}.
PROBE: IF PERSON IS RELUCTANT TO GIVE NAME, SAY: The first name is all we need.
IF NAME IS REFUSED, CODE AS REFUSED AND CONTINUE
FIRST, MIDDLE, LAST
DON’T KNOW ....................................................................
REFUSED ..........................................................................
A-3

d
r

SECTION A UNIVERSE: ALL

PROGRAMMER: STORE INTERPRETER NAME IN S25 AND LOCATOR
(A6 = ANSWER OR r)
A7.
And, what is {IF A5 = 01 OR 2) OR (A4b = 02) FILL your / IF A4a = 02 FILL their} relationship to {NAME}?
{NAME’S} SPOUSE............................................................
NAME’S} MOTHER ............................................................
{NAME’S} FATHER ............................................................
{NAME’S} CHILD ................................................................
GRANDPARENT OF {NAME} ............................................
BROTHER/SISTER (NATURAL/STEP) OF {NAME} ..........
AUNT/UNCLE OF {NAME} .................................................
OTHER RELATIVE.............................................................
NOT RELATED ..................................................................
STAFF AT RESIDENCE .....................................................
DON’T KNOW ....................................................................
REFUSED ..........................................................................

01
02
03
04
05
06
07
08
09
10
d
r

(A7 = ANSWER OR d OR r)
A7a.
PROGRAMMER:
IF A5 = 01 (CONTINUE) ..................................................... 01 (A10)
ELSE CALLBACK TO INTERPRETER .............................. 02 SET A100 = 03 (A100)
CALLBACK TO NAMED INTERPRETER
(A0=14)
A8.
Hello, my name is ___________________. I’m calling on behalf of the Social Security Administration. May I
please speak to {INTERPRETER’S NAME}?
PROBE:

We are not selling anything or asking for money.
SPEAKING .........................................................................
INTERPRETER COMES TO PHONE ................................
CALL BACK LATER ...........................................................
HUNG UP DURING INTRODUCTION ..............................
INTERPRETER REFUSED ................................................

01
02
03 SET A100 = 03 (A100)
04 SET STATUS = 640 (END)
r SET A105 = 02 (A105)

(A8 =01 OR 02)
A9.
{IF A8 = 02 DISPLAY: Hello, my name is ________________. I’m calling on behalf of the Social Security
Administration.} When we last spoke with you, you said this would be a good time for you to interpret the
National Beneficiary Survey for {NAME}. Are you and {NAME} ready to begin?
PROBE:

If you or {NAME} get tired or need a break at any time, please tell me, and we will call back later
to finish.
YES, CONTINUE................................................................
CALL BACK LATER ...........................................................
HUNG UP DURING INTRODUCTION ...............................
INTERPRETER REFUSED ................................................
SET A105 = 02 (A105)

A-4

01
03 SET A100 = 03 (A100)
04 SET STATUS = 640 (END)
05

SECTION A UNIVERSE: ALL

SPEAKING TO NAME OR INTERPRETER / NAME OR INTERPRETER COMES TO PHONE / TO NAME AFTER
REMAIL
IF PREPAY = 1, USE FILLS IN QUESTION TEXT. (A0 = 07 OR 08) OR (A1 = 01, 03 OR 13) OR (A2 = 01, 03, OR
13) OR (A7a = 01) OR (A9 = 01)
IF PREPAY = 0 AND INTERVIEWER IS CALLING OUT, FILL $20.
A10.

{PROGRAMMER, IF A7a = 01 DISPLAY “Please tell {NAME} that I said….”} {(IF A0 = 07 OR 08, OR 09) OR
(A1 = 03) OR (A2 = 03 OR 13) DISPLAY Hello, my name is ________________. I’m calling on behalf of the
Social Security Administration.} {IF A2 = 01 or A2=13 BEGIN HERE} Social Security just sent you
{PROGRAMMER IF A0 = 04 USE another} a letter about an important national health study. I work for
Mathematica Policy Research, a well-known research company based in Princeton, New Jersey. We were
hired by Social Security to conduct this survey. The National Beneficiary Survey is about your health, daily
activities, and any jobs you may have. It also asks about Social Security programs and services you may
use. I’m calling to ask you to take part. The answers you and other people give us will be used to help Social
Security learn how well its programs meet the needs of people with disabilities.
PROBE:

We are not selling anything or asking for money.

The interview {IF A0 = 08 FILL will take around 2 to 3 hours because we are using TTY / IF A0 = 07 FILL will
take around 2 to 3 hours because we are using Relay. / IF (A0 = 04) OR (A1 = 01, 03 OR 13) OR (A2 = 01
OR 03 OR 13) FILL: will take about 60 minutes. But it may be shorter or longer based on the questions you
answer.} {IF PREPAY = 0: To thank you for your time, we will mail you a gift card for $20 when {you
finish/NAME finishes} finish the interview. / IF PREPAY = 1: Security sent a letter with a gift card for $5 as a
thank you. We will send you a $15 gift card after you complete the survey.} The questions are easy. If you
get tired or need a break at any time, please tell me, and we will call back later to finish. This interview may
be recorded for quality assurance. Let’s start now.
INTERVIEWER INSTRUCTION (PREPAY=1): IF SAMPLE MEMBER SAYS HE/SHE DID NOT RECEIVE
GIFT CARD AND WILL NOT COMPLETE THE INTERVIEW UNTIL WE SEND A GIFT CARD, SCHEDULE
APPOINTMENT TO CALL BACK.

CONTINUE....................................................... 01 (A64)
{NAME} WILL CALL MPR ................................ 02 SET A108 = 01 (A108)
CALL BACK LATER ......................................... 03 (IF A1 = 01, 03, 13 OR A2 = 01, 03, A13A;
OR A0 = 07, 08, 09 SET A100 = 01 (A100)
IF A7a = 01 OR A9 = 02 SET A100 = 03
(A100))
DID NOT RECEIVE LETTER/DOES NOT
RECALL LETTER .........................................
REQUESTS PROXY ........................................
REQUESTS IN-PERSON INTERVIEW ............
POSSIBLE PARTICIPATION PROBLEM .........
REFUSED ........................................................

A-5

04
05
06
07
r

(A20)
(A39)
(A39)
(A13)
(IF A1 = 01, 03, 13 OR
A2 = 01, 03, A13A; OR A0 = 07, 08, 09
SET A105 = 01 (A105) / IF A7a = 01 OR
A9 = 01 SET A105 = 02 (A105)

SECTION A UNIVERSE: ALL

NAME OR UNKNOWN INFORMANT CALLS IN
IF PREPAY = 1, USE FILLS IN QUESTION TEXT.
IF PREPAY = 0 AND INTERVIEWER IS CALLING OUT, FILL $20.
(A0=02, 05, OR 06)
A11.
INTERVIEWER: CODE BASED ON SUPERVISOR INSTRUCTION.
{NAME}.............................................................
{NAME} USING TTY.........................................
{NAME} USING RELAY....................................
INFORMANT / POSSIBLE PROXY ..................

01
02
03
04 (A13a)

(A11 = 01, 02, OR 03)
A12.
Hello, my name is ________________________. I’ll be your interviewer today. I work for Mathematica
Policy Research a well-known research company based in Princeton, New Jersey. We were hired by Social
Security to conduct this survey. The National Beneficiary Survey is about your health, daily activities, and
any jobs you may have. It also asks about Social Security programs and services you may use. The
answers you and other people give us will help Social Security learn how well its programs meet the needs
of people with disabilities.
The interview {PROGRAMMER, IF A11 = 01 FILL will take about 60 minutes. But it may be shorter or longer
based on the questions that you answer/ IF A11 = 02 USE will take around 2 to 3 hours because we are
using TTY / IF A11 = 03 FILL will take around 2 to 3 hours because we are using Relay.} {IF PREPAY=0 To
thank you, we will mail you a $20 gift card when we finish the interview/ IF PREPAY=1: Social Security sent
you a letter with a gift card for $5 as a thank you. We will send you a $15 gift card after you complete the
survey.} The questions are easy. If you get tired or need a break at any time, please tell me, and we will call
back later to finish. This interview may be recorded for quality assurance. Let’s start now.
INTERVIEWER INSTRUCTION (PREPAY=1): IF SAMPLE MEMBER SAYS HE/SHE DID NOT RECEIVE
GIFT CARD AND WILL NOT COMPLETE THE INTERVIEW UNTIL WE SEND A GIFT CARD, SCHEDULE
APPOINTMENT TO CALL BACK.

CONTINUE....................................................... 01 (A64)
WANTS TO SCHEDULE INTERVIEW ............. 02 IF A11 = 01 SET A100 = 01 (A100)
IF A11 = 02 SET A100 = 04 (A100)
IF A11 = 03 SET A100 = 05 (A100)
NEEDS PROXY ............................................... 03
NEEDS IN-PERSON ........................................ 04 (A39)
POSSIBLE PARTICIPATION PROBLEM ......... 05 (A13)
REFUSED ........................................................
r IF A11 = 01, 02, 03 SET A105 = 01 (A105)
IF A11 = 04 SET A105 = 02 (A105)
DIFFICULTY PARTICIPATING (SPEAKING WITH NAME / INFORMANT / UNKNOWN PROXY WHO CALLS IN)
(A1 = 06) OR (A2 = 06) OR (A4b = 05) OR (A10 = 07) OR (A11 = 04) OR (A12 = 05)
A13.
INTERVIEWER: WHO ARE YOU SPEAKING WITH?
{NAME} / INTERPRETER ................................ 01
INFORMANT/POSSIBLE PROXY .................... 02

A-6

SECTION A UNIVERSE: ALL

(A11 = 04) OR (A13 = 01 OR 02)
A13a. INTERVIEWER: IF BARRIER ALREADY STATED, CODE RESPONSE THEN CONFIRM BY READING
APPROPRIATE CATEGORY BELOW.
{PROGRAMMER: IF A11 = 04, USE: PROBE: Thank you very much for calling and offering to help.
IF NEEDED: What problem does {NAME} have that might prevent {him/her} from taking part for
{himself/herself}?
IF (A1 = 06) OR (A2 = 06) OR (A4b = 05) OR (A10 = 07) OR (A12 = 05) FILL
PROBE:

Why {IF A13 = 01 FILL would you/ IF A13 = 02 FILL would {NAME}} have a problem taking part
in the survey?

INTERVIEWER: PROBE FOR DON’T KNOW. IF MORE THEN ONE PROBLEM, PROBE FOR THE MAIN
PROBLEM.
HEARING DIFFICULTY ...................................
SPEECH DIFFICULTY .....................................
COGNITIVE BARRIER .....................................
PHYSICAL BARRIER .......................................
INCARCERATED .............................................
INSTITUTIONALIZED ......................................
HOSPITALIZED ...............................................
DECEASED ......................................................
SERVING IN MILITARY ...................................
LIVING OUTSIDE USA ....................................
DON’T KNOW ..................................................
REFUSED ........................................................

A-7

01
02
03
04
06
07
08
09
10
11
d
r

(A46)
SET A103 = 01 (A103)
(A27a)
(A27a)
(A103a)
SET A103 = 02 (A103)
SET A103 = 03 (A103)
SET A105 = 02 (A105)

SECTION A UNIVERSE: ALL

(A13a = 01, 02, 04, OR d)
A14.
Social Security just sent {IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME} a letter about an important
national health survey.} I work for Mathematica Policy Research, a well-known research company based in
Princeton, New Jersey that was hired by Social Security to conduct this survey. {IF A12 = 05 START HERE}
We would like {IF A13 = 01 FILL you to have / IF A13 = 02 FILL {NAME} to have} the chance to answer the
questions for {IF A13 = 01 FILL yourself / IF A13 = 02 FILL himself / herself} if at all possible. I’m going to
read some ways that we can arrange for {IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME}} to take part in
the study.
PROBE: What would work best?
PROBE (PREPAY=1): Social Security sent a letter with a $5 gift card as a thank you. We will send
{you/NAME} a $25 gift card after {you/NAME} complete the survey.

INTERVIEWER: READ LIST AND CODE ONE ONLY. IF MORE THAN ONE MENTIONED, ASK WHAT IS
EASIEST FOR {NAME}.
We can break the interview into a few short calls to {IF
A13 = 01 FILL you / IF A13 = 02 FILL {NAME} ....... 01 (A64)
We can use Relay or TTY for the interview .................... 02 (A16)
{PROGRAMMER, DISPLAY 03 ONLY IF A13a = 01} I
can switch to a phone amplifier now ....................... 03 (A64)
{PROGRAMMER, DISPLAY 04 ONLY IF A13a = 01}
We can call later using a phone amplifier................ 04 SET A100 = 06 (A100)
{PROGRAMMER, DISPLAY 05 ONLY IF IN
CLUSTERED SAMPLE S1 = 01 We could send
an interviewer to {{IF A13 = 01 FILL your / IF
A13 = 02 FILL {his/her} home ................................. 05 (A42)
{PROGRAMMER DISPLAY 06 ONLY IF A13 = 02}
INFORMANT OFFERS TO BE PROXY .................. 06 (A39)
{PROGRAMMER, DISPLAY 07 ONLY IF SAMPLE
TYPE = UNCLUSTERED, S1 = 02 AND A13
= 01} {NAME} REQUESTS IN-PERSON
INTERVIEW ............................................................ 07 (A40)
{PROGRAMMER DISPLAY 08 ONLY IF A13 = 01}
{NAME} REQUESTS PROXY ................................. 08 (A39)
PHYSICAL PROBLEM: {NAME} UNABLE TO
PARTICIPATE ........................................................ 09 (A46)
SUGGESTS ANOTHER WAY {SPECIFY__) .................. 10
DON’T KNOW .................................................................

d (A39)

REFUSED .......................................................................

r IF A13 = 01 SET A105 = 01 (A105) /
IF A13 = 02 SET A105 = 02 (A105)

(A14 = 10)
A14a. What is that way?
02) OR (A67 = d)
A72
PROGRAMMER CHECK: IS {NAME’S} IDENTITY VERIFIED (NAME VERIFIED {A66 = 01 OR 02} AND IS
BIRTHDATE VERIFIED (A70 = 01) OR (A71 = 01 OR 02)?
YES (VERIFIED) .............................................. 01
NO (FAILED VERIFICATION) .......................... 00 SET A102 = 04 (A102)
PROGRAMMER: CALCULATE AGE AT INTERVIEW (CURRENTAGE) USING DATE OF INTERVIEW - SELFREPORTED DATE OF BIRTH GIVEN IN A68 (TO BE USED IN SECTION E). DO NOT
RE-CALCULATE UPON RE-ENTRY.

A-23

SECTION A UNIVERSE: ALL

NAME/PROXY COGNITIVE TEST
(A72 = 01)
A73.
INTERVIEWER: WHO ARE YOU SPEAKING WITH?
INTERVIEWER: IF YOU ARE SPEAKING WITH AN INTERPRETER, CODE SPEAKING WITH {NAME}.
NAME – CATI OR CAPI INTERVIEW ..............
NAME, TTY INTERVIEW .................................
NAME, RELAY INTERVIEW ............................
PROXY (CATI) .................................................
PROXY (CAPI) .................................................

01
02 SET A110 = 01 (A110)
03 SET A110 = 01 (A110)
04
05

(A73=01, 04 OR 05)
A74.
Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be
sure my explanation was clear.
Here’s the first explanation. The survey asks about {IF (A73 = 03) FILL your / IF (A73 = 04 OR 05) FILL
{NAME’s}} health, daily activities, and any jobs {IF (A73 = 03) FILL you / IF (A73 = 04 OR 05) FILL {NAME}}
might have. Please tell me in your own words what the survey is about.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................

00
01
02 (A77)
03 (A77)
r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)

A75 IS DELETED
(A74 = 00 OR 01)
A76.
INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. The survey asks about {your/NAME}’s health, daily activities, and any jobs {IF (A73 = 03)
FILL you / IF (A73 = 04 OR 05) FILL {NAME}} might have. Please tell me in your own words, what the
survey is about.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................

A-24

00 (A80)
01 (A80)
02
03
r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)

SECTION A UNIVERSE: ALL

(A74 = 02 OR 03) OR (A76=02 OR 03)
A77.
Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means
you can choose whether or not to take part. If you decide to take part, you can refuse to answer any
questions you do not like. You can also stop the interview at any time. Whether you choose to take part or
not, {your/NAME’s} disability benefits will not be affected in any way.
When I say your taking part is completely voluntary, what does that mean to you?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part.
I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away my
benefits if I refuse, etc.
INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 (A78)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
(A77=02)
A77a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can
choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you
do not like. You can also stop the interview at any time. Whether you choose to take part or not,
{your/NAME’s} disability benefits will not be affected in any way. When I say your taking part is completely
voluntary, what does that mean to you?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take
part. I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away
my benefits if I refuse, etc.
INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01
INACCURATE ANSWER ................................. 02 (A80)
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
(A77 = 01 OR A77a = 01)
A78.
Here’s the last explanation. All your answers will be kept confidential and used only for the research
purposes of the study. When I say that your answers will be kept confidential, what does that mean to you?
PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only
researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS: “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 (A110)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)

A-25

SECTION A UNIVERSE: ALL

(A78 = 02)
A78a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the
study.
When I say that your answers will be kept confidential, what does that mean to you?
PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only
researchers will see what I said. What I say will be (kept) private. It will only be used for
research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 IF A73 = 03 SET A110 = 01 (A110) /
IF A73 = 04 OR 05 SET A110 = 02 (A110)
INACCURATE ANSWER - FAILED .................. 02
REFUSED ........................................................ r IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)
A79 IS DELETED
RESPONDENT OR PROXY FAILS COGNITIVE TEST. FIND A PROXY/ANOTHER PROXY
(A76 = 00 OR 01) OR (A77a = 02 OR A78a = 02)
A80.
Thank you. Our study rules say that we need to find {IF (A73 = 03) USE someone / IF (A73 = 04) USE
someone else} who can help {IF (A64 = 01) FILL you / IF (A64 = 02) FILL {NAME}} answer the survey
questions. Is there someone there who could answer questions about {(IF A64 = 01) FILL your / IF (A64 =
02) FILL {NAME’s}} health, daily activities, and any jobs {IF (A64 = 01) FILL you / IF (A64 = 02) FILL he/she}
might have?
PROBE:

This might be someone who lives with {you/NAME}, a friend, or someone like a social worker or
case worker.
YES, PROXY COMES TO PHONE ..................
YES, CALL BACK PROXY LATER...................
YES, PROXY LIVES ELSEWHERE .................
NO PROXY AVAILABLE ..................................
DON’T KNOW ..................................................
REFUSED ........................................................

01
02
03
04
d
r

(A85)
(A82)
SET A106 = 04 (A106)
SET A106 = 04 (A106)
IF A73 = 03 SET A105 = 01 (A105) /
IF A73 = 04 OR 05 SET A105 = 03 (A105)

(A80 = 02)
A81.
What is that person’s name so that we can call back and ask for them?
NAME: PREFIX, FIRST, `MIDDLE, LAST, SUFFIX
PROGRAMMER: RECORD NAME LOCATING DATABASE
SET A100 = 02 (A100)

A-26

SECTION A UNIVERSE: ALL

(A80 = 03)
A82.
Do you have that person’s name and/or telephone number? If you don’t have all the information, please tell
me what you can.
YES .................................................................. 01
NO .................................................................... 00 SET A102 = 07 (A102)
(A82 = 01)
A83.
PREFIX, FIRST, MIDDLE, LAST, SUFFIX
DON’T KNOW ..................................................
REFUSED ........................................................

d
r

Please give me the telephone number, area code first.
TELEPHONE NUMBER: | | | |-| | |
DON’T KNOW ..................................................
REFUSED ........................................................

|-|
d
r

|

|

|

|

PROGRAMMER: STORE 3 PROXY NAME AND PHONE NUMBER IN LOCATING
DATABASE.
IF BOTH NAME AND PHONE NUMBER REFUSED, SET A106 = 05 (A106)
(A83 = ANSWER)
A84.
PROGRAMMER: WHAT KIND OF PROXY CONTACT INFORMATION DOES A83 CONTAIN?
VALID PHONE NUMBER ................................. 01 SET A101 = 02 (A101)
INVALID PHONE NUMBER ............................. 02 SET A106 = 05 (A106)
NO PHONE NUMBER ...................................... 03 SET A106 = 05 (A106)
CALL TO NEW PROXY/NEW PROXY COMES TO PHONE
(A1 = 13) OR (A56 = 01 OR O2) OR (A80 = 01)
IF PREPAY = 1, USE FILLS IN QUESTION TEXT.
IF PREPAY = 0 AND INTERVIEWER IS CALLING OUT, FILL $20.
A85.

{IF (A56 = 01 OR 02) OR (A80 = 01) USE Hello, my name is ________________. I’m calling on behalf of
the Social Security Administration.} Social Security just sent {NAME} a letter about an important national
health survey. I work for Mathematica Policy Research, a well-known research company that was hired by
Social Security to conduct this survey. The National Beneficiary Survey is about beneficiaries’ health, daily
activities, and any jobs they may have. It also asks about Social Security programs or services {he/she} may
use. I’ve been told that you know about these topics and are the best person to answer the survey on behalf
of {NAME}.
The interview will take about 60 minutes. But it may be shorter or longer based on the questions you
answer. [IF PREPAY = 0: To thank you, we will mail you a gift card for $20 when we finish the interview./ IF
PREPAY = 1: Social Security sent {NAME} a letter with a $5 gift card as a thank you. We will send {NAME}
a $15 gift card after you complete the survey.] Would you be able to help us?
INTERVIEWER INSTRUCTION (PREPAY=1): IF PROXY SAYS SAMPLE MEMBER DID NOT RECEIVE
GIFT CARD AND WILL NOT COMPLETE INTERVIEW UNTIL WE SEND GIFT CARD, SCHEDULE
APPOINTMENT.

YES .................................................................. 01
CALL BACK LATER ......................................... 02 SET A100 = 02 (A100)
DON’T KNOW .................................................. d SET A106 = 03 (A106)
REFUSED ........................................................ r SET A105 = 03 (A105)
A-27

SECTION A UNIVERSE: ALL

A-28

SECTION A UNIVERSE: ALL

(A85=01)
A85a. Before we start, please tell me your name.
FIRST, MIDDLE, LAST
DON’T KNOW ..................................................
REFUSED ........................................................

d
r

NEW PROXY / NEW PROXY COMES-TO-PHONE COGNITIVE TEST
(A85 = 01)
A86.
Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be
sure my explanation was clear.
Here’s the first explanation. The survey asks about {NAME’s} health, daily activities, and any jobs {he/she}
might have. Please tell me in your own words what the survey is about.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “LISTS NONE”
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................

00
01
02 (A89)
03 (A89)
r SET A105 = 03 (A105)

A87 IS DELETED
(A86 = 00 OR 01)
A88.
INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. The survey asks about {NAME}’s health, daily activities, and any jobs {he/she} might
have. Please tell me in your own words what the survey is about.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE ....................................................
LISTS ONLY 1 TOPIC ......................................
LISTS ANY 2 TOPICS ......................................
LISTS 3 TOPICS ..............................................
REFUSED ........................................................

00 (A92)
01 (A92)
02
03
r SET A105 = 03 (A105)

(A86 = 02 OR 03) OR (A88 = 02 OR 03)
A89.
Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means
you can choose whether or not to take part. If you decide to take part, you can refuse to answer any
questions you do not like. You can also stop the interview at any time. Whether you choose to take part or
not, {NAME’s} disability benefits will not be affected in any way.
When I say your taking part is completely voluntary, what does that mean to you?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take
part. I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one
will take away my benefits if I refuse, etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 (A90)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r SET A105 = 03 (A105)

A-29

SECTION A UNIVERSE: ALL

(A89 = 02)
A89a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can
choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you
do not like. You can also stop the interview at any time. Whether you choose to take part or not, {NAME’s}
disability benefits will not be affected in any way. When I say your taking part is completely voluntary, what
does that mean to you?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take
part. I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one
will take away my benefits if I refuse, etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01
INACCURATE ANSWER ................................. 02 (A92)
REFUSED ........................................................ r SET A105 = 03 (A105)
(A89a = 01)
A90.
Here’s the last explanation. All your answers will be kept confidential and used only for the research
purposes of the study. When I say that your answers will be kept confidential, what does that mean to you?
PROBE: IF RESPONDENT SAYS: It is confidential, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only
researchers will see what I said. What I say will be (kept) private. It will only be used for
research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 SET A110 = 02 (A110)
INACCURATE ANSWER ................................. 02
REFUSED ........................................................ r SET A105 = 03 (A105)
(A90 = 02)
A90a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the
study.
When I say that your answers will be kept confidential, what does that mean to you?
PROXY: IF RESPONDENT SAYS: It is confidential, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only
researchers will see what I said. What I say will be (kept) private. It will only be used for
research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER ..................................... 01 SET A110 = 02 (A110)
INACCURATE ANSWER ................................. 02 (A92)
REFUSED ........................................................ r SET A105 = 03 (A105)

A-30

SECTION A UNIVERSE: ALL

A91 IS DELETED
(A88 = 00 OR 01) OR (A89a = 02) OR (A90a = 02)
A92.
Thanks for your patience. There seems to be a problem, and I need to check with my supervisor about what
to do next. My supervisor will get back to you.
PROXY FAILED COGNITIVE TEST................. 01 SET A106 = 04 (A106)
CALL BACK LATER TO SAME NUMBER

(INTERIM)

(A1 = 04) OR (A3 = 02) OR (A5 = 02) OR (A7a = 01) OR (A8 = 03) OR (A9=03) OR (A10 = 03) OR (A12 = 02) OR
(A14 = 04) OR (A17 = 01, 02, 03 OR 04) OR (A18=01 or 02 or 03) OR (A20 = 02; OR A27b = 01) OR (A28 =
ANSWER) OR (A47 = ANSWER) OR (A52 = 01) OR (A55 = 02) OR (A56 = 03) OR (A57 = 02) OR (A58 = 02) OR
(A81 = ANSWER) OR (A84 = 01) OR (A85 = 02)
A100.

(INTERNAL VARIABLE – NOT DISPLAYED FOR USER – SHOW FOR TESTING PURPOSES ONLY)
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.

START NEXT SCREENER AT…
{YOUR NAME} ...........................................................................
{PROXY NAME} .........................................................................
{INTERPRETER NAME} ...........................................................
{NAME} using TTY .....................................................................
{NAME} using Relay ...................................................................
{NAME} using a phone amplifier ................................................
{NEW PROXY NAME} AFTER FIRST PROXY FAILED
COGNITIVE TEST ..............................................................
{NAME} at {IF A1 = 07; OR A2 = 07; OR A4b = 07;
OR A13a = 08 FILL HOSPITAL NAME FROM A28/
IF A1 = 11; OR A2 = 11; OR A4b = 09; OR A13a = 07
FILL INSTITUTION NAME FROM A28 ...............................
IF A4a = 02 AND A6 = ANSWER {NEW INTERPRETER
NAME} ................................................................................

01
02
03
04
05
06

A0 = 01
A0 = 10
A0 = 14
A0 = 08
A0 = 07
A0 = 09

07 A0 = 10

08 A0 = 01
09 A0 = 15

PROGRAMMER: SEND TO CALLBACK SCREEN AND INTERVIEWER WILL SET CALL BACK STATUS THERE.
GO TO END
NEW PHONE NUMBER FOR NAME/PROXY/LEAD TO NAME/LEAD TO PROXY
(A36 = 01) OR (A38 = ANSWER) OR (A52 = 01) OR (A62 = 03, 05, OR 09) OR (A84 = 03, 05, OR 09)
A101. Thank you very much. We will be calling {NAME/PROXY/LEAD FROM BELOW} shortly.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND 01 OR 02 VALUES BELOW. 03 SHOULD NOT BE
DISPLAYED.
START NEXT SCREENER AT…
{NAME} ...................................................................................... 01 A0 = 01
{PROXY} WHO LIVES ELSEWHERE ........................................ 02 A0 = 10
LEAD .......................................................................................... 03 SET A106 = 06 (A106)

A-31

SECTION A UNIVERSE: ALL

A101a. PROGRAMMER: GO TO END.
SEND TO LOCATING: NAME OR PROXY (INTERIM)
(A1 = 14) OR (A2 = 14) OR (A4b = 11) OR (A24 = 00) OR (A36 = 00) OR (A37 = 00 OR d) OR (A52 = 00) OR (A56 =
07) OR (A62 = 01, OR 02) OR (A72 = 00) OR (A82 = 00) OR (A84 = 01, 02, 04, 05, 07, OR 08)
A102. Thank you very much. Goodbye.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
INTERVIEWER: PRESS 1 TO CONTINUE
START NEXT SCREENER AT…
{NAME}: NO SUCH PERSON HERE .....................
{NAME}: NEED PHONE NUMBER ONLY ..............
{NAME} NEED ALL CONTACT INFORMATION ....
{NAME} FAILED VERIFICATION – FIND NAME ...
{PROXY}: NO SUCH PERSON HERE ...................
{PROXY}: NEED PHONE NUMBER .....................

01
02
03
04
05
06

SET STATUS = 530 (END) A0 = 01
SET STATUS = 530 (END) A0 = 01
SET STATUS = 530 (END) A0 = 01
SET STATUS = 530 (END) A0 = 01
SET STATUS = 380 (END) A0 = 13
SET STATUS = 380 (END) A0 = 13

PROGRAMMER: FOR 05 – 06 SUPERVISOR WILL SET NEXT
STARTING QUESTION AND MAY OVERWRITE CODES
INELIGIBLE (INTERIM / POSSIBLE FINAL)
(A1 = 09, 12, OR 18) OR (A2 = 09, 12, OR 18) OR (A4b = 08,10, OR 14) OR (A13a = 06, 10 OR 11) OR (A26 = 01)
OR
(A33 = 01)
A103. Thank you for explaining. That’s all the questions we have for you. Goodbye.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
NOTE:

PROGRAMMER, THESE CASES ARE INTERIM UNTIL AFTER SUPERVISOR REVIEW.
THEY
WILL
NOT
CYCLE
THROUGH
THE
SCREENER
AGAIN
UNLESS
SUPERVISOR/PROGRAMMER RESETS CASE STATUS.

INTERVIEWER: PRESS ENTER TO CONTINUE
INCARCERATED ...................................................
IN ACTIVE MILITARY ............................................
LIVING OUTSIDE THE USA ..................................

01
02
03

SET STATUS = 421 (END)
SET STATUS = 422 (END)
SET STATUS = 461 (END)

(A1=08) OR (A2=08) 0R (A4b=07) OR (A13a=09)
A103a. I am sorry to hear {NAME} has passed away. I was calling about a study we are conducting for the Social
Security Administration. You might have seen a letter Social Security sent [NAME} explaining the study.
When did {NAME} pass away?
|__|__| / |__|__| / |__|__|__|__|
MONTH DAY
YEAR
(1 – 12) (1 – 31) (2000 – 2016)
DON’T KNOW ........................................................
REFUSED ..............................................................

d
r

Thank you. Please accept my condolences. Goodbye.
PROGRAMMER: SET STATUS = 440. GO
TO END

A-32

SECTION A UNIVERSE: ALL

BARRIERS TO PARTICIPATION – (INTERIM NON-RESPONSE / POSSIBLE FINAL NON-RESPONSE)
(A1 = 17) OR (A2 = 17) OR (A4b = 13) OR (A46 = 05, 06, 07, 08, OR 09) OR (A56 = 06)
A104. Thank you very much for explaining. That’s all the questions I have. Thanks for your time. Goodbye.
PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.
PROGRAMMER, THESE CASES ARE INTERIM UNTIL AFTER SUPERVISOR
REVIEW. THEY WILL NOT CYCLE
THROUGH THE SCREENER
RESETS CASE STATUS.

AGAIN

UNLESS

SUPERVISOR/PROGRAMMER

INTERVIEWER: PRESS ENTER TO CONTINUE
HOSPITALIZED ........................................
INSTITUTIONALIZED ...............................
COGNITIVE BARRIER ..............................
HEARING/SPEECH BARRIER .................
PHYSICAL BARRIER ................................
UNAVAILABLE DURING FP .....................
FINAL LANGUAGE BARRIER ..................

01
02
03
04
05
06
07

SET STATUS = 420 (END)
SET STATUS = 420 (END)
SET STATUS = 412 (END)
SET STATUS = 411 (END)
SET STATUS = 410 (END)
SET STATUS = 430 (END)
SET STATUS = 400 (END)

REFUSALS (INTERIM / FINAL)
(IF ANY OF THE FOLLOWING QUESTIONS = r: A1, A2, A4b, A5, A8, A9, A10, A12, A13a, A14, A17, A18, A20,
A21, A22, A27b, A29, A30, A37, A40, A41, A43, A44, A45, A46, A48, A49, A50, A53, A56, A57, A58, A60, A61, A66,
A67, A67a, A68, A74, A76, A77, A78, A78a, A80, A85, A86, A88, A89, A89a, A90, A90a)
A105.

Thank you for your time. Goodbye.
PROGRAMMER:

GO TO REFUSAL SCREEN SO INTERVIEWER CAN RECORD REASON FOR
REFUSAL. WHILE THE CASE IS STILL IN INTERIM STATUS, THESE CASES WILL
BE SUBJECT TO CALL SCHEDULER RULES THAT WILL DETERMINE WHETHER
AND WHEN TO START THE NEXT SCREENER CALL (A0 – 01 OR A0 = 10) OR SET
AS 860 (END) (REVIEW NEEDED FOR FIELD BY SUPERVISOR , AKA HOLD FOR
CAPI)

START NEXT SCREENER AT:
{NAME} REFUSED.................................... 01
{UNKNOWN} REFUSED ........................... 02
{PROXY} REFUSED ................................. 03

SET STATUS = 200 (REFUSAL SCREEN) A0 = 01
SET STATUS = 220 (REFUSAL SCREEN) A0 = 01
SET STATUS = 210 (REFUSAL SCREEN) A0 = 10

INTERVIEWER: PRESS ENTER TO RECORD REASONS FOR REFUSAL IN REFUSAL SCREEN.
SUPERVISOR REVIEW (INTERIM)
(A1 = 15) OR (A2 = 15) OR (A3 = 03 OR r) OR (A4 = r) OR (A4a = 03 OR r) OR (A4b = 03 OR 12) OR (A15 =
ANSWER) OR (A18 = 05 OR d) OR (A24 = r) OR (A26=r) OR (A28 = r) OR (A29 = r) OR (A47 = d OR r) OR (A50 =
2) OR (A51 = r) OR (A56 = 05 OR 08) OR (A60 = 00 OR d) OR (A80 = 04 OR d) OR (A101 = 03)
A106.

Thank you for your time. Goodbye.
INTERVIEWER: IF CASE NEEDS A SPANISH INTERVIEWER, PLEASE RECORD IN APPOINTMENT OR
EXIT, AS APPROPRIATE.
POSSIBLE LANGUAGE PROBLEM ................
CALL INFORMANT TO SET TTY/RELAY
CALL BACK TIME ....................................
NEED TO LOCATE NEW PROXY ...................
PROXY FAILED COGNITIVE TEST / NO
OTHER PROXY AVAILABLE...................
OTHER SUPERVISOR REVIEW .....................
CALL LEAD FOR NAME/PROXY INFO ...........

A-33

01 SET STATUS = 380 (END)
02 SET STATUS = 380 (END)
03 SET STATUS = 380 (END)
04 SET STATUS = 380 (END)
05 SET STATUS = 380 (END)
06 SET STATUS = 380 (END)

SECTION A UNIVERSE: ALL

HOLD FOR CAPI (INTERIM - REQUIRES SUPERVISOR REVIEW)
(A29 = ANSWER) OR (A45 = 01,02, OR d)
A107. Thank you very much. Our field interviewer will call to arrange a time for the interview.
PROGRAMMER: IN ADDITION TO THESE CASES BEING HELD FOR CAPI, REFUSALS AND
UNLOCATABLES WILL ALSO BE HELD FOR CAPI UNDER CERTAIN
CIRCUMSTANCES THAT THE SUPERVISORS WILL DECIDE. NOTE ALSO THAT ALL
CAPI CASES WILL START THE CAPI SCREENER AT A0 = 01.
INTERVIEWER:

PRESS 1TO CONTINUE

HOLD FOR CAPI .............................................

0 SET STATUS = 860 (END) A0 = 01

RESPONDENT WILL CALL MPR (INTERIM)
(A10 = 02) OR (A17 = 05 OR 06)
A108. Thanks for offering to call in. Please write down our toll-free number. {IF (A10 = 02 OR A17 = 06) FILL 877293-5740. / IF (A17 = 05) FILL Call 877-293-5741 for a TTY interview.} [CONFIRM NUMBERS] We are
available days, evenings, and weekends. If you call after hours, please leave a message. We will get back to
you the next day.
INTERVIEWER: PRESS ENTER TO CONTINUE
{NAME} WILL CALL ......................................... 01 SET STATUS = 830 (END) A0 = 02
{NAME} WILL CALL/TTY.................................. 02 SET STATUS = 830 (END) A0 = 08
{NAME} WILL CALL/RELAY ............................. 03 SET STATUS = 830 (END) A0 = 07
REQUEST FOR LETTER (INTERIM)
(A22 = 01) OR (A25 = 00) OR (A26 = r) OR (A59 = 02)
A109. You should receive the letter from Social Security in about a week. Thank you for your time. Goodbye.
INTERVIEWER: PRESS 1 TO CONTINUE
START NEXT SCREENER AT…
{NAME} REQUESTS LETTER ......................... 01 SET STATUS = 831 (END) A0 = 04
PROXY REQUESTS LETTER ......................... 02 SET STATUS = 831 (END) A0 = 11
CONTINUE WITH INTERVIEW
(A78a = 01) OR (A90a = 01)
A110. RESPONDENT CHECK SCREEN
INTERVIEWER: WE SHOW THE RESPONDENT IS
(IF A73 = 01, 02; OR A73 = 03 AND A78a = 01 FILL {NAME}
(IF A73 = 04 OR 05 AND A78a = 01; OR A90a = 01 FILL PROXY
INTERVIEWER: IS THIS INFORMATION CORRECT?
YES .................................................................. 01 (B1)
NO ................................................................. 00
(A110 = 00)
A110a. INTERVIEWER: WHO IS THE RESPONDENT?
SAMPLE MEMBER .......................................... 01 (B1)
PROXY ............................................................. 02

A-34

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

SECTION B: DISABILITY AND CURRENT WORK STATUS
DISABILITY STATUS
(All)
B1.

First, I have some questions about how {your/NAME’s} health affects {your/his/her} daily activities. Does a
physical or mental condition limit the kind or amount of work or other daily activities {you/NAME} can do?
PROBE 1: In other words, are there things {you/NAME} can’t do as much or can’t do at all that people the
same age can?
PROBE 2: Daily activities include cooking, shopping, getting around the home, paying bills, or working at a
job.
YES ............................................................................................ 01
NO .............................................................................................. 00 (B5)
DON’T KNOW ............................................................................ d (B5)
REFUSED .................................................................................. r (B5)

(B1=01)
B2.
What physical or mental condition is the main reason {you are/NAME is} limited?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
PROBE 2: What causes this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B1=01)
B3.
{Do you/Does NAME} have any other physical or mental conditions that limit the kind or amount of work or
other daily activities {you/he/she} can do?
PROBE 1: In other words, are there things {you/NAME} can’t do as much or can’t do at all that people the
same age can?
PROBE 2: Daily activities include cooking, shopping, getting around the home, paying bills, or working at a
job.
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)
(B1=01 and B3=01)
B4.
What are those conditions?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
PROBE 2: What causes this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
GO TO B18_age

B-1

d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B1=00, d, r)
B5.
{Are you/Is NAME} currently receiving disability benefits from Social Security?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B9)
DON’T KNOW ............................................................................ d (B9)
REFUSED .................................................................................. r (B9)
(B1=00, d, r and B5=01)
B6.
What physical or mental condition is the main reason {you are/NAME is} became eligible for disability
benefits?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
PROBE 2: What causes this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B1=00, d, r and B5=01)
B7.
{Do you/Does NAME} have any other physical or mental conditions that made {you/him/her} eligible for
disability benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)
(B1=00, d, r and B5=01 and B7=01)
B8.
What are those conditions?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
PROBE 2: What causes this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

GO TO B18_ age

(B1=00, d, r and B5=00, d, r)
B9.
{Have you/Has NAME} received disability benefits from Social Security at any time during the last five
years?
YES ............................................................................................ 01 (B11)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B1=00, d, r and B5=00, d, r and B9=00, d, r)
B10.
We are only interviewing people who have received disability benefits in the past five years. I need to check
with my supervisor and get back to you. Thank you for your help.
PRESS 1 TO CONTINUE ........................................................... 01
END CALL. STATUS ”SUPERVISOR REVIEW 380.”

B-2

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B1=00, d, r and B5=00, d, r and B9=01)
B11.
{Do you/Does NAME} still have the physical or mental conditions that made {you/him/her} eligible for Social
Security disability benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B15)
DON’T KNOW ............................................................................ d (B15)
REFUSED .................................................................................. r (B15)

(B1=00, d, r and B5=00, d, r and B9=01 and B11=01)
B12.
What physical or mental condition is the main reason {you were/NAME was} eligible for disability benefits?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
PROBE 2: What causes this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B1=00, d, r and B5=00, d, r and B9=01 and B11=01)
B13.
{Do you/Does NAME} have any other physical or mental conditions that made {you/him/her} eligible for
disability benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)

(B1=00, d, r and B5=00, d, r and B9=01 and B11=01 and B13=01)
B14.
What are those conditions?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name do doctors call {your/NAME’s} health condition?
PROBE 2: What causes this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
GO TO B18_age

B-3

d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B1=00, d, r and B5=00, d, r and B9=01 and B11=00, d, r)
B15.
What physical or mental condition was the main reason {you were/NAME was} limited when {you/he/she}
first started getting disability benefits from Social Security?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name did doctors call {your/NAME’s} health condition?
PROBE 2: What caused this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B1=00, d, r and B5=00, d, r and B9=01 and B11=00, d, r)
B16.
Did {you/NAME} have any other physical or mental conditions that limited the kind or amount of work or
other daily activities {you/he/she} could do when {you/he/she} first started getting disability benefits?
PROBE:

Daily activities include cooking, shopping, getting around the home, or paying bills.
YES ............................................................................................ 01
NO .............................................................................................. 00 (B18_age)
DON’T KNOW ............................................................................ d (B18_age)
REFUSED .................................................................................. r (B18_age)

(B1=00, d, r and B5=00, d, r and B9=01 and B11=00, d, r and B16=01)
B17.
What were those conditions?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: By what name did doctors’ call {your/NAME’s} health condition?
PROBE 2: What caused this condition?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B1=00, d, r and B5=00, d, r)
B18_age. How old {were you/was NAME} when {you/he/she} first became limited in the kind or amount of work or
other daily activities {you/he/she} could do? Your best estimate is fine.
INTERVIEWER: IF AGE IS NOT KNOWN, ENTER ‘99’ TO PROBE FOR A YEAR.
INTERVIEWER: IF LESS THAN ONE YEAR OR SINCE BIRTH, ENTER ‘0’ IN AGE.
|

|

| (B20 IF AGE 0-64)

AGE
(0-64) (or ‘99’ to probe for year)
SINCE BIRTH ............................................................................. 00 (B20)
DON’T KNOW ............................................................................ d (B19)
REFUSED .................................................................................. r (B19)
(B18_age=99)
B18_year.
PROBE: READ IF NECESSARY: In what year?
| | | | |
YEAR
(1933-2016) (B20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

B-4

d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B18_age=d, r) or (B18_age=99 and B18_year=d, r)
B19.
Did {you/NAME} become limited before the age of 18 or after age 18?
PROBE:

Your best guess is fine.
LESS THAN 18 .......................................................................... 01
18 OR OLDER ........................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

PROGRAMMER: CALCULATE AGE OF ONSET BASED ON B18_AGE AND B18_YEAR:
If B18_age=0-64, then B18_age_calc=B18_age. Else if B18_age=99 and B18_yr ≠ d or r and B18_year=A68b,
B18_age_calc=0. Else if B18_age=99 and B18_yr ≠ d or r and B18_year ≠ A68b, B18_age_calc= B18yr - A68b.
Else, if B18_age=99 and B18_yr=d or r, B18_age_calc= B18_yr. Else, if B18_age=d or r, B18_age_calc=B18_age.
B20.

SOFT EDIT: B18_age_calc SHOULD NOT EXCEED CURRENT AGE. IF B18_age_calc>CURRENTAGE_
TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER: AGE OF DISABILITY ONSET IS
GREATER THAN CURRENT AGE. CHECK ENTRY. IF NECESSARY READ: I must have recorded an
incorrect answer. I show that {you are/NAME is} now (CURRENTAGE), and {you/he/she} became limited
when {you were/(he/she) was} (B18_age_calc). Should I change {your/NAME’s} the age when {you/NAME}
first became limited?
CHANGE AGE WHEN FIRST BECAME LIMITED ..................... 01
(CHANGE B18_age) SUPPRESS .............................................. 02

B21.

CHECK: HAS {NAME} BEEN LIMITED SINCE ADULTHOOD (B18_age_calc NE D OR R, AND
B18_age_calcIS > OR = 18) OR (IF B18_age_calc=D OR R and B19=02)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B24)

(B21=01)
B22.
{Were you/Was NAME} working at a job for pay or profit before {you/he/she} started receiving disability
benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B24)
DON’T KNOW ............................................................................ d (B24)
REFUSED .................................................................................. r (B24)
(B22=01)
BP1.
{Are you/Is NAME} now able to do the same kind of work {you/he/she} did before {you/he/she} started
receiving Social Security disability benefits? (NSHA WS-56 modified)
PROBE: {Are you/Is NAME} able to do the same type of job activities {you were/he was/she was} doing
before?
YES ............................................................................................ 01 (B24)
NO .............................................................................................. 00 (BP1b)
DON’T KNOW ............................................................................ d (B24)
REFUSED .................................................................................. r (B24)

B-5

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(BP1=00)
BP1b. Why {are you/is NAME} no longer able to do the kind of work {you/he/she} did before {you/he/she} started
receiving Social Security disability benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?

HEALTH CONDITION DOES NOT ALLOW JOB PERFORMANCE...........
LACKS THE PHYSICAL ENERGY, STRENGTH OR
STAMINA REQUIRED ................................................................................
PAIN INTERFERES WITH A JOB OR WORK SCHEDULE
JOB IS TOO STRESSFUL .........................................................................
MEDICAL AND THERAPY APPOINTMENTS INTERFERE WITH
A REGULAR WORK SCHEDULE ..............................................................
THE TIME NEEDED FOR PERSONAL CARE AND MAINTAINING
HEALTH IS TOO SUBSTANTIAL/INTERFERES WITH A REGULAR
WORK SCHEDULE ....................................................................................
HEALTH GOES UP AND DOWN IN UNPREDICTABLE WAYS ................
UNABLE TO GET THE MEDICAL TREATMENT NEEDED TO
IMPROVE YOUR HEALTH ENOUGH TO GO TO WORK .........................
UNABLE TO GET MEDICAL DEVICE NEEDED TO WORK ......................
OTHER (SPECIFY) ....................................................................................
(BP1b=09)
BP1b_oth.

01 (B23)
02 (B23)
03 (B23)
04 (B23)

05 (B23)
06 (B23)
07 (B23)
08 (B23)
09 (BP1B_oth)

What other reason?
Other (SPECIFY) ___________________________________
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(B23)
d (B23)
r (B23)

(B21=01 and B22=01)
B23.
Did the job {you/NAME} had before {you/he/she} started receiving Social Security disability require
{you/him/her} to use a computer?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
CURRENT WORK STATUS
(All)
B24.

These next questions are about {your/NAME’s} personal goals and {your/his/her} current work-related
activities. {Are you/Is NAME} currently working at a job or business for pay or profit?
PROBE: We are interested in both full-time and part-time work for pay or profit
YES ............................................................................................ 01 (B30)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

B-6

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B24 = 0, d, r)
B24b. Did {you/NAME} work for pay or profit at any time during the last 6 months? (NEW)
PROBE: We are interested in both full-time and part-time work for pay or profit.
YES ............................................................................................ 01 (B28)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B24=00, d, or r and B24b=00, d, or r and SampGrp=02)
B10.
I’m sorry, we are only interviewing people who are working now or worked in the past 6 months. Thank you
for your help.
PRESS 1 TO CONTINUE ........................................................... 01
END CALL. STATUS ”SUPERVISOR REVIEW 380.”
B25. ITEM MOVED TO FOLLOW B29_10_Other
B26. ITEM MOVED TO FOLLOW B25
B27. ITEM MOVED TO FOLLOW B26

(B24=00, d, r or B24b=01, 00, d, or r)
B28.
{Have you/Has NAME} been looking for paid work during the last four weeks?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B25, new position)
DON’T KNOW ............................................................................ d (B25, new position)
REFUSED .................................................................................. r (B25, new position)

(B28=01)
B28a. Are {you/NAME} looking for part-time or full-time work?
FULL-TIME ................................................................................. 01 (B29)
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d (B29)
REFUSED .................................................................................. r (B29)

(B28=01 and B28a=2)
B28b. About how many hours per week would {you/NAME} like to work?
| | |
HOURS

(1-60)

(1-168)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

B-7

d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B28=01)
B29.
Next, I am going to read you a list of things that some people do to look for work. Please tell me whether or
not {you/NAME} did any of these things during the last four weeks. To look for work in the last four weeks
did {you/NAME}:
YES

NO

DON’T
KNOW

REFUSED

a.

Contact {your/NAME’S} state’s unemployment office?

01

00

d

r

b.

Ask friends or relatives?

01

00

d

r

c.

Look through job advertisements in a newspaper or on the
Internet?

01

00

d

r

d.

Contact the State Vocational Rehabilitation Agency or
{VRNAME FROM {NAME’S} CURRENT STATE}?

01

00

d

r

e.

Contact a local independent living center?

01

00

d

r

f.

Contact a private employment agency or program?

01

00

d

r

01

00

d

r

f1. Contact a former employer in person, by mail or email, or by
phone?
g.

Contact any other employers in person, by mail or email, or
by phone?

01

00

d

r

h.

Do anything else that I didn’t mention?

01

00

d

r

PROGRAMMER: IF B29h=01, GO TO B29h_OTHERWISE, GO TO B29_1a.

(B28=01 and B29_h=01)
B29h_Other. What was it?
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

(B28=01)
B29_1a.

d
r

{Have/Has} {you/NAME} received any job offers within the past four weeks?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B29_7)
DON’T KNOW ............................................................................ d (B25, new position)
REFUSED .................................................................................. r (B25, new position)

(B29_1a=01)
B29_1b.
Did {you/NAME} turn any of these job offers down?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B30)
DON’T KNOW ............................................................................ d (B25, new position)
REFUSED .................................................................................. r (B25, new position)

B-8

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B29_1a=01 and B29_1b=01)
B29_2. Now, I am going to read you a list of reasons why people sometimes do not accept a job offer. Please tell
me if any of these are reasons why {you/NAME} did not accept a job that {you/he/she} {were/was} offered in
the past four weeks.
YES

NO

DON’T
KNOW

REFUSED

{You/NAME} would have needed special equipment or
medical devices that {you do / he does /s he does} not
currently have in order to do the work

01

00

d

r

[You/NAME} did not have the personal assistance
[you/he/she] needed to get ready for work each day
(EXAMPLE IF NEEDED: This includes things like dressing
and bathing)

01

00

d

r

c.

{You/NAME} could not get the help that {you/he/she] needed
caring for children or others

01

00

d

r

d.

{You/NAME} did not have reliable transportation to and from
the job

01

00

d

r

e.

The job did not offer a flexible enough schedule

01

00

d

r

f.

Job did not pay enough.

01

00

d

r

g.

The job did not offer health insurance benefits

01

00

d

r

h.

{You/NAME} would have lost benefits (you need / he needs /
she needs) like Social Security, disability insurance, workers’
compensation, or Medicaid, if [you/he/she] accepted the job

01

00

d

r

Is there anything else that I did not mention that made
{you/NAME} turn down a recent job offer

01

00

d

r

a.

b.

i.

(B29_2_i=01)
B29_2_i_Oth. What other reasons?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B29_1a=01 and B29_1b=01)
B29_2CHECK.CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (B29_5CHECK)
NO .............................................................................................. 00

(B29_1a=01 and B29_1b=01 AND RTYPE=01)
B29_3CHECK: IS PAY A REASON RESPONDENT DID NOT ACCEPT JOB (B29_2f=01)?
YES ............................................................................................ 01 (B29_3a)
NO .............................................................................................. 00 (B29_3b)

B-9

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B29_2f=01 AND RTYPE=01)
B29_3a. You said that one of the reasons you did not accept a job you were offered was because it did not pay enough.
What is the lowest wage or salary you would have accepted for this job?
INTERVIEWER: Read only if necessary, otherwise code:
$|

|

|

|,|

|

|

|.|

|

|

DON’T KNOW .........................................
REFUSED ...............................................
B29_3ahop.

d
r

(B29_5CHECK)
(B29_5CHECK)

Is this:
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY .............................................
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
DON’T KNOW .........................................
REFUSED ...............................................

01
02
03
04
05
06
07
d
r

(1-25)
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(B29_4a)
(B29_4a)

(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

(B29_5CHECK)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)

(B29_2f=00, d, OR r AND RTYPE=01)
B29_3b. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary you
would be willing to accept for such a job?
INTERVIEWER: If they hesitate or seem to be having difficulty, add: If you have no idea, just say so.
INTERVIEWER: Read only if necessary, otherwise code:
$|

|

|

|,|

|

|

|.|

|

DON’T KNOW .........................................
REFUSED ...............................................
B29_3bhop

d
r

(Skip to B29_5CHECK)
(Skip to B29_5CHECK)

Is this:
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY .............................................
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
DON’T KNOW .........................................
REFUSED ...............................................

B-10

|

01
02
03
04
05
06
07
d
r

(1-25)
(1-384
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(B29_4a)
(B29_4a)

(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

(B29_5CHECK)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)
(B29_4a)

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_3ahop or B29_3bhop OUT OF RANGE
B29_3check:

Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary
you would have accepted for this job is [insert ((B29_3a and B29_3ahop) OR (B29_3b and
B29_3hop)). Is this correct?”
CHANGE LOWEST WAGE OR SALARY ................................... 01 (CHANGE B29_3a
OR B29_3b)
CHANGE PAY PERIOD ............................................................. 02 (CHANGE B29_3ahop
OR B29_3bhop)
SUPPRESS ................................................................................ 03

(B29_3ahop=02, 03, 04, 05, 06, 07, d or r) or (B29_3bhop=02, 03, 04, 05, 06, 07, d, or r)
B29_4a.
How many hours per week would you expect to work for this amount of pay?
| | |
HOURS
(1-99)

(Skip to B29_5CHECK)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d (B29_4b)
r (B29_4b)

(B29_4a=d or r)
B29_4b.
Would you expect to work full-time or part-time?
FULL-TIME ................................................................................. 01
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B29_1a=01 and B29_1b=01)
B29_5CHECK. IS LOSING BENEFITS REASON DID NOT ACCEPT JOB (B29_h=01)?
YES ............................................................................................ 01 (B29_5)
NO .............................................................................................. 00 (B30)
(B29_2 h=01)
B29_5.
You said that one of the reasons {you/NAME} did not accept a job was because (you/he/she) would have
lost benefits (you/he/she) needed such as Social Security, disability insurance, workers’ compensation,
or Medicaid. There are many ways people find out about how working will affect their benefits. For
example, some people call the Social Security office, some search the Internet, and others contact
disability service organizations. Did {you/NAME} contact anyone or do any of these things in order to find
out how [your/his/her] benefits would be affected if {you/he/she} went to work?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

B-11

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B29_2 h=01)
B29_6. What benefits {were/was} {you/NAME} most worried about losing?
INTERVIEWER: MARK ALL THAT APPLY
PRIVATE DISABILITY INSURANCE .......................................... 01
WORKERS’ COMPENSATION .................................................. 02
VETERANS’ BENEFITS ............................................................. 03
MEDICARE................................................................................. 04
MEDICAID .................................................................................. 05
SSA DISABILITY BENEFITS...................................................... 06
PUBLIC ASSISTANCE OR WELFARE ...................................... 07
FOOD STAMPS ......................................................................... 08
PERSONAL ASSISTANCE SERVICES (PAS) ........................... 09
UNEMPLOYMENT BENEFITS ................................................... 10
OTHER STATE DISABILITY BENEFITS .................................... 11
OTHER GOVERNMENT PROGRAMS ...................................... 12
OTHER (SPECIFY) .................................................................... 13 (B29_6_oth)
(B29_6=13)
B29_6_Oth: What other benefits?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
GO TO B30

B-12

d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B29_1a=00)
B29_7. Now, I am going to read you a list of reasons why people are sometimes unable to find a job. Please tell me
if any of these are reasons why {you/NAME} {have/has} not found a job that {you/he/she} {think/thinks} is
right for {you/him/her}.
YES

NO

DON’T
KNOW

REFUSED

01

00

d

r

(Example if needed: This includes things like dressing and
bathing)

01

00

d

r

c.

{You/NAME} cannot get the help that {you need/ he needs/
she needs] caring for children or others

01

00

d

r

d.

{You/NAME] [do/does] not have reliable transportation to and
from work

01

00

d

r

e.

The jobs that are available do not offer a flexible enough
schedule.

01

00

d

r

f.

{You/NAME} cannot find a job {you are/he is/she is} qualified
for.

01

00

d

r

g.

The jobs that are available do not pay enough

01

00

d

r

h.

Employers will not give {you/NAME} a chance to show that
{you/he/she} can work.

01

00

d

r

i.

The jobs that are available do not offer health insurance
benefits.

01

00

d

r

j.

{You/NAME} would lose benefits (you need / he needs / she
needs) like Social Security, disability insurance, workers’
compensation, or Medicaid if {you/he/she} took a job

01

00

d

r

Is there anything else that I did not mention that is a reason
why (you/Name) (have/has) not been able to find a job?

01

00

d

r

a.

b.

k.

{You/NAME} would need special equipment or medical
devices to work which {you do /he does /she does} not
currently have
[You/NAME} [do/does] not have the personal assistance
[you/he/she] [need/needs] to get ready for work each day

(B29_7_k=01)
B29_7_k_Oth. What other reasons?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(B29_1a=00)
B29_7CHECK.

d
r

CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (B29_9CHECK)
NO .............................................................................................. 00

(B29_1a=00 AND RTYPE=01)
B29_8CHECK: IS PAY A REASON RESPONDENT DID NOT ACCEPT JOB (B29_7g=1)?
YES ............................................................................................ 01 (B29_8a)
NO .............................................................................................. 00 (B29_8b)

B-13

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B29_7g=01 AND RTYPE=01)
B29_8a. You said that one of the reasons you are unable to find a job is that the jobs that are available do not pay
enough. What is the lowest wage or salary you would accept for a job that matched your current needs
and abilities?
INTERVIEWER: Read only if necessary, otherwise code:
$|

|

|

|,|

|

|

|.|

|

|

DON’T KNOW ............................................................................
REFUSED ..................................................................................
B29_8ahop. Is this:
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY .............................................
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................

01
02
03
04
05
06
07

(1-25)
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)

d (B29_9CHECK)
r (B29_9CHECK)

(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

(B29_9CHECK)
(B29_8c)
(B29_8c)
(B29_8c)
(B29_8c)
(B29_8c)
(B29_8c)

d (B29_8c)
r (B29_8c)

(B29_7g=00, d, OR r AND RTYPE=01)
B29_8b. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary
you would be willing to accept for such a job?
INTERVIEWER: IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: If you have no idea, just
say so.
IF R SAYS HAS NO INTEREST IN WORKING, CODE AS DON’T KNOW.
INTERVIEWER: Read only if necessary, otherwise code:
$|

|

|

|,|

|

|

|.|

|

|

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d (B29_9CHECK)
r (B29_9CHECK)

B29_8bhop. Is this:
HOURLY ................................................. 01 (1-25)
(1-300)
(B29_9CHECK)
DAILY ...................................................... 02 (1-384)
(1-1,922)
(B29_8c)
WEEKLY ................................................. 03 (1-1,923)
(1-9,615)
(B29_8c)
BI-WEEKLY ............................................. 04 (1-4,166)
(1-20,833)
(B29_8c)
TWICE A MONTH ................................... 05 (1-4,166)
(1-20,833)
(B29_8c)
MONTHLY ............................................... 06 (1-8,333)
(1-41,666)
(B29_8c)
ANNUALLY.............................................. 07 (1-100,000) (1-500,000) (B29_8c)
DON’T KNOW ............................................................................ d (B29_8c)
REFUSED .................................................................................. r (B29_8c)

B-14

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_8ahop or B29_8bhop) OUT OF RANGE
B29_8check: Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary you
would have accepted for this job is [insert ((B29_8a and B29_8ahop) OR (B29_8b and
B29_8hop)). Is this correct?”
CHANGE LOWEST WAGE OR SALARY ................................... 01 (CHANGE B29_8a
OR B29_8b)
CHANGE PAY PERIOD ............................................................. 02 (CHANGE B29_8ahop
OR B29_8bhop)
SUPPRESS ................................................................................ 03

(B28_8ahop=02, 03, 04, 05, 06, 07, d, or r) or (B28_8bhop=02, 03, 04, 05, 06, 07, d, or r)
B29_8c. How many hours per week would you expect to work for this amount of pay?
|

| |
HOURS
(1-99)

(Skip TO B29_9CHECK)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d (B29_8d)
r (B29_8d)

(B29_8c=d or r)
B29_8d. Would you expect to work full-time or part-time?
FULL-TIME ................................................................................. 01
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(B29_1a=00)
B29_9CHECK.

IS LOSING BENEFITS REASON DID NOT ACCEPT JOB (B29_7=j)?
YES ............................................................................................ 01 (B29_9)
NO .............................................................................................. 00 (B30)

(B29_7=j)
B29_9. You said that one of the reasons {you/NAME} {have/has} not been able to find a job is because {you/he/she}
would lose benefits (you need / he needs / she needs) such as Social Security, disability insurance, workers’
compensation, or Medicaid if {you/he/she} did get a job. There are many ways people find out about how
working will affect their benefits. For example, some people call the Social Security office, some search the
Internet, and others contact disability service organizations. {Have/Has} {you/NAME} contacted anyone or
done any of these things in order to find out how {your/his/her} benefits will be affected if {you/he/she} did go
to work?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

B-15

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B29_7=j)
B29_10. What benefits {are/is} {you/NAME} most worried about losing?
INTERVIEWER: MARK ALL THAT APPLY
PRIVATE DISABILITY INSURANCE .......................................... 01
WORKERS’ COMPENSATION .................................................. 02
VETERANS’ BENEFITS ............................................................. 03
MEDICARE................................................................................. 04
MEDICAID .................................................................................. 05
SSA DISABILITY BENEFITS...................................................... 06
PUBLIC ASSISTANCE OR WELFARE ...................................... 07
FOOD STAMPS ......................................................................... 08
PERSONAL ASSISTANCE SERVICES (PAS) ........................... 09
UNEMPLOYMENT BENEFITS ................................................... 10
OTHER STATE DISABILITY BENEFITS .................................... 11
OTHER GOVERNMENT PROGRAMS ...................................... 12
OTHER (SPECIFY) .................................................................... 13 (B29_10_oth)

(B29_10=13)
B29_10_Oth: What other benefits?

DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO B30

B-16

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B25.
Other beneficiaries have said that they are not working for a number of reasons. I am going to read you a
list of these reasons. For each, please tell me if it is a reason why {you are/NAME is} not currently working.
{Are you/ Is NAME} not working because
PROBE: I need to read the entire list even though some of the reasons may not apply to {you/NAME}. If a
reason does not apply to {you/NAME}, please just say so.
INTERVIEWER: IF RESPONDENTS SAYS 'DOES NOT APPLY' CODE AS 'NO'.
YES

NO

DON’T
KNOW

REFUSED

A physical or mental condition prevents {you/NAME} from
working

01

00

d

r

{You/NAME} cannot find a job that {you are/ he is /she is}
qualified for

01

00

d

r

{You do/NAME does} not have reliable transportation to and
from work

01

00

d

r

d.

{You are/NAME is} caring for children or others

01

00

d

r

e.

ITEM DELETED

01

00

d

r

f.

{You/NAME} cannot find a job {you want / he wants / she
wants}

01

00

d

r

{You are/NAME is} waiting to finish school or a training
program

01

00

d

r

Workplaces are not accessible to people with {your/NAME’s}
disability

01

00

d

r

{You do/NAME does} not want to lose benefits (you need / he
needs / she needs) like Social Security, disability insurance,
workers’ compensation, or Medicaid

01

00

d

r

{Your/NAME’s} previous attempts to work have been
discouraging

01

00

d

r

k.

ITEM DELETED

01

00

d

r

l.

Others do not think {you/NAME} can work

01

00

d

r

01

00

d

r

{You/NAME} does not have the special equipment or medical
devices that {you/he/she} would need in order to work

01

00

d

r

{You/NAME} cannot get the help {you need / he needs / she
needs} with personal care. This includes things like help
dressing and bathing to get ready for work or eating lunch
and using the restroom at work.

01

00

d

r

{You/NAME} cannot get help {you need/he needs/she needs}
with tasks you would do at work. This includes having
someone help you with things like writing, reading, lifting or
reaching.

01

00

d

r

a.
b.
c.

g.
h.
i.

j.

m. Employers will not give {you/NAME} a chance to show that
{you/he/she} can work
n.
o.

p.

B-17

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B26.
Are there any other reasons why {you are/NAME is} not working that I did not mention?
YES ............................................................................................ 01 (B27)
NO .............................................................................................. 00 (B29_11aCHECK)
DON’T KNOW ............................................................................ d (B29_11aCHECK)
REFUSED .................................................................................. r (B29_11aCHECK)
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) AND (B26=01)
B27.
What are they?
INTERVIEWER: ENTER VERBATIM RESPONSE

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B29_11aCHECK. IS PHYSICAL OR MENTAL CONDITION REASON NOT WORKING (B25a=01)?
YES ............................................................................................ 01 (BP3)
NO .............................................................................................. 00 (B29_11CHECK)
(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) AND (B25_a=01)
BP3.
You said that one of the reasons {you are/NAME is} not working is because a physical or mental health
condition prevents {you/him/her} from working. I am going to read you a list of reasons why some people say
their health prevents them from working. For each, please tell me “yes” if it is a reason why {your/NAME’s}
health prevents {you/him/her} from working. You may say yes to more than one reason. (NEW)

YES

NO

DON’T
KNOW

REFUSED

a.

{Your/NAME’s} health would interfere with job performance

01

00

d

r

b.

{You do/NAME does} not have the physical energy or stamina
required to work at a job

01

00

d

r

{You experience/NAME experiences} severe pain that interferes
with a job or work schedule

01

00

d

r

d.

Working at a job is too stressful

01

00

d

r

e.

Work would be physically harmful to {your/NAME’s} health

01

00

d

r

f.

Medical and therapy appointments {you need/NAME needs} for
your health condition interfere with a regular work schedule

01

00

d

r

g.

The time {you need/NAME needs} for personal care and to take
care of {your/his/her} health interferes with a regular work schedule

01

00

d

r

h.

{Your/NAME’s} health goes up and down in unpredictable ways

01

00

d

r

i.

{You are/NAME is} unable to get the medical treatment {you
need/he needs/she needs} to improve {your/his/her} health enough
to go to work

01

00

d

r

Any other reasons not mentioned?

01

00

d

r

c.

j.

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) and (BP3_j=01)
BP3._Oth
What other reasons?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

B-18

d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B29_11CHECK. IS LOSING BENEFITS REASON NOT WORKING (B25i=01)?
YES ............................................................................................ 01 (B29_11a)
NO .............................................................................................. 00 (B29_12CHECK)

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) AND (B25i=01)
B29_11a. You said that one of the reasons {you/he/NAME} {are/is} not working is because {you do / he does / she
does} not want to lose benefits (you need / he needs / she needs) such as Social Security, disability
insurance, workers’ compensation, or Medicaid. There are many ways people find out about how working
will affect their benefits. For example, some people call the Social Security office, some search the
Internet, and others contact disability service organizations. Did {you/NAME} contact anyone or do any of
these things in order to find out how {your/his/her} benefits would be affected if {you/he/she} went to work?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) AND (B25i=01) AND B29_11a=response
B29_11b. What benefits {were/was} {you/NAME} most worried about losing?
INTERVIEWER: MARK ALL THAT APPLY.
PRIVATE DISABILITY INSURANCE ..........................................
WORKERS’ COMPENSATION ..................................................
VETERANS’ BENEFITS .............................................................
MEDICARE.................................................................................
MEDICAID ..................................................................................
SSA DISABILITY BENEFITS......................................................
PUBLIC ASSISTANCE OR WELFARE ......................................
FOOD STAMPS .........................................................................
PERSONAL ASSISTANCE SERVICES (PAS) ..........................
UNEMPLOYMENT BENEFITS ...................................................
OTHER STATE DISABILITY BENEFITS ....................................
OTHER GOVERNMENT PROGRAMS ......................................
OTHER (SPECIFY) ....................................................................

01
02
03
04
05
06
07
08
09
10
11
12
13 (B29_11b_oth)

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r) AND (B25i=01) AND (B29_11b=13)
B29_11b_Oth: What other benefits?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B28=00, d, or r) OR (B29_1a=d or r) OR (B29_1b=d or r)
B29_12CHECK. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (B30)
NO .............................................................................................. 00

B-19

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

((B28=00, d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r) AND (RTYPE=01)
B29_8CHECK: DID RESPONDENT GIVE PHYSICAL OR MENTAL CONDITION AS ONLY REASON NOT
WORKING (( (B25_b, B25_c, B25_d, B25_f, B25_g, B25_h, B25_i, B25_j, B25_l, B25_m, B25_n, B25_o=00, d, OR
r) and (B26 0, d, r)?
YES ............................................................................................ 01 (B30)
NO .............................................................................................. 00 (B29_12a)

RTYPE = 1 AND ((at least one item in B25_b, B25_c, B25_d, B25_f, B25_g, B25_h, B25_i, B25_j, B25_l, B25_m,
B25_n, B25_o= 1) or B26 = 1)
B29_12a. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary
you would be willing to accept for such a job?
INTERVIEWER: IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: If you have no idea, just
say so. IF R SAYS HAS NO INTEREST IN WORKING, CODE AS DON’T KNOW.
INTERVIEWER: Read only if necessary, otherwise code:
$|

|

|

|,|

|

|

|.|

|

|

DON’T KNOW ............................................................................
REFUSED ..................................................................................
B29_12ahop. Is this:
HOURLY .................................................
DAILY ......................................................
WEEKLY .................................................
BI-WEEKLY .............................................
TWICE A MONTH ...................................
MONTHLY ...............................................
ANNUALLY..............................................
DON’T KNOW .........................................
REFUSED ...............................................

01
02
03
04
05
06
07
d
r

(1-25)
(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)
(B29_12b)
(B29_12b)

d (B30)
r (B30)

(1-300)
(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

(B30)
(B29_12b)
(B29_12b)
(B29_12b)
(B29_12b)
(B29_12b)
(B29_12b)

PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_12ahop OUT OF RANGE
B29_12check

Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary
you would have accepted for this job is [insert ((B29_12a and B29_12ahop). Is this correct?”
CHANGE LOWEST WAGE OR SALARY ................................... 01 (CHANGE B29_12a)
CHANGE PAY PERIOD ............................................................. 02 (CHANGE B29_12ahop)
SUPPRESS ................................................................................ 03

(B29_12ahop=02, 03, 04, 05, 06, 07, d, or r)
B29_12b. How many hours per week would you expect to work for this amount of pay?
| | |
(B30)
HOURS
(1-99)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d (B29_12c)
r (B29_12c)

(B29_12b=d or r)
B29_12c. Would you expect to work full-time or part-time?
FULL-TIME ................................................................................. 01
PART-TIME ................................................................................ 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

B-20

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(All)
B30.

Did {you/NAME} work at a job or business for pay or profit anytime in 2016?
YES ............................................................................................ 01 (B33)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

PROGRAMMER NOTE: If B24=01 or B24b = 1 or B30=01, go to B33. Else, go to B30_b.
NEW ITEM
((B24 = 0, d, r, or B24b=0, d, r) and B30=0, d, r)
B30_b. {Have you/Has NAME} worked for pay or profit since {you/NAME} started receiving disability benefits?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00 (B33)
DON’T KNOW ............................................................................ d (B33)
REFUSED .................................................................................. r (B33)
(All)
B33.

CHECK: WAS {NAME} WORKING WHEN LIMITATION BEGAN (B22=01)?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00

(B33=00) OR (B34=00)
B34
CHECK: IS {NAME} CURRENTLY WORKING (B24=01) OR WORKED IN PAST 6 MONTHS (B24b=01)?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00
(B33=00 and B34=00)
B35.
CHECK: DID {NAME} WORK IN 2016 (B30=01)?
YES ............................................................................................ 01 (B37)
NO .............................................................................................. 00
(B30b=00, d, or r) or (B33=00 and B34=00 and B35=00)
B36.
{Have you/Has NAME} ever worked for pay or profit?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B37)
DON’T KNOW ............................................................................ d (B37)
REFUSED .................................................................................. r (B37)
(B36=01)
B36b. In what year did {you/NAME} last work for pay or profit? (NEW)
PROBE: We are interested in both full-time and part-time work for pay or profit.
PROBE: Did {you/NAME} last work for pay or profit more than 5 years ago? More than 10 years
ago? More than 20 years ago?
| | | | | ..............................................................
YEAR
(1933-2017)
DON’T KNOW ................................................................. d
REFUSED ....................................................................... r

B-21

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(All)
B37.

Do {your/NAME’s} personal goals include working at a job, moving up in a job, or learning new job skills?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
B37a.

Do {your/NAME’s} personal goals include someday working and earning enough to stop receiving Social
Security disability benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
B38.

{Do you/Does NAME} ever discuss work and career goals with family, friends, or anyone else?
YES ............................................................................................ 01
NO .............................................................................................. 00 (B47)
DON’T KNOW ............................................................................ d (B47)
REFUSED .................................................................................. r (B47)

(B38=01)
B39.
Who is the main person {you discuss/NAME discusses} work goals with?
INTERVIEWER: MARK ONLY ONE.
PARENT/GUARDIAN .................................................................
SPOUSE/PARTNER ..................................................................
FRIEND ......................................................................................
JOB COACH...............................................................................
EMPLOYER/SUPERVISOR .......................................................
OTHER RELATIVE.....................................................................
CASEWORKER/COUNSELOR/PROGRAM STAFF ..................
MEDICAL PROVIDER ................................................................
OTHER NON-RELATIVE ...........................................................
OTHER (SPECIFY) ...................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
08
10
09
d
r

(B38=01 and B39=09)
B39_oth. Who was it?
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

B-22

d
r

(B40)
(B40)
(B40)
(B40)
(B40)
(B40)
(B40)
(B40)
(B39_oth)
(B39_oth)
(B47)
(B47)

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B38=01 and B39=01-10)
B40.
Please tell me how much you agree or disagree with the following statement. Would you say you strongly
agree, agree, disagree, or strongly disagree? {Your/NAME’s} {RESPONSE FROM B39} thinks
{your/NAME’s} personal goals should include working at a job, moving up in a job, or learning new job skills.
STRONGLY AGREE ..................................................................
AGREE.......................................................................................
DISAGREE .................................................................................
STRONGLY DISAGREE ............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
B47.

01
02
03
04
d
r

(B47)
(B47)
(B47)
(B47)
(B47)
(B47)

Please tell me how much you agree or disagree with the following statements. Would you say you strongly
agree, agree, disagree, or strongly disagree?

a.

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

DON’T
KNOW

REFUSED

01

02

03

04

d

r

You see {yourself/NAME}
working and earning enough
to stop receiving disability
benefits in the next two years.

01

02

03

04

d

r

You see {yourself/NAME} {(IF
B24=01) continuing to work/
(IF B24=00,d, r) working} for
pay in the next five years.

01

02

03

04

d

r

01

02

03

04

d

r

You see {yourself/NAME} {(IF
B24=01) continuing to work/
(IF B24=00,d, r) working} for
pay in the next two years.

(ASK B47b IF B47a=01,02,
OTHERWISE GO TO B47c)
b.

c.

{ASK B47d IF B47c=01,02,
OTHERWISE GO TO B48)
d.

B-23

You see {yourself/NAME}
working and earning enough
to stop receiving disability
benefits in the next five years

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(B47_a=3 OR 4) AND (B47c=3 OR 4)
BP4a. Why don’t you see {yourself/NAME} working in the near future? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
HEALTH-RELATED REASONS
EXISTING HEALTH PROBLEM GETS WORSE ..................................
GET INJURED ......................................................................................
WORK HAS A NEGATIVE IMPACT ON HEALTH ................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ..........................................
HEALTH INTERFERES WITH JOB PERFORMANCE. ........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG ..................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY .........................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
WORK IS TOO STRESSFUL ...............................................................
EMPLOYMENT-RELATED REASONS
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
HEALTH INTERFERES WITH JOB PERFORMANCE .........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .................
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ................................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
PERSONALITY CONFLICTS WITH OTHERS AT WORK....................
PERSONAL CIRCUMSTANCES
NEED TO CARE FOR CHILDREN OR OTHERS .................................
NEED PERSONAL ASSISTANCE TO GET READY FOR
WORK EACH DAY ...............................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE.............................................................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK ..............................................................................
DRUG/ALCOHOL RELAPSE ...............................................................
WOULD RATHER DO OTHER THINGS THAN WORK .......................
DO NOT LIKE WORKING ....................................................................
WORK IS TOO STRESSFUL ...............................................................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW ......................................................................................
REFUSED ............................................................................................

B-24

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27 (Bp4_oth)
d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(BP4a=27)
BP4a_oth. INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(If B47a=01 OR 02 and B47_b=03 OR 04) OR (B47_c=01 OR 02 and B47_d=03 OR 04)
BP4b. Why do you not see {yourself/NAME} working enough to leave benefits in the near future? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
HEALTH-RELATED REASONS
EXISTING HEALTH PROBLEM GETS WORSE ..................................
GET INJURED ......................................................................................
WORK HAS A NEGATIVE IMPACT ON HEALTH ................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ..........................................
HEALTH INTERFERES WITH JOB PERFORMANCE .........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG ..................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY .........................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
WORK IS TOO STRESSFUL ...............................................................
EMPLOYMENT-RELATED REASONS
NEED TIME TO GO TO MEDICAL APPOINTMENTS..........................
HEALTH INTERFERES WITH JOB PERFORMANCE .........................
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .................................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .................
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ................................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK .........................................
PERSONALITY CONFLICTS WITH OTHERS AT WORK....................
PERSONAL CIRCUMSTANCES
NEED TO CARE FOR CHILDREN OR OTHERS .................................
NEED PERSONAL ASSISTANCE TO GET READY FOR
WORK EACH DAY ...............................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE.............................................................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK ..............................................................................
DRUG/ALCOHOL RELAPSE ...............................................................
WOULD RATHER DO OTHER THINGS THAN WORK .......................
DO NOT LIKE WORKING ....................................................................
WORK IS TOO STRESSFUL ...............................................................
OTHER (SPECIFY) ..............................................................................
DON’T KNOW ......................................................................................
REFUSED ............................................................................................
B-25

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27 (Bp4a_oth)
d
r

SECTION B UNIVERSE: ALL WHO PASSED SECTION A
QUESTIONS NEEDED FROM SECTION A: RTYPE, CURRENT AGE
PRELOADED VARIABLES: NONE

(BP4b=27)
BP4b_oth. INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
B48.

d
r

CHECK: IS {NAME} CURRENTLY WORKING (B24 = 01)?
YES ............................................................................................ 01 (C1)
NO .............................................................................................. 00

(B48=00)
B48a. CHECK: WAS (NAME) WORKING IN THE LAST 6 MONTHS (B24b=01)?
YES ............................................................................................ 01 (C_B_1)
NO .............................................................................................. 00
B49.

CHECK: WAS {NAME} WORKING IN 2016 (B30 = 01)?
YES ............................................................................................ 01 (D1)
NO .............................................................................................. 00 (SC1CHECK)

B-26

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

SECTION C: CURRENT EMPLOYMENT
(B24=01)
C1.
Now I am going to ask some questions about the jobs {you/NAME} currently {have/has}. When answering
these questions, please include both part-time and full-time jobs, but only include jobs {you hold/NAME
holds} for pay or profit.
How many jobs {do you/does NAME} currently have?
|__|__| NUMBER OF JOBS (1-5)
(1-15)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B24=01l)
C1a. What are the main reasons {you/NAME} decided to work? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
TO HAVE MORE INCOME .............................................
TO FEEL BETTER ABOUT MYSELF/IMPROVE
WELL BEING ..................................................................
TO FEEL MORE INDEPENDENT ...................................
TO ACHIEVE PERSONAL CAREER GOALS .................
ENJOY WORKING/PERSONAL SATISFACTION ..........
DON’T WANT TO RELY ON BENEFITS .........................
HEALTH IMPROVED ......................................................
HAD MORE TIME/STOPPED DOING
SOMETHING ELSE ........................................................
OTHER (SPECIFY) .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01 (C2)
02
03
04
05
06
07

(C2)
(C2)
(C2)
(C2)
(C2)
(C2)

08
09
d
r

(C2)
(C1a_oth)
(C2)
(C2)

(C1a=09)
C1a_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C-1

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER: C2 THROUGH C14 ASKED FOR ALL JOBS WHEN C1>01
(B24=01)
C2.
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND FIRST JOB:
Let us start with {your/NAME’s} main job – that is, the job at which {you work/(he/she) works} the most
hours.
What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
Now I would like to ask about {your/NAME’S} {second/third/fourth} job.
What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?
ELSE (C1=01):
What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high
school; sales clerk in a women’s shoe store.
PROBE 2: What are {your/NAME’S} main activities or duties? What else {do you/does NAME} do? What
else? {Do you /Does NAME} supervise anyone?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B24=01)
C3.
What kind of business is this?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For what type of organization or industry {do you/does NAME} work? For example: accounting
firm, daycare center, educational facility, food services.
PROBE 2: What do they make, sell, or do where {you work/NAME works}?
PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses),
or retail trade (selling to customers) or something else?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B24=01)
C4mth. In what month and year did {you/NAME} start working there?
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
PROBE: Your best estimate is fine.
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................

C-2

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(B24=01)
C4yr.
PROBE 1: In what month and year did {you/NAME} start working there?
INTERVIEWER: ENTER YEAR
PROBE 2: Your best estimate is fine.
|__|__|__|__| (1981-2017)
YEAR
(1951-2017)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B24=01)
C5.
SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (C4yr) SHOULD BE GREATER THAN
OR EQUAL TO YEAR OF BIRTH (A04_d) PLUS 14 YEARS.
IF RESPONDENT FAILS EDIT,
INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born
in (A04_d) and {you/NAME} started working at this job in (C4yr), which means {you/NAME} started working
at this job when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE: C4YR – YEAR
OF BIRTH) years old. Is that correct?
YES ............................................................................................ 01
NO .............................................................................................. 02 (CHANGE C4YR)
SUPPRESS ................................................................................ 03
(B24=01)
C5A.
Beneficiaries do not always know that they should report a change in work status to Social Security. Around
that time did {you/NAME} let Social Security know that {you were/ (he/she) was} working?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C6)
DON’T KNOW ............................................................................ d (C6)
REFUSED .................................................................................. r (C6)
(C5a=01)
C5B.
How soon after {you/NAME} started this job did {you/NAME} tell Social Security {you were/(he/she) was}
working?
PROBE: Your best estimate is fine.
INTERVIEWER: IF R TOLD SSA BEFORE STARTED WORKING, CODE AS 1 WEEK.
WEEKS ...................................................................................... 01 (C5BWeek)
MONTHS .................................................................................... 02 (C5BMonth)
DON’T KNOW ............................................................................ d (C6)
REFUSED .................................................................................. r (C6)
(C5a=01 and C5b=01)
C5BWEEK. INTERVIEWER: ENTER NUMBER OF WEEKS
| | | WEEKS
(1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

C-3

d (C6)
r (C6)

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C5a=01 and C5b=02)
C5BMonth. INTERVIEWER: ENTER NUMBER OF MONTHS
| | | WEEKS/MONTHS
(1-12)
DON’T ........................................................................................
REFUSED ..................................................................................

d (C6)
r (C6)

(B24=01)
C6.
{Are you/Is NAME} self-employed at this job?
PROBE: Self-employed means that you work for yourself/ or own your own business.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(B24=01)
C7.
There are a number of special work programs available to people with disabilities. Is {your/NAME’s} job part
of a sheltered workshop program, transitional employment program, the Business Enterprise Program for
the blind, or a supported employment program?
PROBE:

A sheltered workshop is a program that provides employment with subsidized wages (or special
wages that would not be available in a regular job) for people with disabilities. A transitional
employment program allows workers with disabilities to work at reduced levels while they ease
back into the workplace.
The Business Enterprise Program for the blind offers legally blind persons the opportunity to
own their own businesses. Supported employment programs provide job coaches or other
on-the-job supports to help individuals with disabilities get and keep jobs.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(B24=01)
C8.
How many hours per week {do you/does NAME} usually work at this job?
PROBE: Include overtime if {you/he/she} usually {work/works} overtime.
|

|

|

| HOURS PER WEEK (1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(B24=01)
C9.
How many weeks per year {do you/does NAME} usually work at this job, including paid vacation and
holidays?
PROBE 1: There are 52 weeks in a year.
PROBE 2: Please include time off for vacation and holidays if {you are/NAME is} paid for that time.
PROBE 3: If {you have/NAME has} worked less than a year, please answer for the number of weeks
{you expect/NAME expects} to work.
|

|

| WEEKS PER YEAR (1-52)

DON’T KNOW ............................................................................
REFUSED ..................................................................................
C-4

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

C-5

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(B24=01)
C10.
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND FIRST JOB:
For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is}
paid on this job. On {your/NAME’s} main job {are you/is (he/she} paid by the hour?
PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is}
paid on {your/(his/her)} {second/third/fourth} job. On {your/NAME’s} {second/third/fourth} job {are you/is
(he/she} paid by the hour? ELSE (C1=01): For the purpose of this survey, it is important to obtain some
information on how much {you are/NAME is} paid on {your/(his/her)} current job. On {your/NAME’s} current
job {are you/is (he/she} paid by the hour?
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:

{Your/NAME’s} main job is the job we have been talking about. The one at which {you
work/(he/she) works} the most hours.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C12amt)
DON’T KNOW ............................................................................ d (C12amt)
REFUSED .................................................................................. r (C12amt)

(C10=01)
C11.
What is {your/NAME’s} regular hourly pay, including tips and commissions?
PROBE: IF LESS THAN $5.00 AN HOUR: Does this include tips and commissions?
INTERVIEWER: IF ENTERING AN AMOUNT WITH CENTS, PLEASE ENTER DECIMAL POINT
$|

|

|

|.|

|

| PER HOUR (1 – 25.00) (1 - 300.00)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

IF C1>1 AND HAVE NOT ASKED ABOUT ALL JOBS, LOOP BACK TO C2.
ELSE, GO TO C15
(C10=00, d, or r)
C12amt. Before taxes and other deductions how much {are you/is NAME} paid on this job, including tips and
commissions.
PROBE:

Is that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|

|

|

|.|

|

|

| . 00

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

C-6

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C10=00, d, or r)
C12hop. INTERVIEWER: ENTER HOW OFTEN PAID
DAILY...................................................................
WEEKLY ..............................................................
BI-WEEKLY .........................................................
TWICE A MONTH ................................................
MONTHLY ...........................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................

01
02
03
04
05
06
d
r

(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)

(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

PROGRAMMER: CALCULATE MONTHLY PRE-TAX PAY BASED ON C12AMT AND C12HOP FOR EACH JOB:
If C10=01, and C11and C8≠d or r, C_JobMnthPay(1)=c11*c8*4.35.
If C10=01 and C8 or C11=d, C_JobMnthPay(1)=d.
If C10=01 and C8 or C11=r and neither are d, C_JobMnthPay(1)=r.
If C10=00, d, or r and C12amt or C12hop=d, C_JobMnthPay(1)=d.
If C10=00, d, or r and C12amt or C12hop=r, and neither are d, C_JobMnthPay(1)=r.
If C10=00, d, or r and c12hop=1, C_JobMnthPay(1)=c12amt*21.74.
If C10=00, d, or r and c12hop=2, C_JobMnthPay(1)=c12amt*4.35.
If C10=00, d, or r and c12hop=3, C_JobMnthPay(1)=c12amt*2.17.
If C10=00, d, or r and c12hop=4, C_JobMnthPay(1)=c12amt*2.
If C10=00, d, or r and c12hop=5, C_JobMnthPay(1)=c12amt.
If C10=00, d, or r and c12hop=6, C_JobMnthPay(1)=c12amt/12.
(C10=00, d, or r)
C13amt. For this job, about how much is left as take-home pay after taxes and other deductions?
PROBE:

Is that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|

|

|

|.|

|

|

| . 00

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C10=00, d, or r)
C13hop. INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY ..........................................................
TWICE A MONTH ................................................
MONTHLY ............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................

C-7

01
02
03
04
05
06
d
r

(1-346)
(1-1,730)
(1-3,750)
(1-3,750)
(1-7,500)
(1-90,000)

(1-1,730)
(1-8,653)
(1-18,750)
(1-18,750)
(1-37,500)
(1-450,000)

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER: CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON C13AMT AND C13HOP:
If C10=01 and C11 and C8≠d or r, C_JobMnthPayTH(1)=c11*c8*4.35.
If C10=01 and C8_1 or C11=d, C_JobMnthPayTH(1)=d.
If C10=01 and C8_1 or C11=r and neither are d, C_JobMnthPayTH(1)=r.
If C10=00, d, or r and C13amt or C13hop=d, C_JobMnthPayTH(1)=d.
If C10=00, d, or r and C13amt or C13hop=r, and neither are d, C_JobMnthPayTH(1)=r.
If C10=00, d, or r and c13hop=1, C_JobMnthPayTH(1)=c13amt*21.74.
If C10=00, d, or r and c13hop=2, C_JobMnthPayTH(1) =c13amt*4.35.
If C10=00, d, or r and c13hop=3, C_JobMnthPayTH(1)=c13amt*2.17.
If C10=00, d, or r and c13hop=4, C_JobMnthPayTH(1)=c13amt*2.
If C10=00, d, or r and c13hop=5, C_JobMnthPayTH(1)=c13amt.
If C10=00, d, or r and c13hop=6, C_JobMnthPayTH(1)=c13amt/12.
(C10=00, d, or r) and (C12hop=01, 02, 03, 04, 05, or 06) and (C13hop=01, 02, 03, 04, 05, or 06)
C14.
SOFT EDIT: AMOUNT OF TAKE-HOME PAY MUST BE LESS THAN OR EQUAL T0 PRE-TAX PAY. IF
AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND
AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY (C_JobMnthPay(1)) NE D OR R, AND
C_JobMnthPayTH(1) > C_JobMnthPay(1), TRIGGER EDIT AND DISPLAY FOLLOWING TEXT:
INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY IS GREATER THAN AMOUNT
OF CALCULATED PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an
incorrect answer. You said that {you are/NAME is} paid (C12amt) per (C12hop) before taxes and other
deductions which would be about (C_JobMnthPay(1) per month and that (C13amt) per (C13hop), or about
(C_JobMnthPayTH(1) per month, is left as take-home pay after taxes and other deductions. Based on what
I recorded, your take home pay is more than your pre-tax pay. Should I change the amount
{you are/NAME is} paid before taxes and other deductions or the amount {you take/NAME takes} home after
taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS .................................................................... 01 CHANGE C12amt)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE C13amt)
SUPPRESS ................................................................................ 03

C-8

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C10=00, d, or r) and (C12hop=01, 02, 03, 04, 05, or 06) and (C13hop=01, 02, 03, 04, 05, or 06)
C14a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND
CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF TAKE MONTHLY
HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY
(C_JobMnthPay(1)) NE D OR R, AND (C_JobMnthPay(1) - C_JobMnthPayTH(1) / C_JobMnthPayTH(1) >
.30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, DIFFERENCE IN AMOUNT OF
CALCULATED MONTHLY TAKE HOME PAY AND CALCULATED MONTHLY PRE-TAX PAY IS GREATER
THAN 30%. CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said
that {you are/NAME is} paid (C12amt) per (C12hop) before taxes and other deductions which would be
about (C_JobMnthPay(1) per month and that (C13amt) per (C13hop), or about (C_JobMnthPayTH(1) per
month is left as take-home pay after taxes and other deductions. Is this correct or should I change the
amount {you are/NAME is} paid before taxes and other deductions or the amount {you take/NAME takes}
home after taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS .................................................................... 01 CHANGE C12amt)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE C13amt)
SUPPRESS ................................................................................ 03
PROGRAMMER: CALCULATE TOTAL MONTHLY PAY FROM ALL JOBS COMBINED (TO BE USED LATER IN
SECTION K):
If C_JobMnthPay(1) or C_JobMnthPay(2) or C_JobMnthPay(3) (for all jobs listed)=d,
C_CurMnthPay=d.
If C_JobMnthPay(1) or C_JobMnthPay(2) or C_JobMnthPay(3) (for all jobs listed)=r, and none=d,
C_CurMnthPay=r. Else, C_CurMnthPay=Sum of (C_JobMnthPay(1) AND C_JobMnthPay(2) AND
C_JobMnthPay(3), etc. (for all jobs listed)).

(B24=01)
C15.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (CP4)
NO .............................................................................................. 00 (CP2)
(C1=>1 AND C15 = 00)
CP2.
How did {you/NAME} find {your/his/her} (main/current) job? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE ....................
AMERICA’S WORKFORCE CENTERS .....................................
THROUGH FRIENDS OR RELATIVES .....................................
THROUGH JOB ADVERTISEMENTS IN A NEWSPAPER
OR ON THE INTERNET ............................................................
THROUGH THE STATE VOCATIONAL REHABILITATION
AGENCY OR {VRNAME FROM {NAME’S} CURRENT STATE}
THROUGH A PRIVATE EMPLOYMENT AGENCY OR
PROGRAM .................................................................................
BY CONTACTING A FORMER EMPLOYER .............................
BY CONTACTING ANY OTHER EMPLOYERS .........................
OTHER (SPECIFY) ....................................................................
(CP2=09)
CP2_Oth.

04 (CP2a)
05 (CP2a)
06
07
08
09

What other way did {you/NAME} find this job?
Other (SPECIFY)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

C-9

01 (CP2a)
02 (CP2a)
03 (CP2a)

d
r

(CP2a)
(CP2a)
(CP2a)
(CP2_Oth)

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1=>1 AND C15 = 00)
CP2a. CHECK: DID {NAME} MENTION MORE THAN ONE WAY FOUND MAIN/CURRENT JOB IN CP2?
YES ............................................................................................ 01 (CP2b)
NO .............................................................................................. 00 (CP3)
(C1=>1 AND C15 = 00 AND CP2a= 01)
CP2b. What was the main way {you/NAME} found {your/his/her} (main/current) job? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE ....................
AMERICA’S WORKFORCE CENTERS .....................................
THROUGH FRIENDS OR RELATIVES .....................................
THROUGH JOB ADVERTISEMENTS IN A NEWSPAPER OR
ON THE INTERNET ...................................................................
THROUGH THE STATE VOCATIONAL REHABILITATION
AGENCY OR {VRNAME FROM {NAME’S} CURRENT STATE}
THROUGH A PRIVATE EMPLOYMENT AGENCY OR
PROGRAM .................................................................................
BY CONTACTING A FORMER EMPLOYER .............................
BY CONTACTING ANY OTHER EMPLOYERS .........................
OTHER (SPECIFY) ....................................................................
(CP2b=09)
CP2_Oth.

04 (CP3)
05 (CP3)
06
07
08
09

(CP3)
(CP3)
(CP3)
(CP2_Oth)

What other way did {you/NAME} find this job?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C-10

01 (CP3)
02 (CP3)
03 (CP3)

d (CP3)
r (CP3)

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1=>1 AND C15 = 00)
CP3.
I am going to read a list of things that some people use or receive to help them find or keep a job. Please tell
me if {you/NAME} used or received each to help find or keep working at {your/his/her} (main/current) job. Did
{you/NAME}…
YES

NO

NA

DON’T
KNOW

REFUSED

a.

…use a job coach?

01

00

na

d

r

b.

…use a sign language interpreter?

01

00

na

d

r

c.

…use a reader or interpreter for the blind?

01

00

na

d

r

d.

…use an assistant or caregiver for personal care? (IF
NEEDED: This includes help bathing and dressing to
get ready for work and eating lunch or using the
restroom at work)

01

00

na

d

r

e. …use a personal assistant at work to help with jobrelated tasks? (IF NEEDED: This includes help with
writing, reading, lifting, or reaching).
f.

…receive on the job training?

01

00

na

d

r

g.

…receive counseling about how work will affect your
benefits?

01

00

na

d

r

h.

…receive help with transportation?

01

00

na

d

r

i.

…receive help with child or family care?

01

00

na

d

r

j.

… use special equipment or devices?

01

00

na

d

r

(C1=>1 AND C15 = 00) AND (CP3j=01)
CP3k.1. What special equipment or devices did you use?
INTERVIEWER: CODE ALL THAT APPLY.
BRACE .......................................................................................
CANE/CRUTCHES/WALKER.....................................................
WHEELCHAIR............................................................................
MODIFIED COMPUTER HARDWARE .......................................
MODIFIED COMPUTER SOFTWARE .......................................
HEARING AID/DEVICE ..............................................................
SPECIAL GLASSES ...................................................................
SPECIAL CHAIR/BACK SUPPORT ...........................................
SPECIAL SHOES/STOCKINGS .................................................
OTHER (SPECIFY) __________________________________
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(CP3k.1=06)
CP3k.1_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C-11

d
r

01
02
03
04
05
07
08
09
10
06 (CP3k.1_oth)
d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1=>1 AND C15 = 00)
CP3l.
Did {you/NAME} use or receive anything else to help find or keep working at {your/his/her} (main/current)
job?
YES .................................................................................
NO ...................................................................................
NOT APPLICABLE ..........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01 (CP3lm_oth)
00
na
d
r

(CP3l=01)
CP3lm_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C1=>1 AND C15 = 00 or 01)
CP4.
Did a friend, family member, coworker, caseworker, or anyone else help {you/him/her} find or keep working
[IF C15=00 keep working} {your/his/her} (main/current) job? (NEW)
PROBE: Help could include telling you about a job, helping you get ready for an interview, making a
connection for you, or giving you support or encouragement.
YES ...................................................................................
NO.....................................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................

01
00
d
r

(CP5)
(CP7)
(CP7)
(CP7)

(CP4=01)
CP5.
Who did {you/NAME} get help from? (NEW) Code all that apply.
A PARENT OR GUARDIAN ............................................
A SPOUSE OR PARTNER .............................................
ANOTHER RELATIVE ....................................................
A FRIEND OR MENTOR.................................................
AN EMPLOYER OR SUPERVISOR................................
A CO-WORKER ..............................................................
A CASEWORKER OR COUNSELOR .............................
A JOB COACH ................................................................
A MEDICAL PROVIDER .................................................
OTHER (SPECIFY) .........................................................
(CP5=10)
CP5_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C-12

01
02
03
04
05
06
07
08
09
10 (CP5_oth.)

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(CP4=01)
CP6.
What kind of help did {you/NAME} get from these people? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
HELP CARING FOR CHILDREN OR OTHERS ..............
HELP WITH PERSONAL CARE .....................................
TRANSPORTATION .......................................................
HELP FINDING A JOB ....................................................
TRAINING .......................................................................
SOMEONE TO TALK TO/GET ADVICE .........................
HELP GETTING ACCOMMODATIONS ..........................
FINANCIAL ASSISTANCE ..............................................
OTHER (SPECIFY) .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
02
03
04
05
06
07
08
09 (CP6_oth)
d
r

(CP6=09)
CP6_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C1=>1 AND C15 = 00)
CP7.
As far as you know does anyone at {your/NAME’s} (main/current) job know that you have a disability? (NOD
2010 Q930 modified)
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
00 (CP8)
d (CP8)
r (CP8)

(CP7=01)
CP7a. Who at {your/NAME’s} (main/current) job knows that you have a disability? (NOD 2010 Q935)

YES

NO

NA

DON’T
KNOW

REFUSED

{Your/NAME’s} co-workers?

01

00

na

d

r

b.

{Your/NAME’s} manager, supervisor, or boss?

01

00

na

d

r

c.

Other staff responsible for hiring or providing
accommodations (such as Human Resources)?

01

00

na

d

r

Anyone else?

01

00

na

d

r

a.

d.

PROGRAMMER NOTE: If CP7a_d=01, go to CP7a_oth. Else, go to CP8.
CP7a_oth.
Who else?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C-13

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1=>1 AND C15 = 00)
CP8.
How comfortable or uncomfortable {do you/does NAME} feel about discussing {your/his/her} disability or
health condition with others at {your/his/her} (current/main} job? (modified from NOD 2010 Q925)
Very comfortable, ............................................................
Comfortable .....................................................................
Neither comfortable nor uncomfortable ...........................
Uncomfortable .................................................................
Very uncomfortable .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
02
03
04
05
d
r

(C1=>1 AND C15 = 00)
CP10. As far as you know, do other people with disabilities work at {your/NAME’s} (main/current) job? (NEW)
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
00
d
r

(C1=>1 AND C15=00)
C16.
{Have you/Has NAME} received any promotions at {your/his/her} (main/current) job during the past 12
months?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(B24=01)
C17.
CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (C19)
NO .............................................................................................. 00

(C1>=1 AND C17=00)
C18.
Taking all things into account, how satisfied are you with your {main/current} job? Would you say
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Very satisfied, ............................................................................
Somewhat satisfied, ..................................................................
Not very satisfied, or ..................................................................
Not at all satisfied? ....................................................................
DON’T KNOW ...........................................................................
REFUSED .................................................................................

01
02
03
04
d
r

(B24=01)
C19.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (C21)
NO .............................................................................................. 00

C-14

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1>=1 AND C19=00)
C20.
I am going to read to you a list of benefits that some employers offer their employees. Please tell me
whether or not {your/NAME’s} {main/current} employer offers {you/him/her} any of these benefits.
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Does {your/NAME’s} employer offer {you/NAME}
PROBE:

Please answer ‘yes’ if {you are/NAME is} eligible for the benefit but {haven’t/hasn’t} yet started
to receive it.
YES

NO

DON’T
KNOW

REFUSED

Health care insurance? (IF NECESSARY: medical and/or
hospital)

01

00

d

r

b.

Dental benefits?

01

00

d

r

c.

Sick days with pay?

01

00

d

r

d.

Paid vacation?

01

00

d

r

e.

Free or low-cost childcare?

01

00

d

r

f.

Transportation, a transportation allowance, or transportation
discounts?

01

00

d

r

g.

Long-term disability benefits?

01

00

d

r

h.

Pension or retirement benefits?

01

00

d

r

i.

Flexible health or dependent care spending accounts?

01

00

d

r

a.

(C1>=1)
C21.
CHECK: DOES {NAME} HAVE MORE THAN ONE CURRENT JOB (C1>01)?
YES ............................................................................................ 01
NO .............................................................................................. 00

(C1>=1)
C32.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (C34)
NO .............................................................................................. 00

C-15

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1>=1 AND C32=00)
C33.
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Please tell me whether or not {your/NAME’s} {main/current} employer has made any of these changes
because of {your/his/her} physical or mental health condition. Has {your/NAME’s} employer because of
{your/his/her} physical or mental health condition…
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:

a.

b.

c.

d.

e.

f.

{Your/NAME’s} main job is the job we have been talking about.
{you work/(he/she) works} the most hours.
YES

NO

DON’T
KNOW

REFUSED

Provided {you/NAME} with any special equipment or assistive
technology?
(PROBE: For example special tools or equipment, software,
or devices to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Made any changes in {your/NAME’s} work schedule?
(PROBE: For example, working fewer hours, changing the
time {you arrive or leave/(he/she) arrives or leaves}, or taking
more breaks to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Made any changes to the tasks {you were/NAME was}
assigned or how they are performed?
(PROBE: For example, a light duty job or less demanding job
tasks to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Made any changes to the physical work environment to make
things easier for {you/NAME}?
(PROBE: For example, modifying {your/his/her} work area,
improving accessibility in the building, or providing assigned
parking to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Arranged for co-workers or others to assist {you/NAME}?
(PROBE: For example, providing a personal care attendant,
interpreter, or job coach while at work.)

01

00

d

r

Made any other changes that I didn’t mention to
accommodate {your/NAME’s} condition in the workplace?

01

00

d

r

PROGRAMMER: IF C33f=01, GO TO C33f_Other, ELSE GO TO C34.

(C32=00 and C33f=01)
C33f_Other. What other changes?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

C-16

The one at which

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1>=1)
C34.
Are there any changes in {your/NAME’s} {main/current} job or workplace related to {your/his/her} physical or
mental health condition that {you need/(he/she) needs}, but that have not been made?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:

{Your/NAME’s} main job is the job that we have been talking about.
{you work/(he/she) works} the most hours.

The one at which

YES ............................................................................................ 01
NO .............................................................................................. 00 (C38)
DON’T KNOW ............................................................................ d (C38)
REFUSED .................................................................................. r (C38)

(C34=01)
C35.
What are those changes?
PROBE:

Anything else?

INTERVIEWER: ENTER VERBATIM RESPONSE

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C34=01)
C36.
CHECK: IS {NAME} SELF EMPLOYED (C6=01)?
YES ............................................................................................ 01 (C38)
NO .............................................................................................. 00

(C34=01 and C36=00)
C37.
Did {you/NAME} or anyone else ask {your/his/her} employer for (any of) these changes?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C1=>1)
CP12. Is there anything special about {your/NAME’s} (main/current) job that helps {you/NAME} to keep working
with a disability? (NEW)
YES ............................................................................................ 01
NO .............................................................................................. 00 (CP13a)
DON’T KNOW ............................................................................ d (CP13a)
REFUSED .................................................................................. r (CP13a)

C-17

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(CP12=01)
CP12a. What is special about {your/NAME’s} (main/current) job that helps {you/NAME} to keep working with a
disability? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
MODIFIED JOB DUTIES.................................................
SPECIAL EQUIPMENT OR MODIFIED SPACE .............
FLEXIBLE SCHEDULE ...................................................
WORK AT HOME ............................................................
HEALTH INSURANCE ....................................................
SICK LEAVE ...................................................................
SUPERVISOR UNDERSTANDS DISABILITY NEEDS ...
CO-WORKER ASSISTANCE ..........................................
OTHER(SPECIFY) .........................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
02
03
04
05
06
07
08
09 (CP12a_oth)
d
r

(CP12a=09)
CP12a_oth. What else about {your/NAME’s} (main/current) job allows {you/NAME} to keep working?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C1=>1)
(C1=>1) CP13a. Next I am going to ask you about types of problems some people experience that could cause
them to work less or stop working. During the past year, did {you/NAME} have any problems with… (NEW)

a.

b.

c.

YES

NO

DON’T
KNOW

REFUSED

{Your/NAME’s} health, that caused {you/him/her} to work
less or stop working, for example worsening illness or the
need to go to medical appointments,?

01

00

d

r

{Your/NAME’s} job, that caused {you/him/her} to work
less or stop working, for example the need for
accommodations, or problems with {your/NAME’s} coworkers?,?

01

00

d

r

{Your/NAME’s} personal circumstances, that caused
{you/him/her} to work less or stop working, for example
the need for childcare, not having reliable transportation,
or worry about losing other benefits?

01

00

d

r

PROGRAMMER NOTE: CP13A1 SHOULD BE ASKED IMMEDIATELY AFTER CP13A.A IF =YES. THEN CYCLE
BACK TO CP13A.B,

C-18

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(CP13a=01)
CP13.a1.What was it about {your/NAME’s} health that might have caused {you/NAME} to have to work less or stop
working? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
EXISTING HEALTH PROBLEM GETS WORSE ........................
NEW HEALTH PROBLEM STARTS ..........................................
GET INJURED ...........................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH .........................
NEED TO BE HOSPITALIZED ...................................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG .......................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY...............
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ...............................
WORK IS TOO TIRING OR STRESSFUL .................................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15 (CP13.a1_oth)
d
r

(CP13.a1=15)
CP13.a1_Oth. INTERVIEWER: Please specify.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

PROGRAMMER NOTE: CP13B1 SHOULD BE ASKED IMMEDIATELY AFTER CP13A.B IF =YES. THEN CYCLE
BACK TO CP13A.C,

C-19

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(CP13b=01)
CP13.b1. What was it about {your/NAME’s} (main/current) job that might have caused {you/NAME} to have to work
less or stop working? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
JOB DOES NOT PAY ENOUGH ................................................
JOB DOES NOT OFFER HEALTH INSURANCE BENEFITS ....
NEED A DIFFERENT SCHEDULE OR SHIFT ...........................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ......................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ...............................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
08
09
10
11 (CP13b1_oth)
d
r

(CP13.b1=11)
CP13.b1_Oth. INTERVIEWER: Please specify.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

C-20

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: CP13C1 SHOULD BE ASKED IMMEDIATELY AFTER CP13A.C IF =YES.
(CP13c=01)
CP13.c1.What was it about {your/NAME’s} personal circumstances that might have caused {you/NAME} to have to
work less or stop working? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
NEED HELP CARING FOR CHILDREN OR OTHERS ..............
NEED PERSONAL ASSISTANCE .............................................
GET INJURED ...........................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE ..................................................
PERSONALITY CONFLICTS WITH OTHERS AT THE JOB .....
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB ..................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK ....................................................................
DRUG/ALCOHOL RELAPSE .....................................................
WOULD RATHER DO OTHER THINGS THAN WORK .............
DO NOT LIKE WORKING ..........................................................
WORK IS TOO TIRING OR STRESSFUL .................................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
08
09
10
11
12 (CP13.c1_oth)
d
r

(CP13.c1=12)
CP13.c1_Oth. INTERVIEWER: Please specify.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

C-21

d
r

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(CP13a=01 or CP13b=01 or C13c=01)
CP14. What {did you/NAME do} or what things helped {you/NAME} to be able to keep working? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
WORKING FEWER HOURS A DAY ..........................................
WORKING FEWER DAYS A WEEK ..........................................
WORKING A DIFFERENT SHIFT ..............................................
A MORE FLEXIBLE SCHEDULE/ABLE TO START DAY LATER
HAVING/HAVING MORE SICK OR OTHER LEAVE .................
PERSONAL CARE ATTENDANT/PERSONAL ASSISTANT
TO HELP WITH GETTING READY AND/OR DO
HOUSEHOLD TASKS ................................................................
ASSISTANCE WITH WORK TASKS..........................................
MORE UNDERSTANDING EMPLOYER/CO-WORKERS .........
ASSISTIVE DEVICE AT WORK .................................................
PHYSICAL MODIFICATIONS OF WORKSPACE ......................
JOB COACH ..............................................................................
SIGN LANGUAGE INTERPRETER ...........................................
READER/INTERPRETER FOR THE BLIND ..............................
ON THE JOB TRAINING............................................................
BEHAVIORAL COACHING ........................................................
BENEFITS COUNSELING .........................................................
TRANSPORTATION ASSISTANCE...........................................
CHILD/FAMILY CARE ASSISTANCE ........................................
OTHER.......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(CP14=19)
CP14_oth.

01
02
03
04
05

06
07
08
09
10
11
12
13
14
15
16
17
18
19
d
r

(CP14_Oth)

What other things helped {you/NAME} be able to keep working?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C1>=1)
C38.
CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (C39a2)
NO .............................................................................................. 00

C-22

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1>=1 AND RTYPE=01)
C39.
Again, thinking about your {main/current} job, how much do you agree or disagree with each of the following
statements? Would you say you strongly agree, agree, disagree, or strongly disagree?
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:

Your main job is the job that we have been talking about. The one at which you work the most
hours.

a. You have a chance to develop your
abilities
b. You have recognition or respect from
others
c. You can work on your own in your job
if you want to
d. You can work with others in a group
or team if you want to
e. Your work is interesting or enjoyable
f. Your work gives you a feeling of
accomplishment or contribution
g. IF {NAME} IS NOT SELFEMPLOYED (C6=00, d, or r): Your
supervisor is supportive
ELSE: SKIP TO C39_h
h. Your co-workers are friendly and
supportive

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

NA

DON’T
KNOW

REFUSED

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

(C1>=1)
C39a2. Sometimes people work fewer hours or earn less money than they could in order to care for family
members, keep the cash benefits they need, or just to have more free time. In (your/NAME’s) (main/current
job), (do you/ does he/ does she) work fewer hours or earn less money than (you/he/she) could for any
reason?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C39_1)
DON’T KNOW ............................................................................ d (C39_1)
REFUSED .................................................................................. r (C39_1)

C-23

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1>=1 AND C39a2=01)
C39b. (Do you/Does NAME) work fewer hours or earn less money than (you/he/she) could because (you/he/she)…
PROBE:

I need to ask everyone in our study the same questions, even if they don’t seem to apply to
(you/NAME).
YES

NO

DON’T
KNOW

REFUSED

a.

{Are/Is} taking care of children or others?

01

00

d

r

b.

{Are/Is} enrolled in school or a training program?

01

00

d

r

c.

Want(s) to keep Medicare or Medicaid coverage?

01

00

d

r

d.

Want(s) to keep cash benefits (you/he/she) need such as
disability or workers compensation?

01

00

d

r

e.

Just (do/does) not want to work more?

01

00

d

r

f.

Are there any reasons I didn’t mention why (you are/NAME
is) working or earning less than (you/he/she) could?

01

00

d

r

PROGRAMMER: IF C39b_f=01 GO TO C39f_Other, ELSE SKIP TO C39_1
(C39b_f=01)
C39f_Other What other reason?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C1>=1)
C39_1. Have any of {your/NAME’s} disability-related benefits been reduced or ended because of {your/his/her}
(main/current) job?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C39_3)
DON’T KNOW ............................................................................ d (C39_3)
REFUSED .................................................................................. r (C39_3)
(C1>=1 AND C39_1=01)
C39_2 What benefits have been reduced or ended as a result of {your/NAME’s} (main/current) job?
INTERVIEWER: MARK ALL THAT APPLY.
PRIVATE DISABILITY INSURANCE..........................................
WORKERS’ COMPENSATION ..................................................
VETERANS’ BENEFITS.............................................................
MEDICARE ................................................................................
MEDICAID ..................................................................................
SSA DISABILITY BENEFITS .....................................................
PUBLIC ASSISTANCE OR WELFARE ......................................
FOOD STAMPS .........................................................................
PERSONAL ASSISTANCE SERVICES (PAS) ..........................
UNEMPLOYMENT BENEFITS ..................................................
OTHER STATE DISABILITY BENEFITS ...................................
OTHER GOVERNMENT PROGRAMS ......................................
OTHER.......................................................................................
C-24

01
02
03
04
05
06
07
08
09
10
11
12
13

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C1>=1)
C39_3. Now, I am going to read you a list of things that sometimes help people to work more hours or earn more
money. If any of these do not apply to {you/NAME}, please just say so. At [your/NAME’s] (main/current)
job, do you think that [you/she/he] could work or earn more if you/he/she had.
YES

NO

DON’T
KNOW

REFUSED

Help caring for {your/his/her} children or others in the
household?

01

00

d

r

Help with {your/his/her} own personal care such as bathing,
dressing, preparing meals, and doing housework?

01

00

d

r

c.

Reliable transportation to and from work?

01

00

d

r

d.

Better job skills?

01

00

d

r

e.

A job with a flexible work schedule?

01

00

d

r

f.

Help with finding and getting a better job?

01

00

d

r

g.

Any special equipment or medical devices?
PROGRAMMER: IF C39_3g=01, GO TO C39_3g_Other,
ELSE GO TO C39_3h.

01

00

d

r

Is there anything else that I didn’t mention that would help
[you/NAME] work or earn more?

01

00

d

r

a.
b.

h.

PROGRAMMER: IF C39_3h=01, GO TO C39_3h_Other, ELSE GO TO C39_4.
(C39_3g=01)
C39_3g_Other. What other special equipment or medical devices?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C39_3h=01)
C39_3h_Other

d
r

What else?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

(C1>=1)
C39_4.

d
r

One last question about (your / NAME’s) (main/current) job. Because of {your/his/her} work, has Social
Security needed to make any changes to the amount of {your/his/her} disability benefits?
PROBE: Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C39_5)
DON’T KNOW ............................................................................ d (C39_5)
REFUSED .................................................................................. r (C39_5)

C-25

SECTION C UNIVERSE: CURRENTLY WORKING (B24=01)
VARIABLES NEEDED FROM OTHER SECTIONS: CURRENTLY WORKING (B24), WORKED IN 2016 (B30), RTYPE, BIRTH
YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C39_4=01)
C39_4a. Because of these changes has the Social Security Administration paid {you/NAME} the wrong benefit
amount?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C1>=1)
C39_5.

{Were you/Was NAME} asked to re-pay benefits because the Social Security Administration overpaid
{you/him/her}?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C40a)
DON’T KNOW ............................................................................ d (C40a)
REFUSED .................................................................................. r (C40a)

(C39_5=01)
C39_6.
{Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/(he
was/she was} working while receiving benefits?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C40a)
DON’T KNOW ............................................................................ d (C40a)
REFUSED .................................................................................. r (C40a)
(C39_6=01)
CP16. Did you change how much you worked because you were asked to re-pay the Social Security
Administration? (NEW)
YES ............................................................................................ 01
NO .............................................................................................. 00 (C40a)
DON’T KNOW ............................................................................ d (C40a)
REFUSED .................................................................................. r (C40a)
(C16=01)
CP16a. What did {you/NAME} change about the hours you worked? Did {you/he/she}…. (NEW)
Reduce {your/his/her} work hours by a little, ..............................
Reduce {your/his/her} work hours by a lot, .................................
Increase {your/his/her} work hours by a little, or .........................
Increase {your/his/her} work hours by a lot? ...............................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
d
r

(B24=01)
C40a. CHECK: WAS {NAME} WORKING DURING THE PAST 6 MONTHS (B24B = 01)?
YES ............................................................................................ 01 (C_B1)
NO .............................................................................................. 00 (C40b)

(B24=01)
C40b. CHECK: WAS {NAME} WORKING IN 2016 (B30 = 01)?
YES ............................................................................................ 01 (D1)
NO .............................................................................................. 00 (SC1)

C-26

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

SECTION C_B: EMPLOYMENT IN PAST 6 MONTHS
NOTE: This section asked of those working in the past 6 months but not currently working (B24=00 and
B24b=01)
(B24=02 and B24b=01)
C_B1. Now I am going to ask some questions about the jobs {you/NAME} had during the last 6 months. When
answering these questions, please include both part-time and full-time jobs, but only include jobs {you
/NAME} held for pay or profit.
How many jobs did {you/NAME} have during the past 6 months?
|__|__| NUMBER OF JOBS (1-5)
(1-15)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C_B1=>1)
C_B1a. What are the main reasons {you/NAME} decided to work? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
TO HAVE MORE INCOME .............................................
TO FEEL BETTER ABOUT MYSELF/IMPROVE
WELL BEING ..................................................................
TO FEEL MORE INDEPENDENT ...................................
TO ACHIEVE PERSONAL CAREER GOALS .................
ENJOY WORKING/PERSONAL SATISFACTION ..........
DON’T WANT TO RELY ON BENEFITS .........................
HEALTH IMPROVED ......................................................
HAD MORE TIME/STOPPED DOING SOMETHING
ELSE ...............................................................................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
02
03
04
05
06
07
08
09
d
r

(C_B1a=09)
C_B2a_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-1

d
r

(C_B2a_oth)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER: C_B2 THROUGH C_B14 ASKED FOR ALL JOBS WHEN C_B1>01
(C_B1=>1)
C_B2. PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB:
Let us start with {your/NAME’s} main job – that is, the job at which {you/(he/she)} worked the most hours.
What kind of work did {you/ NAME} do, that is, what was {your/NAME’s} occupation?
PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
Now I would like to ask about {your/NAME’S} {second/third/fourth} job.
What kind of work did {you/NAME} do, that is, what was {your/NAME’s} occupation?
ELSE (C_B1=01):
What kind of work did {you/NAME} do, that is, what was {your/NAME’s} occupation?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high
school; sales clerk in a women’s shoe store.
PROBE 2: What were {your/NAME’S} main activities or duties? What else did {you/NAME} do? What
else? Did {you/NAME} supervise anyone?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1)
C_B3. What kind of business was this?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For what type of organization or industry did {you/NAME} work? For example: accounting firm,
daycare center, educational facility, food services.
PROBE 2: What do they make, sell, or do where {you/NAME} worked?
PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses),
or retail trade (selling to customers) or something else?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1)
C_B4amth.In what month and year did {you/NAME} start working there?
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
PROBE: Your best estimate is fine.
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................

C_B-2

d
r

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1)
C_B4ayr.

PROBE 1: In what month and year did {you/NAME} start working there?

INTERVIEWER: ENTER YEAR
PROBE 2: Your best estimate is fine.
|__|__|__|__| (1981-2017)
YEAR
(1951-2017)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1
C_B5. SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (C_B4ayr) SHOULD BE GREATER
THAN OR EQUAL TO YEAR OF BIRTH (A04_d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT,
INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born
in (A04_d) and {you/NAME} started working at this job in (C_B4ayr), which means {you/NAME} started
working at this job when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE:
C_B4aYR – YEAR OF BIRTH) years old. Is that correct?
YES ............................................................................................ 01
NO .............................................................................................. 02 (CHANGE C_B4ayr)
SUPPRESS ................................................................................ 03
(C_B1=>1)
C_B4bmth. In what month and year did {you/NAME} stop working there?
PROBE: Your best estimate is fine.
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1)
C_B4byr. PROBE 1: In what month and year did {you/NAME} stop working there?
PROBE 2: Your best estimate is fine.
INTERVIEWER: ENTER YEAR
|__|__|__|__|
YEAR

(1981-2017)
(1951-2017)

DON’T KNOW ............................................................................
REFUSED ..................................................................................
C_B5acheck1.

SOFT EDIT: DATE {NAME} STOPPED WORKING AT THIS JOB (C_B4bmth, C_B4byr) SHOULD
BE LATER THAN DATE {NAME} STARTED WORKING AT THIS JOB (C_B4amth, C_Ba4yr). IF
RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I
show that {you/NAME} started working at this job in (C_B4amth, C_Ba4yr) and that (you/NAME)
stopped working at this job in (C_B4bmth, C_B4byr). Is that correct?
YES ............................................................................................
NO, CHANGE ANSWER TO C_B4b ..........................................
NO, CHANGE ANSWER TO CB4a ............................................
NO, CHANGE ANSWERS FOR BOTH C_B4a AND CB4b ........
SUPPRESS ................................................................................

C_B-3

d
r

01
02 (CHANGE C_B4b)
03 (CHANGE C_B4a)
04 (CHANGE C_B4a, C_B4b)
05

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

C_B5acheck2.

SOFT EDIT: IF DATE {NAME} STOPPED WORKING AT THIS JOB (C_B4bmth, C_B4byr) AND
DATE {NAME} STARTED WORKING AT THIS JOB (C_B4amth, C_Ba4yr) ARE THE SAME
(C_B4amth, C_Ba4yr – C_B4bmth, C_B4byr = 0), INTERVIEWER READ: You said that
{you/NAME} started and stopped working at this job in (CB4a_mth, CB4a_yr). I’d like to verify that
{you/NAME} worked at this job for less than one month. Is this correct?
YES, WORKED AT JOB FOR LESS THAN ONE MONTH ........ 01
NO, WORKED AT JOB FOR MORE THAN ONE MONTH ......... 02 (CHANGE B4b or
B4a)
SUPPRESS ................................................................................ 03

C_B5acheck3.

SOFT EDIT: IF YEAR {NAME} STOPPED WORKING AT THIS JOB MORE THAN 6 MONTHS AGO
(CURRENT DATE - C_B4bmth, C_B4byr => 7), INTERVIEWER READ: You said that {you/NAME}
stopped working at this job in (C_B4bmth,C_B4byr). That is more than six months ago. Is this
correct?
YES, JOB ENDED MORE THAN 6 MONTHS AGO ................... 01 (C_B5d)
NO, JOB DID ENDED WITHIN THE PAST 6 MONTHS ............ 02
SUPPRESS ................................................................................ 03

C_B5d CHECK: DID THIS JOB END MORE THAN 6 MONTHS AGO (CB5acheck3=01)?
YES ............................................................................................ 01 (CHANGE B24b)
NO .............................................................................................. 00
(C_B1=>1)
C_B5A. Beneficiaries do not always know that they should report a change in work status to Social Security. Did
{you/NAME} let Social Security know that {you were/ (he/she) was} working?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B6)
DON’T KNOW ............................................................................ d (C_B6)
REFUSED .................................................................................. r (C_B6)
(C_B5a=01)
C_B5B. How soon after {you/NAME} started this job did {you/NAME} tell Social Security {you were/(he/she) was}
working?
PROBE: Your best estimate is fine.
INTERVIEWER: IF R TOLD SSA BEFORE STARTED WORKING, CODE AS 1 WEEK.
WEEKS ...................................................................................... 01 (C_B5BWeek)
MONTHS .................................................................................... 02 (C_B5BMonth)
DON’T KNOW ............................................................................ d (C_B6)
REFUSED .................................................................................. r (C_B6)
(C_B5a=01 and C_B5b=01)
C_B5BWEEK. INTERVIEWER: ENTER NUMBER OF WEEKS
| | | WEEKS
(1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

C_B-4

d (C_B6)
r (C_B6)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B5a=01 and C_B5b=02)
C_B5BMonth. INTERVIEWER: ENTER NUMBER OF MONTHS
| | | WEEKS/MONTHS
(1-12)
DON’T ........................................................................................
REFUSED ..................................................................................

d (C_B6)
r (C_B6)

(C_B1=>1)
C_B6. {Were you/Was NAME} self-employed at this job?
PROBE: Self-employed means that you work for yourself/ or own your own business.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B1=>1
C_B7. There are a number of special work programs available to people with disabilities. Was {your/NAME’s} job
part of a sheltered workshop program, transitional employment program, the Business Enterprise Program
for the blind, or a supported employment program?
PROBE:

A sheltered workshop is a program that provides employment with subsidized wages (or special
wages that would not be available in a regular job) for people with disabilities. A transitional
employment program allows workers with disabilities to work at reduced levels while they ease
back into the workplace.
The Business Enterprise Program for the blind offers legally blind persons the opportunity to
own their own businesses. Supported employment programs provide job coaches or other
on-the-job supports to help individuals with disabilities get and keep jobs.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(C_B1=>1)
C_B8. How many hours per week did {you/NAME} usually work at this job?
PROBE: Include overtime if {you/he/she} usually worked overtime.
|

|

|

| HOURS PER WEEK (1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1)
C_B9. How many weeks per year did {you/NAME} usually work at this job, including paid vacation and holidays?
PROBE 1: There are 52 weeks in a year.
PROBE 2: Please include time off for vacation and holidays if {you were/NAME was} paid for that time.
PROBE 3: If {you/NAME} worked less than a year, please answer for the number of weeks {your/NAME}
worked.
|

|

| WEEKS PER YEAR (1-52)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

C_B-5

d
r

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1)
C_B10. PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME
was} paid on this job. For {your/NAME’s} main job you held in the past six months {were you/was (he/she}
paid by the hour?
PROGRAMMER: IF MORE THAN ONE JOB (C_B1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME
was} paid for {your/(his/her)} {second/third/fourth} job. For {your/NAME’s} {second/third/fourth} job {were
you/was (he/she} paid by the hour? ELSE (C_B1=01):
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB.
PROBE:

{Your/NAME’s} main job is the job we have been talking about. The one at which {you /(he/she)}
worked the most hours.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B12amt)
DON’T KNOW ............................................................................ d (C_B12amt)
REFUSED .................................................................................. r (C_B12amt)

(C_B10=01)
C_B11. What was {your/NAME’s} regular hourly pay, including tips and commissions?
PROBE: IF LESS THAN $5.00 AN HOUR: Did this include tips and commissions?
INTERVIEWER: IF ENTERING AN AMOUNT WITH CENTS, PLEASE ENTER DECIMAL POINT
$|

|

|

|.|

|

| PER HOUR (1 – 25.00) (1 - 300.00)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B10=00, d, or r)
C_B12amt.
Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips
and commissions.
PROBE:

Was that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|

|

|

|.|

|

|

| . 00

DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B10=00, d, or r)
C_B12hop.
INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY ..........................................................
TWICE A MONTH ................................................
MONTHLY............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................

C_B-6

01
02
03
04
05
06
d
r

(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)

(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER: CALCULATE MONTHLY PRE-TAX PAY BASED ON C_B12AMT AND C12HOP FOR EACH JOB:
If C_B10=01, and C_B11and C_B8≠d or r, C_B _JobMnthPay(1)=c_B11*c_B8*4.35.
If C_B10=01 and C_B8 or C_B11=d, C_B_JobMnthPay(1)=d.
If C_B10=01 and C_B8 or C_B11=r and neither are d, C_B_JobMnthPay(1)=r.
If C_B10=00, d, or r and C_B12amt or C_B12hop=d, C_B_JobMnthPay(1)=d.
If C_B10=00, d, or r and C_B12amt or C_B12hop=r, and neither are d, C_B_JobMnthPay(1)=r.
If C_B10=00, d, or r and c_B12hop=1, C_B_JobMnthPay(1)=c_B12amt*21.74.
If C_B10=00, d, or r and c_B12hop=2, C_B_JobMnthPay(1)=c_B12amt*4.35.
If C_B10=00, d, or r and c_B12hop=3, C_B_JobMnthPay(1)=c_B12amt*2.17.
If C_B10=00, d, or r and c_B12hop=4, C_B_JobMnthPay(1)=c_B12amt*2.
If C_B10=00, d, or r and c_B12hop=5, C_B_JobMnthPay(1)=c_B12amt.
If C_B10=00, d, or r and c_B12hop=6, C_B_JobMnthPay(1)=c_B12amt/12.
(C_B10=00, d, or r)
C_B13amt.
PROBE:

For this job, about how much was left as take-home pay after taxes and other deductions?
Was that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN
$|

|

|

|.|

|

|

| . 00

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B10=00, d, or r)
C_B13hop. INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY ..........................................................
TWICE A MONTH ................................................
MONTHLY ............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................

C_B-7

01
02
03
04
05
06
d
r

(1-346)
(1-1,730)
(1-3,750)
(1-3,750)
(1-7,500)
(1-90,000)

(1-1,730)
(1-8,653)
(1-18,750)
(1-18,750)
(1-37,500)
(1-450,000)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER: CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON C13AMT AND C13HOP:
If C_B10=01 and C_B11 and C_B8≠d or r, C_B_JobMnthPayTH(1)=c_B11*c_B8*4.35.
If C_B10=01 and C_B8_1 or C_B11=d, C_B_JobMnthPayTH(1)=d.
If C_B10=01 and C_B8_1 or C_B11=r and neither are d, C_B_JobMnthPayTH(1)=r.
If C_B10=00, d, or r and C_B13amt or C_B13hop=d, C_B_JobMnthPayTH(1)=d.
If C_B10=00, d, or r and C_B13amt or C_B13hop=r, and neither are d, C_B_JobMnthPayTH(1)=r.
If C_B10=00, d, or r and c_B13hop=1, C_B_JobMnthPayTH(1)=c_B13amt*21.74.
If C_B10=00, d, or r and c_B13hop=2, C_B_JobMnthPayTH(1) =c_B13amt*4.35.
If C_B10=00, d, or r and c_B13hop=3, C_B_JobMnthPayTH(1)=c_B13amt*2.17.
If C_B10=00, d, or r and c_B13hop=4, C_B_JobMnthPayTH(1)=c_B13amt*2.
If C_B10=00, d, or r and c_B13hop=5, C_B_JobMnthPayTH(1)=c_B13amt.
If C_B10=00, d, or r and c_B13hop=6, C_B_JobMnthPayTH(1)=c_B13amt/12.

(C_B10=00, d, or r) and (C_B12hop=01, 02, 03, 04, 05, or 06) and (C_B13hop=01, 02, 03, 04, 05, or 06)
C_B14. SOFT EDIT: AMOUNT OF TAKE-HOME PAY MUST BE LESS THAN OR EQUAL T0 PRE-TAX PAY. IF
AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND
AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY (C_JobMnthPay(1)) NE D OR R, AND
C_JobMnthPayTH(1) > C_JobMnthPay(1), TRIGGER EDIT AND DISPLAY FOLLOWING TEXT:
INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY IS GREATER THAN AMOUNT
OF CALCULATED PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an
incorrect answer. You said that {you were/NAME was} paid (C_B12amt) per (C_B12hop) before taxes and
other deductions which would be about (C_B_JobMnthPay(1) per month and that (C_B13amt) per
(C_B13hop), or about (C_B_JobMnthPayTH(1) per month, is left as take-home pay after taxes and other
deductions. Based on what I recorded, {your/NAME’s} take home pay was more than {your/NAME’s} pre-tax
pay. Should I change the amount {you were/NAME was} paid before taxes and other deductions or the
amount {you/NAME} took home after taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ...........................................................................
CHANGE AMOUNT OF TAKE-HOME PAY ...............................
SUPPRESS ................................................................................

C_B-8

01 CHANGE C_B12amt)
02 (CHANGE C_B13amt)
03

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B10=00, d, or r) and (C_B12hop=01, 02, 03, 04, 05, or 06) and (C_B13hop=01, 02, 03, 04, 05, or 06)
C_B14a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND
CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF TAKE MONTHLY
HOME PAY (C_B_JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY
(C_B_JobMnthPay(1)) NE D OR R, AND (C_B_JobMnthPay(1) – C_B_JobMnthPayTH(1) /
C_B_JobMnthPayTH(1) > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER,
DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND CALCULATED
MONTHLY PRE-TAX PAY IS GREATER THAN 30%. CHECK ENTRY. IF NECESSARY READ: I may
have recorded an incorrect answer. You said that {you were/NAME was} paid (C_B12amt) per (C_B12hop)
before taxes and other deductions which would be about (C_B_JobMnthPay(1) per month and that
(C_B13amt) per (C_B13hop), or about (C_B_JobMnthPayTH(1) per month was left as take-home pay after
taxes and other deductions. Is this correct or should I change the amount {you were/NAME was} paid
before taxes and other deductions or the amount {you/NAME} took home after taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ...........................................................................
CHANGE AMOUNT OF TAKE-HOME PAY ...............................
SUPPRESS ................................................................................

01 CHANGE C_B12amt)
02 (CHANGE C_B13amt)
03

PROGRAMMER: CALCULATE TOTAL MONTHLY PAY FROM ALL JOBS COMBINED (TO BE USED LATER IN
SECTION K):
If C_B_JobMnthPay(1) or C_B_JobMnthPay(2) or C_B_JobMnthPay(3) (for all jobs listed)=d,
C_B_CurMnthPay=d.
If C_B_JobMnthPay(1) or C_B_JobMnthPay(2) or C_B_JobMnthPay(3) (for all jobs listed)=r, and
none=d, C_B_CurMnthPay=r. Else, C_B_CurMnthPay=Sum of (C_B_JobMnthPay(1) AND
C_B_JobMnthPay(2) AND C_B_JobMnthPay(3), etc. (for all jobs listed)).
IF C_B1 = 1, GO TO C_B15.
IF C_B1>1 AND HAVE NOT ASKED ABOUT ALL JOB, LOOP BACK TO C_B2.

(C_B1=>1)
C_B15. CHECK: WAS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (C_B4)
NO .............................................................................................. 00

C_B-9

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1 AND C_B15=00)
C_BP2. How did {you/NAME} find {your/his/her} main job? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE .........
AMERICA’S WORKFORCE CENTERS ..........................
THROUGH FRIENDS OR RELATIVES ..........................
THROUGH JOB ADVERTISEMENTS IN A
NEWSPAPER OR ON THE INTERNET..........................
THROUGH THE STATE VOCATIONAL
REHABILITATION AGENCY OR {VRNAME
FROM {NAME’S} CURRENT STATE}.............................
THROUGH A PRIVATE EMPLOYMENT AGENCY
OR PROGRAM ...............................................................
BY CONTACTING A FORMER EMPLOYER ..................
BY CONTACTING ANY OTHER EMPLOYERS ..............
OTHER............................................................................

(C_BP2=09)
C_BP2_Oth.

01
02
03
04

05
06
07
08
09

(C_BP2_Oth)

What other way did {you/NAME} find this job?
Other (SPECIFY)
DON’T KNOW ................................................................. d
REFUSED ....................................................................... r

(C_BP3)
(C_BP3)

(C_B1=>1 AND C_B15=00)
C_BP2a. CHECK: DID {NAME} MENTION MORE THAN ONE WAY FOUND MAIN JOB?
YES ............................................................................................ 01 (C_BP2b)
NO .............................................................................................. 00 (C_BP3)
(C_BP2a = 01)
C_BP2b. What was the main way {you/NAME} found {your/his/her} main job? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
THROUGH STATE’S UNEMPLOYMENT OFFICE .........
AMERICA’S WORKFORCE CENTERS ..........................
THROUGH FRIENDS OR RELATIVES ..........................
THROUGH JOB ADVERTISEMENTS IN A
NEWSPAPER OR ON THE INTERNET..........................
THROUGH THE STATE VOCATIONAL
REHABILITATION AGENCY OR {VRNAME
FROM {NAME’S} CURRENT STATE}.............................
THROUGH A PRIVATE EMPLOYMENT AGENCY
OR PROGRAM ...............................................................
BY CONTACTING A FORMER EMPLOYER ..................
BY CONTACTING ANY OTHER EMPLOYERS ..............
OTHER............................................................................

C_B-10

01
02
03
04

05
06
07
08
09

(C_BP2_Oth)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_BP2b=09)
C_BP2_Oth.

What other way did {you/NAME} find this job?

Other (SPECIFY)
DON’T KNOW ......................................................................................
REFUSED ............................................................................................

d (C_B P3)
r (C_BP3)

((C_B1=>1 AND C_B15=00)
C_BP3. I am going to read a list of things that some people use or receive to help them find or keep a job. Please tell
me if {you/NAME} used or received each to help find or work at {your/his/her} (main) job. Did {you/NAME}…
YES

NO

NA

DON’T
KNOW

REFUSED

a.

…use a job coach?

01

00

na

d

r

b.

…use a sign language interpreter?

01

00

na

d

r

c.

…use a reader or interpreter for the blind?

01

00

na

d

r

d.

…use an assistant or caregiver for
personal care (IF NEEDED: This includes
help bathing or dressing to get ready for
work and eating lunch or using the
restroom at work)t?

01

00

na

d

r

01

00

na

d

r

e. …use a personal care assistant at work to
help with job-related tasks? (IF NEEDED:
This includes help with writing, reading,
lifting, or reaching.
f.

…receive on the job training?

g.

…receive counseling about how work will
affect your benefits?

01

00

na

d

r

h.

…receive help with transportation?

01

00

na

d

r

i.

…receive help with child or family care?

01

00

na

d

r

j.

… use special equipment or devices?

01

00

na

d

r

(C_BP3j=01)
C_BP3k.1.
What special equipment or devices did you use?
INTERVIEWER: CODE ALL THAT APPLY.
BRACE .......................................................................................
CANE/CRUTCHES/WALKER.....................................................
WHEELCHAIR............................................................................
MODIFIED COMPUTER HARDWARE .......................................
MODIFIED COMPUTER SOFTWARE .......................................
HEARING AID/DEVICE ..............................................................
SPECIAL GLASSES ...................................................................
SPECIAL CHAIR/BACK SUPPORT ...........................................
SPECIAL SHOES/STOCKINGS .................................................
OTHER ___________________________________________
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(C_BP3k.1=06)
C_BP3k.1_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-11

d
r

01
02
03
04
05
07
08
09
10
06 (C_BP3k.1_oth.)
d
r

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1 AND C_B15=00)
C_BP3l. Did {you/NAME} use or receive anything else to help find or keep working at {your/his/her} (main) job?
YES .................................................................................
NO ...................................................................................
NA ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP3l=01)
C_BP3lm_oth.

01
00
na
d
r

(C_BP3lm_oth)

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C_B1=>1 AND C_B15=00 or 01)
C_BP4. Did { a friend, family member, coworker, caseworker, or anyone else help you find {your/his/her} (main) job?
PROBE: Help could include telling you about a job, helping you get ready for an interview, making a
connection for you, or giving you support or encouragement.
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
00
d
r

(C_BP5)
(C_BP7)
(C_BP7)
(C_BP7)

01
02
03
04
05
06
07
08
09
10

(C_BP5_oth)

(C_BP4=01)
C_BP5. Who did {you/NAME} get help from? (NEW)
INTERVIEWER: CODE ALL THAT APPLY
A PARENT OR GUARDIAN ............................................
A SPOUSE OR PARTNER .............................................
ANOTHER RELATIVE ....................................................
A FRIEND OR MENTOR.................................................
AN EMPLOYER OR SUPERVISOR................................
A CO-WORKER ..............................................................
A CASEWORKER OR COUNSELOR .............................
A JOB COACH ................................................................
A MEDICAL PROVIDER .................................................
OTHER............................................................................
(C_BP5=10)
C_BP5_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-12

d
r

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_BP4=01)
C_BP6. What kind of help did {you/NAME} get from these people? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
HELP CARING FOR CHILDREN OR OTHERS ................
HELP WITH PERSONAL CARE .......................................
TRANSPORTATION .........................................................
HELP FINDING A JOB......................................................
TRAINING .........................................................................
SOMEONE TO TALK TO/GET ADVICE ...........................
HELP GETTING ACCOMMODATIONS ............................
FINANCIAL ASSISTANCE................................................
OTHER .............................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................
(C_BP6=09)
C_BP6_oth.

01
02
03
04
05
06
07
08
09
d
r

(C_BP6_oth)

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C_B1=>01 AND C_B15=00)
C_BP7. As far as you know did anyone at {your/NAME’s} (main) job know that {you/he/she} have a disability? (NOD
2010 Q930 modified)
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-13

01
00
d
r

(C_BP8)
(C_BP8)
(C_BP8)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_BP7=01)
C_BP7a.Who at {your/NAME’s} (main) job knew that {you have/he has/she has} a disability? (NOD 2010 Q935)
INTERVIEWER: CODE ALL THAT APPLY.

YES

NO

NA

DON’T
KNOW

REFUSED

a.

{Your/NAME’s} co-workers?

01

00

na

d

r

b.

{Your/NAME’s} manager, supervisor, or
boss?

01

00

na

d

r

c.

Other staff responsible for hiring or
providing accommodations (such as
Human Resources)?

01

00

na

d

r

d.

Anyone else?

01

00

na

d

r

(C_BP7ad=01)
C_BP7a_oth. Who else?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C_B1=>1 AND C_B15=00)
C_BP8. How comfortable or uncomfortable did {you/NAME} feel about discussing {your/his/her} disability or health
condition with others at {your/his/her} (main) job? (modified from NOD 2010 Q925)
Very comfortable, ..............................................................
Comfortable ......................................................................
Neither comfortable nor uncomfortable .............................
Uncomfortable ...................................................................
Very uncomfortable ...........................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................

01
02
03
04
05
d
r

(C_B1=>1 AND C_B15=00)
C_BP10. As far as you know, did other people with disabilities work at {your/NAME’s} (main) job? (NEW)
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(C_B1=>1 AND C_B15=00)
C_B16. Did {you/NAME} receive any promotions at this job?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

C_B-14

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1)
C_B17. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES ............................................................................................ 01 (C_B19)
NO .............................................................................................. 00
(C_B17=00)
C_B18. Taking all things into account, how satisfied were you with your {main} job? Would you say
PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”
Very satisfied, ............................................................................
Somewhat satisfied, ..................................................................
Not very satisfied, or ..................................................................
Not at all satisfied? ....................................................................
DON’T KNOW ...........................................................................
REFUSED .................................................................................

01
02
03
04
d
r

(C_B1=>1 )
C_B19. CHECK: IS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (CB_21)
NO .............................................................................................. 00
(C_B19=00)
C_B20. I am going to read to you a list of benefits that some employers offer their employees. Please tell me whether
or not {your/NAME’s} {main} employer offered {you/him/her} any of these benefits.
PROGRAMMER: USE “MAIN” IF C1>01.
Did {your/NAME’s} (main) employer offer {you/NAME}
PROBE:

Please answer ‘yes’ if {you were/NAME was} eligible for the benefit but didn’t yet start to receive
it when you stopped working at that job.
YES

NO

DON’T
KNOW

REFUSED

Health care insurance? (IF NECESSARY: medical and/or
hospital)

01

00

d

r

b.

Dental benefits?

01

00

d

r

c.

Sick days with pay?

01

00

d

r

d.

Paid vacation?

01

00

d

r

e.

Free or low-cost childcare?

01

00

d

r

f.

Transportation, a transportation allowance, or transportation
discounts?

01

00

d

r

g.

Long-term disability benefits?

01

00

d

r

h.

Pension or retirement benefits?

01

00

d

r

i.

Flexible health or dependent care spending accounts?

01

00

d

r

a.

(C_B1=>1)
C_B32. CHECK: WAS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (C_B34)
NO .............................................................................................. 00

C_B-15

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B32=00)
C_B33. PROGRAMMER: USE “MAIN” IF C_B1>01.
Please tell me whether or not {your/NAME’s} {main} employer made any of these changes because of
{your/his/her} physical or mental health condition. Did {your/NAME’s} employer, because of {your/his/her}
physical or mental health condition, …
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.
PROBE:

a.

b.

c.

d.

e.

f.

{Your/NAME’s} main job was the job we have been talking about.
{you/(he/she)} worked the most hours.
YES

NO

DON’T
KNOW

REFUSED

Provide {you/NAME} with any special equipment or assistive
technology?
(PROBE: For example special tools or equipment, software,
or devices to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Make any changes in {your/NAME’s} work schedule?
(PROBE: For example, working fewer hours, changing the
time {you arrive or leave/(he/she) arrives or leaves}, or taking
more breaks to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Make any changes to the tasks {you were/NAME was}
assigned or how they are performed?
(PROBE: For example, a light duty job or less demanding job
tasks to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Make any changes to the physical work environment to make
things easier for {you/NAME}?
(PROBE: For example, modifying {your/his/her} work area,
improving accessibility in the building, or providing assigned
parking to accommodate {your/NAME’s} condition in the
workplace.)

01

00

d

r

Arrange for co-workers or others to assist {you/NAME}?
(PROBE: For example, providing a personal care attendant,
interpreter, or job coach while at work.)

01

00

d

r

Make any other changes that I didn’t mention to
accommodate {your/NAME’s} condition in the workplace?

01

00

d

r

PROGRAMMER: IF C33f=01, GO TO C33f_Other, ELSE GO TO C34.

(C_B32=00 and C_B33f=01)
C_B33f_Other. What other changes?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

C_B-16

The one at which

d
r

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1)
C_B34. Were there any changes in {your/NAME’s} {main} job or workplace related to {your/his/her} physical or
mental health condition that {you/(he/she)} needed, but that were not made?
PROGRAMMER: USE “MAIN” IF C_B1>01.
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB.
PROBE:

{Your/NAME’s} main job was the job that we have been talking about. The one at which {you
/(he/she)} worked the most hours.
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B38)
DON’T KNOW ............................................................................ d (C_B38)
REFUSED .................................................................................. r (C_B38)

(C_B34=01)
C_B35. What are those changes?
PROBE:

Anything else?

INTERVIEWER: ENTER VERBATIM RESPONSE

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B34 = 01)
C_B36. CHECK: WAS {NAME} SELF EMPLOYED (C_B6=01)?
YES ............................................................................................ 01 (C_B38)
NO .............................................................................................. 00

(C_B34=01 and C_B36=00)
C_B37. Did {you/NAME} or anyone else ask {your/his/her} employer for (any of) these changes?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(C_B1=>1)
C_BP12. Was there anything special about your (main) job that helped you to work with a disability? (NEW)
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_BP13a)
DON’T KNOW ............................................................................ d (C_BP13a)
REFUSED .................................................................................. r (C_BP13a)

C_B-17

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_BP12=01)
C_BP12.a. What was special about {your/NAME’s} (main) job that helped {you/him/her} to work with a disability?
(NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
Modified job duties ..........................................................
Special equipment or modified space..............................
Flexible schedule ............................................................
Work at home ..................................................................
Health insurance .............................................................
Sick leave ........................................................................
Supervisor understands disability needs .........................
Co-worker assistance ......................................................
Other ...............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
02
03
04
05
06
07
08
09 (C_BP12a_oth)
d
r

C_BP12a_oth What else about {your/NAME’s} (main) job allowed {you/him/her} to work?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(C_B1=>1)
C_BP13a. You said that {you/NAME} worked at this job within the past six months, but that {you are/he is/she is} not
currently working. Did {you/NAME} have any problems with… (NEW)

a.

b.

c.

YES

NO

DON’T
KNOW

REFUSED

{Your/NAME’s} health, that caused {you/him/her} to stop
working, for example worsening illness or the need to go
to medical appointments?

01

00

d

r

{Your/NAME’s} job, that caused {you/him/her} to stop
working, for example the need for accommodations or
problems with {your/his/her} co-workers?

01

00

d

r

{Your/NAME’s} personal circumstances that caused
{you/him/her} to stop working,, for example the need for
childcare, not having reliable transportation, or worry
about losing other benefits?

01

00

d

r

C_B-18

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: C_BP13A1 SHOULD BE ASKED IMMEDIATELY AFTER C_BP13A.A IF =YES. THEN
CYCLE BACK TO C_BP13A.B
(C_BP13a=01)
C_BP13.a1.What was it about {your/NAME’s} health that caused {you/him/her} to stop working? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
EXISTING HEALTH PROBLEM GETS WORSE .............
NEW HEALTH PROBLEM STARTS ...............................
GET INJURED ................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH ..............
NEED TO BE HOSPITALIZED ........................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ....
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION .....................
HEALTH INTERFERES WITH JOB PERFORMANCE....
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ............................
PAIN INTERFERES WITH WORKING A SET
SCHEDULE .....................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKES TOO LONG ............................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY....
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ....................
WORK IS TOO TIRING OR STRESSFUL ......................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

(C_BP13.a1=15)
C_BP13.a1_oth.

07
08
09
10
11
12
13
14
15
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-19

01
02
03
04
05
06

d
r

(C_BP13.a1_oth.)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: C_BP13B1 SHOULD BE ASKED IMMEDIATELY AFTER C_BP13A.B IF =YES. THEN
CYCLE BACK TO C_BP13A.C.
(C_BP13b=01)
C_BP13.b1. What was it about {your/NAME’s} job that caused {you/him/her} to stop working?

(NEW)

INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
JOB DOES NOT PAY ENOUGH .....................................
JOB DOES NOT OFFER HEALTH INSURANCE
BENEFITS.......................................................................
NEED A DIFFERENT SCHEDULE OR SHIFT ................
NEED TIME TO GO TO MEDICAL
APPOINTMENTS ............................................................
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION .....................
HEALTH INTERFERES WITH JOB
PERFORMANCE ............................................................
DO NOT HAVE THE STRENGTH, PHYSICAL
ENERGY OR STAMINA REQUIRED TO WORK ............
PAIN INTERFERES WITH WORKING A SET
SCHEDULE .....................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TAKE TOO LONG ...............................................
DO NOT HAVE DEVICES NEEDED IN ORDER TO
WORK .............................................................................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP13.b1=11)
C_BP13.b1_oth.

02
03
04
05
06
07
08
09
10
11 (C_BP13.b1_oth.)
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-20

01

d
r

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: C_BP13C1 SHOULD BE ASKED IMMEDIATELY AFTER C_BP13A.C
(C_BP13c=01)
C_BP13.c1.What was it about {your/NAME’s} personal circumstances that caused {you/him/her} to stop working?
(NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
NEED HELP CARING FOR CHILDREN OR
OTHERS .........................................................................
NEED PERSONAL ASSISTANCE ..................................
GET INJURED ................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL
SECURITY, SNAP, MEDICAID/MEDICARE ...................
PERSONALITY CONFLICTS WITH OTHERS AT
THE JOB .........................................................................
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB .......
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK .........................................................
DRUG/ALCOHOL RELAPSE ..........................................
WOULD RATHER DO OTHER THINGS THAN
WORK .............................................................................
DO NOT LIKE WORKING ...............................................
WORK IS TOO TIRING OR STRESSFUL ......................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP13.C1=12)
C_BP13.c1_oth.

04
05
06
07
08
09
10
11
12 (C_BP13.c1_oth.)
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

(C_B1=>1)
C_B38. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?
YES .................................................................................
NO ...................................................................................

C_B-21

01
02
03

d
r

01
00

(C39a2)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1 AND RTYPE=01)
C_B39. Again, thinking about the {main} job {you/NAME} had within the past six months, how much do you agree or
disagree with each of the following statements? Would you say you strongly agree, agree, disagree, or
strongly disagree?
PROGRAMMER: USE “MAIN” IF C_B1>01.
PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C_B1>01) AND FIRST JOB.
PROBE:

{Your/NAME’s} main job is the job that we have been talking about.
{you/he/she} worked the most hours.

a. {You/NAME} had a chance to
develop your abilities
b. {You/NAME} had recognition or
respect from others
c. {You/NAME} could work on
{your/his/her} own in {your/his/her}
job if {you/he/she} wanted to
d. {You/NAME} could work with
others in a group or team if
{you/he/she} wanted to
e. {Your/NAME’s} work was
interesting or enjoyable
f. {Your/NAME’s} work gave you a
feeling of accomplishment or
contribution
g. IF {NAME} WAS NOT SELFEMPLOYED (C_B6=00, d, or r):
{Your/NAME’s} supervisor was
supportive. ELSE: SKIP TO
C_B39_g
h. {Your/NAME’s} co-workers were
friendly and supportive

The one at which

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

NA

DON’T
KNOW

REFUSED

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

01

02

03

04

05

d

r

(C_B1=>1)
C_B39a2.Sometimes people work fewer hours or earn less money than they could in order to care for family
members, keep the cash benefits they need, or just to have more free time. In (your/NAME’s) (main) job, did
you/he/she} work fewer hours or earn less money than (you/he/she) could for any reason?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B39_1)
DON’T KNOW ............................................................................ d (C_B39_1)
REFUSED .................................................................................. r (C_B39_1)

C_B-22

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B39a=01)
C_B39b. Did (you/NAME) work fewer hours or earn less money than (you/he/she) could because (you/he/she)…
PROBE:

I need to ask everyone in our study the same questions, even if they don’t seem to apply to
(you/NAME).
YES

NO

DON’T
KNOW

REFUSED

a.

{Were/Was} taking care of children or others?

01

00

d

r

b.

{Were/Was } enrolled in school or a training program?

01

00

d

r

c.

Wanted to keep Medicare or Medicaid coverage?

01

00

d

r

d.

Wanted to keep cash benefits (you/he/she) need such as
disability or workers compensation?

01

00

d

r

e.

Just did not want to work more?

01

00

d

r

f.

Are there any reasons I didn’t mention why (you were/NAME
was) working or earning less than (you/he/she) could?

01

00

d

r

PROGRAMMER: IF C_B39b_f=01 GO TO C_B39f_Other, ELSE SKIP TO C_B39_1
(C_B39b_f=01)
C_B39f_Other What other reason?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1)
C_B39_1.Were any of {your/NAME’s} disability-related benefits reduced or ended because of {your/his/her} (main)
job?
YES ............................................................................................ 01
NO .............................................................................................. 00 (C_B39_3)
DON’T KNOW ............................................................................ d (C_B39_3)
REFUSED .................................................................................. r (C_B39_3)

(C_B39_1=01)
C_B39_2 . What benefits were reduced or ended as a result of {your/NAME’s} (main) job?
INTERVIEWER: MARK ALL THAT APPLY.
PRIVATE DISABILITY INSURANCE..........................................
WORKERS’ COMPENSATION ..................................................
VETERANS’ BENEFITS.............................................................
MEDICARE ................................................................................
MEDICAID ..................................................................................
SSA DISABILITY BENEFITS .....................................................
PUBLIC ASSISTANCE OR WELFARE ......................................
FOOD STAMPS .........................................................................
PERSONAL ASSISTANCE SERVICES (PAS) ..........................
UNEMPLOYMENT BENEFITS ..................................................
OTHER STATE DISABILITY BENEFITS ...................................
OTHER GOVERNMENT PROGRAMS ......................................
OTHER.......................................................................................

C_B-23

01
02
03
04
05
06
07
08
09
10
11
12
13

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

C_B-24

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B1=>1))
C_B39_3. Now, I am going to read you a list of things that sometimes help people keep their jobs. Do you think that
[you/she/he] would have kept working if (you/he/she) had…
YES

NO

DON’T
KNOW

REFUSED

Help caring for {your/his/her} children or others in the
household?

01

00

d

r

Help with {your/his/her} own personal care such as bathing,
dressing, preparing meals, and doing housework?

01

00

d

r

c.

Reliable transportation to and from work?

01

00

d

r

d.

Better job skills?

01

00

d

r

e.

A job with a flexible work schedule?

01

00

d

r

f.

Help with finding and getting a better job?

01

00

d

r

g.

Any special equipment or medical devices?
PROGRAMMER: IF C_B39_3g=01, GO TO
C_B39_3g_Other, ELSE GO TO C_B39_3h.

01

00

d

r

Is there anything else that I didn’t mention that would help
[you/NAME] work or earn more?

01

00

d

r

a.
b.

h.

PROGRAMMER: IF C3_B9_3h=01, GO TO C_B39_3h_Other, ELSE GO TO C_B39_4.
(C39_3g=01)
C_B39_3g_Other. What other special equipment or medical devices?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C39_3h=01)
C_B39_3h_Other What else?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(C_B1=>1)
C_B39_4. One last question about (your / NAME’s) (main) job. Because of {your/his/her} work, did Social Security
need to make any changes to the amount of {your/his/her} disability benefits?
PROBE: Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

C_B-25

01
00
d
r

(C_B39_5)
(C_B39_5)
(C_B39_5) (C_B39_4=01)

SECTION C_B UNIVERSE: EMPLOYMENT IN PAST 6 MONTHS (B24=02 and B24b=01)
VARIABLES NEEDED FROM OTHER SECTIONS: NOT CURRENTLY WORKING (B24 = 0), WORKED DURING PAST 6
MONTHS (B24B = 1), WORKED IN 2016 (B30 = 1), RTYPE, BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(C_B39_4=01)
C_B39_4a.Because of these changes did the Social Security Administration pay {you/NAME} the wrong benefit
amount?
YES ................................................................................. 01
NO ................................................................................... 00
DON’T KNOW ................................................................. d
REFUSED ....................................................................... r
(C_B1=>1)
C_B39_5. {Were you/Was NAME} asked to re-pay benefits because the Social Security Administration overpaid
{you/him/her}?
YES ................................................................................. 01
NO ................................................................................... 00 (C_B40CHECK)
DON’T KNOW ................................................................. d
(C_B40CHECK)
REFUSED ....................................................................... r
(C_B40CHECK)
(C_B39_5=01)
C_B39_6. {Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/he was/she
was} working while receiving benefits?
YES ................................................................................. 01
NO ................................................................................... 00 (C_B40CHECK)
DON’T KNOW ................................................................. d
(C_B40CHECK)
REFUSED ....................................................................... r
(C_B40CHECK)
(C_B39_6=01)
C_BP16. Did you change the way you worked because you were asked to re-pay the Social Security
Administration? (NEW)
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
00
d
r

(C_B40CHECK)
(C_B40CHECK)
(C_B40CHECK)

(C_B16=01)
C_BP16a. What did you change about the way you worked? Did you…. (NEW)
Reduce your work hours by a little, .................................
Reduce your work hours by a lot, ....................................
Increase your work hours by a little, r ..............................
Increase your work hours by a lot or ...............................
Something else? (SPECIFY) ...........................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(C_BP16a=05)
C_BP16a_oth.

(C_BP16a_oth.)

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

(C_B1=>1)
C_B40. CHECK: WAS {NAME} WORKING IN 2016 (B30 = 01)?
YES .................................................................................
NO ...................................................................................

C_B-26

01
02
03
04
05
d
r

d
r

01
00

(D1)
(SC1CHECK)

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

SECTION D: JOBS/OTHER JOBS DURING 2016
(B30=01)
D1.
Now, I will ask you about jobs {you/NAME} had during 2016. When answering these questions, please
include both part-time and full-time jobs, but only include jobs {you/NAME} held for pay or profit for one
month or longer.
PROGRAMMER: IF (C1=01 AND C4 YEAR < 2016) or (C_B1=01 and C_B4a_yr=2016 or C_B4b_yr=2016)
ASK:
Other than (your/NAME’s) jobs that you already told me about, in 2016 did {you/NAME} work for pay at any
other jobs for longer than a month?
PROGRAMMER: IF (C1>01 AND C4 YEAR < 2016) or (C_B1>1 and C_B4a_yr=2016 or C_B4b_yr=2016)
FOR ONE OR MORE CURRENT JOBS IN SECTION C or C_B, ASK:
Other than (your/NAME’s) jobs that you already told me about in 2016, did {you/NAME} work for pay at any
other jobs for longer than a month?
ELSE:
In 2016, did {you/NAME} work for pay at any jobs for longer than a month?
YES ............................................................................................ 01 (D3)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=00, d, or r)
D2.
SOFT EDIT: IF {NAME} WORKED IN 2016 (B30=01) AND {NAME} DID NOT WORK IN 2016 (D1=0, d, r)
INTERVIEWER READ: “Earlier you said that {you/NAME} worked for pay in 2016. Let me repeat the
question I just read and verify your response.”
PROGRAMMER: IF (C1=01 AND C4 YEAR < 2016) or (C_B1=01 and C_B4a_yr=2016 or C_B4b_yr=2016)
ASK:
Other than (your/NAME’s) jobs that you already told me about, in 2016 did {you/NAME} work for pay at any
other jobs for longer than a month?
PROGRAMMER: IF (C1>01 AND C4 YEAR < 2016) or (C_B1>1 and C_B4a_yr=2016 or C_B4b_yr=2016)
FOR ONE OR MORE CURRENT JOBS IN SECTION C or C_B, ASK:
Other than (your/NAME’s) jobs that you already told me about, in 2016 did {you/NAME} work for pay at any
other jobs for longer than a month?
ELSE:
In 2016, did {you/NAME} work for pay at any jobs for longer than a month?
YES ............................................................................................ 01
NO .............................................................................................. 00 (SC1CHECK)
DON’T KNOW ............................................................................ d (SC1CHECK)
REFUSED .................................................................................. r (SC1CHECK)

D-1

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D1=01 or D2=01)
D3.
PROGRAMMER: IF (C1=01 AND C4 YEAR < 2016) or (C_B1=01 and C_B4a_yr=2016 or C_B4b_yr=2016)
ASK::
Other than (your/NAME’s) the job that you already told me about, how many other jobs did {you/NAME} hold
for at least one month in 2016?
PROGRAMMER: IF (C1>01 AND C4 YEAR < 2016) or (C_B1>1 and C_B4a_yr=2016 or C_B4b_yr=2016)
FOR ONE OR MORE CURRENT JOBS IN SECTION C or C_B, ASK:
Other than (your/NAME’s) jobs that you already told me about, how many other jobs did {you/NAME} hold
for at least one month in 2016?
ELSE:
How many jobs did {you/NAME} hold for at least one month in 2016?
|__|__| NUMBER OF JOBS (1-5)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

PROGRAMMER: D4 THROUGH D23 ASKED FOR ALL JOBS WHEN D3>01

(D1=01 or D2=01)
D4.
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:
Now thinking only about these jobs, let us start with {your/NAME’s} main job in 2016 – that is, the job at
which {you worked/(he/she) worked} the most hours.
What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
Now I would like to ask about {your/NAME’S} {second/third/fourth} job in 2016.
What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?
ELSE (D3=01):
What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high
school; sales clerk in a women’s shoe store.
PROBE 2: What are {your/NAME’S} main activities or duties? What else do you do? What else? Do you
supervise anyone?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

D-2

d
r

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D1=01 or D2=01)
D5.
What kind of business was this?
INTERVIEWER: ENTER VERBATIM RESPONSE
PROBE 1: For what type of organization or industry did you work? For example: accounting firm, daycare
center, educational facility, food services.
PROBE 2: What do they make, sell, or do where {you/NAME} worked?
PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses) or
retail trade (selling to customers) or something else?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(D1=01 or D2=01)
D6mth. In what month and year did {you/NAME} start working there?
PROBE: Your best estimate is fine.
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(D1=01 or D2=01)
D6yr.
PROBE 1: In what month and year did {you/NAME} start working there?
PROBE 2: Your best estimate is fine.
INTERVIEWER: ENTER YEAR
|__|__|__|__| (1981-2016)
YEAR
(1951-2016)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(D1=01 or D2=01)
D7.
SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (D6 YEAR) SHOULD BE GREATER
THAN OR EQUAL TO YEAR OF BIRTH (A04d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT,
INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born
in (A04d) and {you/NAME} started working at this job in (D6 YEAR), which means {you/NAME} started
working at this job when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE: D6
YEAR – YEAR OF BIRTH) years old. Is that correct?
YES ............................................................................................ 01
NO .............................................................................................. 02 (CHANGE D6 YEAR)
SUPPRESS ................................................................................ 03

D-3

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D1=01 or D2=01)
D8mth. In what month and year did {you/NAME} stop working there?
PROBE: Your best estimate is fine.
INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN
|__|__| (1-12)
MO
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(D1=01 or D2=01)
D8yr.
PROBE 1: In what month and year did {you/NAME} stop working there?
PROBE 2: Your best estimate is fine.
INTERVIEWER: ENTER YEAR
|__|__|__|__|
YEAR

(1981-2016)
(1951-2016)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(D1=01 or D2=01)
D9.
SOFT EDIT: DATE {NAME} STOPPED WORKING AT THIS JOB (D8 MONTH, D8 YEAR) SHOULD BE
LATER THAN DATE {NAME} STARTED WORKING AT THIS JOB (D6 MONTH, D6 YEAR). IF
RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that
{you/NAME} started working at this job in (D6 MONTH, D6 YEAR) and that (you/NAME) stopped working at
this job in (D8 MONTH, D8 YEAR). Is that correct?
YES ............................................................................................
NO, CHANGE ANSWER TO D6.................................................
NO, CHANGE ANSWER TO D8.................................................
NO, CHANGE ANSWERS FOR BOTH D6 AND D8...................
SUPPRESS ................................................................................

01
02 (CHANGE D6)
03 (CHANGE D8)
04 (CHANGE D6 AND D8)
05

(D1=01 or D2=01)
D10.
SOFT EDIT: IF DATE {NAME} STOPPED WORKING AT THIS JOB (D8 MONTH, D8 YEAR ) AND DATE
{NAME} STARTED WORKING AT THIS JOB (D6 MONTH, D6 YEAR) ARE THE SAME (D8 MONTH, D8
YEAR – D6 MONTH, D6 YEAR = 0), INTERVIEWER READ: You said that {you/NAME} started and stopped
working at this job in (D8 MONTH, D8 YEAR). I’d like to verify that {you/NAME} worked at this job for less
than one month. Is this correct?
YES, WORKED AT JOB FOR LESS THAN ONE MONTH ........ 01
NO, WORKED AT JOB FOR MORE THAN ONE MONTH ......... 02
SUPPRESS ................................................................................ 03
(D1=01 or D2=01)
D11.
SOFT EDIT: IF YEAR {NAME} STOPPED WORKING AT THIS JOB (D8 YEAR) IS BEFORE 2016,
INTERVIEWER READ: You said that {you/NAME} stopped working at this job in (D8 YEAR). I’d like to verify
that this job ended before 2016. Is this correct?
YES, JOB ENDED BEFORE 2016 ............................................. 01
NO, JOB DID NOT END BEFORE 2016 .................................... 02
SUPPRESS ................................................................................ 03

D-4

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D1=01 or D2=01)
D12.
CHECK: DID {NAME} WORK AT THIS JOB FOR LESS THAN ONE MONTH (D10=01)?
YES ............................................................................................ 01 (DP1)
NO .............................................................................................. 00
(D12=00)
D13.
CHECK: DID THIS JOB END BEFORE 2016 (D11=01)?
YES ............................................................................................ 01 (DP1)
NO .............................................................................................. 00
((D1=01 or D2=01) and D12=00 and D13=00)
D14.
{Were you/Was NAME} self-employed at this job?
PROBE:

Self-employed means that you work for yourself or own your own business.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

((D1=01 or D2=01) and D12=00 and D13=00)
D15.
Was this job part of a sheltered workshop, transitional employment program, the Business Enterprise
Program for the blind, or supported employment program?
PROBE:

A sheltered workshop is a program that provides employment with subsidized wages (or special
wages that would not be available in a regular job) for people with disabilities. A transitional
employment program allows workers with disabilities to work at reduced levels while they ease
back into the workplace. The Business Enterprise Program for the Blind offers legally blind
persons for the opportunity to own their own businesses. Supported employment programs
provide job coaches or other on-the-job supports to help individuals with disabilities get and
keep jobs.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(D1=01 or D2=01) and D12=00 and D13=00)
D16.
How many hours per week did {you/NAME} usually work at this job?
PROBE:

Include overtime if {you/he/she} usually worked overtime.
|__|__|__| HOURS PER WEEK (1-60)
(1-168)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

((D1=01 or D2=01) and, D12=00 and D13=00)
D17.
How many weeks per year did {you/NAME} usually work at this job, including paid vacation and holidays?
PROBE 1: Please include time off for vacations and holidays if {you were/NAME was} paid for that time.
PROBE 2: There are 52 weeks in a year.
|__|__| WEEKS PER YEAR (1-52)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

D-5

d
r

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

((D1=01 or D2=01) and D12=00 and D13=00)
D18.
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME
was} paid on {your/(his/her)} main job in 2016. On {your/NAME’s} main job {were you/was (he/she} paid by
the hour?
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND SECOND, THIRD, FOURTH, ETC. JOB:
For the purpose of this survey, it is important to obtain some information on how much {you were/NAME
was} paid on {your/(his/her)} {second/third/fourth} job in 2016. On {your/NAME’s} {second/third/fourth} job
{were you/was (he/she} paid by the hour?
ELSE (D3=01): For the purpose of this survey, it is important to obtain some information on how much {you
were/NAME was} paid on {your/(his/her)} job in 2016. On {your/NAME’s} job {were you/was (he/she} paid
by the hour?
PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:
PROBE:

{Your/NAME’s} main job in 2016 was the job at which {you worked/(he/she) worked} the most
hours.
YES ............................................................................................ 01
NO .............................................................................................. 00 (D20amt)
DON’T KNOW ............................................................................ d (D20amt)
REFUSED .................................................................................. r (D20amt)

((D1=01or D2=01) and D12=00 and D13=00 and D18=01)
D19.
What was {your/NAME’s} regular hourly pay, including tips and commissions?
PROBE: IF LESS THAN $5.00 AN HOUR: Does this include tips and commissions?
$ |___|___|___| . |___|___| PER HOUR

(1 - 25.00)
(1 - 300.00)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

GO TO D23

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r)
D20amt. Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips and
commissions?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$|___|___|___| , |___|___|___| . 00
DON’T KNOW ............................................................................
REFUSED ..................................................................................

D-6

d
r

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

((D1=01 or D2=01) and, D12=00 and D13=00 and D18=00, d, r)
D20hop. Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips and
commissions?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
INTERVIEWER: ENTER HOW OFTEN PAID
DAILY ...................................................................
WEEKLY ..............................................................
BI-WEEKLY ..........................................................
TWICE A MONTH ................................................
MONTHLY............................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................

01
02
03
04
05
06
d
r

(1-384)
(1-1,923)
(1-4,166)
(1-4,166)
(1-8,333)
(1-100,000)

(1-1,922)
(1-9,615)
(1-20,833)
(1-20,833)
(1-41,666)
(1-500,000)

PROGRAMMER, CALCULATE MONTHLY PRE-TAX PAY BASED ON D20AMT AND D20HOP FOR EACH JOB:
If D18=01, and D19 and D16≠d or r, C_2016Job2016 MnthPay(1)=D19*D16*4.35.
If D18=01 and D19 or D16=d, C_2016Job MnthPay(1)=d.
If D18=01 and D19 or D16=r and neither are d, C_2016Job MnthPay(1)=r.
If D18=00, d, OR r AND D20AMT OR D20HOP=d, C_2016Job MnthPay(1)=d.
If D18=00, d, OR r AND D20AMT OR D20HOP=r AND NEITHER ARE d, C_2016Job MnthPay(1)=r.
If D18=00, d, or r and D20hop=1, C_2016Job MnthPay(1)=D20amt*21.74.
If D18=00, d, or r and D20hop=2, C_2016Job MnthPay(1)=D20amt*4.35.
If D18=00, d, or r and D20hop=3, C_2016Job MnthPay(1)=D20amt*2.17.
If D18=00, d, or r and D20hop=4, C_2016Job MnthPay(1)=D20amt*2.
If D18=00, d, or r and D20hop=5, C_2016Job MnthPay(1)=D20amt.
If D18=00, d, or r and D20hop=6, C_2016Job MnthPay(1)=D20amt/12.
If D18=00, d, or r and D20hop or D20amt=d, then C_2016Job MnthPay(1)=d.
If D18=00, d, or r and D20hop or D20amt=r and none=d, then C_2016Job MnthPay(1)=r.

D-7

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

((D12=00 or D2=01) and D13=00 and D18=00, d, r)
D21amt. For this job, about how much was left as take-home pay after taxes and other deductions?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
INTERVIEWER: ROUND TO NEAREST DOLLAR
$|___|___|___| , |___|___|___| . 00
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r)
D21hop. For this job, about how much was left as take-home pay after taxes and other deductions?
PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?
INTERVIEWER: ENTER HOW OFTEN PAID.
DAILY...................................................................
WEEKLY ..............................................................
BI-WEEKLY .........................................................
TWICE A MONTH ................................................
MONTHLY ...........................................................
ANNUALLY ..........................................................
DON’T KNOW ......................................................
REFUSED ............................................................

01
02
03
04
05
06
d
r

(1-346)
(1-1,730)
(1-3,750)
(1-3,750)
(1-7,500)
(1-90,000)

(1-1,730)
(1-8,653)
(1-18,750)
(1-18,750)
(1-37,500)
(1-450,000)

PROGRAMMER, CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON D21AMT AND D21HOP:
If D18=01 and D19 and D16≠d or r, C_2016Job MnthPayTH(1)=D19*D16*4.35.
If D18=01 and D19 or D16=d, C_2016Job MnthPayTH(1)=d.
If D18=01 and D19 or D16=r and neither are d, C_2016Job MnthPayTH(1)=r.
If D18_1=00, d, or r and D21amt or D21hop=d, C_2016Job MnthPayTH(1)=d.
If D18_1=00, d, or r and D21amt or D21hop=r, and neither are d, C_2016Job MnthPayTH(1)=r.
If D18=00, d, or r and D21hop=1, C_2016Job2 MnthPayTH(1)=D21amt*21.74.
If D18=00, d, or r and D21hop=2, C_2016Job MnthPayTH(1) =D21amt*4.35.
If D18=00, d, or r and D21hop=3, C_2016Job MnthPayTH(1)=D21amt*2.17.
If D18=00, d, or r and D21hop=4, C_2016Job MnthPayTH(1)=D21amt*2.
If D18=00, d, or r and D21hop=5, C_2016Job MnthPayTH(1)=D21amt.
If D18=00, d, or r and D21hop=6, C_2016Job MnthPayTH(1)=D21amt/12.
If D18=00, d, or r and D21hop or D21amt=d, then C_2016Job MnthPayTH(1)=d.
If D18=00, d, or r and D21hop or D21amt=r and none=d, then C_2016Job MnthPayTH(1)=r.

D-8

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r) and (D20hop=01, 02, 03, 04, 05, or 06) and
(D21hop=01, 02, 03, 04, 05, or 06)
D22.
SOFT EDIT: AMOUNT OF CALCULATED MONTHLY TAKE-HOME PAY MUST BE LESS THAN OR
EQUAL T0 CALCULATED MONTHLY PRE-TAX PAY. IF AMOUNT OF MONTHLY TAKE HOME PAY
(C_2016Job MnthPayTH(1)) NE D OR R, AND AMOUNT OF PRE-TAX MONTHLY PAY (C_2016Job
MnthPay(1)) NE D OR R, AND C_2016Job MnthPayTH(1) > C_2016Job MnthPay(1), TRIGGER EDIT AND
DISPLAY FOLLOWING TEXT: INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE HOME
PAY IS GREATER THAN AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY. CHECK ENTRY. IF
NECESSARY READ: I must have recorded an incorrect answer. You said that {you were/NAME was} paid
(D20) per (D20 AMOUNT), which would be about (C_2016Job MnthPay(1) before taxes and other
deductions and that (D21) per (D21 AMOUNT), or about (C_2016Job MnthPayTH(1) was left as take-home
pay after taxes and other deductions. Based on what I recorded, your take home pay was more than your
pre-tax pay. Should I change the amount {you were/NAME was} paid before taxes and other deductions or
the amount {you took/NAME took} home after taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND
OTHER DEDUCTIONS ..................................................... 01
CHANGE AMOUNT OF TAKE-HOME PAY ...................... 02
SUPPRESS ....................................................................... 03

(CHANGE D20amt)
(CHANGE D21amt)

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00, d, r) and (D20hop=01, 02, 03, 04, 05, or 06) and
(D21hop=01, 02, 03, 04, 05, or 06)
D22a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND
CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF MONTHLY TAKE
HOME PAY (C_2016Job MnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY
(C_2016Job MnthPay(1)) NE D OR R, AND (C_2016Job MnthPay(1) - C_2016Job MnthPayTH(1) /
C_2016Job MnthPayTH(1) > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER,
DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN 30%. CHECK
ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said that {you were/NAME
was} paid (D20) per (D20 AMOUNT), which would be about (C_2016Job MnthPay(1) before taxes and other
deductions and that (D21) per (D21 AMOUNT) , or about (C_2016Job MnthPayTH(1) was left as take-home
pay after taxes and other deductions. Is this correct or should I change the amount {you were/NAME was}
paid before taxes and other deductions or the amount {you took/NAME took} home after taxes and other
deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS .................................................................... 01 (CHANGE D20amt)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE D21amt)
SUPPRESS ................................................................................ 03
(D1=01 or D2=01)
DP1.
I’m going to ask you about reasons you might have left this job. Did you leave this job because of…

a.
b.
c.

D-9

YES

NO

DON’T
KNOW

REFUSED

{Your/NAME’s} health, for example, because of worsening
illness or the need to go to medical appointments?

01

00

d

r

{Your/NAME’s} job, for example because of the need for
accommodations or problems with {your/his/her} co-workers?

01

00

d

r

{Your/NAME’s} personal circumstances, for example because
{you/he/she} need(s) childcare, don’t have reliable
transportation, or worry about losing other benefits?

01

00

d

r

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: DB1a_1 SHOULD BE ASKED IMMEDIATELY AFTER DP1a IF =YES. THEN CYCLE BACK
TO DBp1b.
(DP1a=01)
DP1a_1. What was it about your health that made you leave this job? (NEW)
CODE ALL THAT APPLY.
PROBE:

Anything else?
EXISTING HEALTH PROBLEM GOT WORSE ................
NEW HEALTH PROBLEM STARTED ..............................
GOT INJURED ..................................................................
JOB HAD A NEGATIVE IMPACT ON HEALTH ................
NEEDED TO BE HOSPITALIZED ....................................
NEEDED TIME TO GO TO MEDICAL APPOINTMENTS .
GOT FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION.......................
HEALTH INTERFERED WITH JOB PERFORMANCE .....
DID NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK ..............................
PAIN INTERFERED WITH WORKING A SET
SCHEDULE ......................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TOOK TOO LONG ................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY .....
DID NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ......................
WORK WAS TOO TIRING OR STRESSFUL ...................
OTHER .............................................................................
DON’T KNOW ...................................................................
REFUSED .........................................................................

(DP1a_1=15)
DP1a_1_oth.

07
08
09
10
11
12
13
14
15
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

D-10

01
02
03
04
05
06

d
r

(DP1a_1_oth.)

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: DB1b_1 SHOULD BE ASKED IMMEDIATELY AFTER DP1b IF =YES. THEN CYCLE BACK
TO DBp1c.
(DP1b=01)
DP1b_1. What was it about your job that made you leave it? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
JOB DID NOT PAY ENOUGH .........................................
JOB DID NOT OFFER HEALTH INSURANCE
BENEFITS.......................................................................
NEEDED A DIFFERENT SCHEDULE OR SHIFT ...........
NEEDED TIME TO GO TO MEDICAL APPOINTMENTS
GOT FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION .....................
HEALTH INTERFERED WITH JOB PERFORMANCE ...
DID NOT HAVE THE STRENGTH, PHYSICAL
ENERGY OR STAMINA REQUIRED TO WORK ............
PAIN INTERFERED WITH WORKING A SET
SCHEDULE .....................................................................
PERSONAL CARE AND GETTING READY FOR
WORK TOOK TOO LONG ..............................................
DID NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ....................
PERSONALITY CONFLICTED WITH OTHERS AT
THE JOB .........................................................................
GOT FIRED FOR BEHAVIOR AT THE JOB ...................
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................
(DP1b_1=13)
DP1b_1_oth.

02
03
04
05
06
07
08
09
10
11
12
13
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

D-11

01

d
r

(DP1b_1_oth.)

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

PROGRAMMER NOTE: DB1c_1 SHOULD BE ASKED IMMEDIATELY AFTER DP1c IF =YES.
(DP1c=01)
DP1c_1. What was it about your personal circumstances that made you leave the job? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
NEED HELP CARING FOR CHILDREN OR OTHERS .
NEED PERSONAL ASSISTANCE TO GET READY
FOR WORK EACH DAY ...............................................
GET INJURED ..............................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL
SECURITY, SNAP, MEDICAID/MEDICARE .................
DO NOT HAVE RELIABLE TRANSPORTATION TO
AND FROM WORK .......................................................
DRUG/ALCOHOL RELAPSE ........................................
WOULD RATHER DO OTHER THINGS THAN WORK
DO NOT LIKE WORKING .............................................
INCREASE IN INCOME FROM ANOTHER SOURCE ..
OTHER..........................................................................
DON’T KNOW ...............................................................
REFUSED .....................................................................

(DP1c_1=10)
DP1c_1_oth.

01
02
03
04
05
06
07
08
09
10
d
r

(DP1c_1_oth.)

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(D1=01 or D2=01)
DP2.
Are there any other reasons that we haven’t talked about why you left this job? (NEW)

(DP2=01)
DP2a_oth.

YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
00
d
r

What other things made you leave this job?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(D1=01 or D2=01)
D24.
CHECK: DID {NAME} HOLD MORE THAN ONE JOB DURING 2016 (D3 > 01)?
YES .................................................................................
01
(REPEAT D4 THROUGH D23 FOR EACH JOB)
NO ...................................................................................
00

D-12

(DP2a_oth)
(D24)
(D24)
(D24)

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D1=01 or D2=01)
D25.
Sometimes people work fewer hours or earn less money than they could in order to care for family
members, keep the cash benefits they need, or just to have more free time. In 2016, did (you/NAME) work
fewer hours or earn less money than (you/he/she) could have for any reason?
YES .................................................................................
01
NO ...................................................................................
00 (D26)
DON’T KNOW .................................................................
d
(D26)
REFUSED .......................................................................
r
(D26)

((D1=01 or D2=01) and D25=01)
D25a. Did (you/NAME) work fewer hours or earn less money than (you/he/she) could have because (you/he/she)…
PROBE:

I need to ask everyone in our study the same questions, even if they don’t seem to apply to
(you/NAME).
YES

NO

DON’T
KNOW

REFUSED

a.

{Were/Was} taking care of children or others?

01

00

d

r

b.

{Were/Was} enrolled in school or a training program?

01

00

d

r

c.

Wanted to keep Medicare or Medicaid coverage?

01

00

d

r

d.

Wanted to keep cash benefits (you/he/she) needed such as
disability or workers compensation?

01

00

d

r

e.

Just did not want to work more?

01

00

d

r

f.

Are there any reasons I didn’t mention why {you/NAME}
might have worked or earned less than {you/he/she} could
have during 2016?

01

00

d

r

PROGRAMMER: IF D25f=01 GO TO D25f_Other, ELSE SKIP TO D25_1
((D1=01 or D2=01) and D25=01 and D25f=01)
D25f_Other What other reason?

DON’T KNOW ...............................................................
REFUSED .....................................................................

d
r

((D1=01 or D2=01) and D25=01)
D25_1. Were any of (your/NAME’s) disability-related benefits reduced or ended as a result of {your/his/her} working
in 2016?
YES ...............................................................................
NO .................................................................................
DON’T KNOW ...............................................................
REFUSED .....................................................................

D-13

01
00
d
r

(D26)
(D26)
(D26)

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D25_1=01)
D25_2. What benefits were reduced or ended as a result of {your/NAME’s} job in 2016?
INTERVIEWER: MARK ALL THAT APPLY.
PRIVATE DISABILITY INSURANCE.............................
WORKERS’ COMPENSATION .....................................
VETERANS’ BENEFITS................................................
MEDICARE ...................................................................
MEDICAID .....................................................................
SSA DISABILITY BENEFITS ........................................
PUBLIC ASSISTANCE OR WELFARE .........................
FOOD STAMPS ............................................................
PERSONAL ASSISTANCE SERVICES (PAS) .............
UNEMPLOYMENT BENEFITS .....................................
OTHER STATE DISABILITY BENEFITS ......................
OTHER GOVERNMENT PROGRAMS .........................
OTHER..........................................................................

01
02
03
04
05
06
07
08
09
10
11
12
13

(D25_2_Other)

(D25_2=13)
D25_2_Other: What other benefits?

DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(D1=01 or D2=01)
D26.
Now, I am going to read you a list of things that sometimes help people to work more hours or earn more
money. If any of these do not apply to {you/NAME}, please just say so.
In 2016, do you think {you/NAME} could have worked or earned more if {you/he/she} had…
YES

NO

NA

DON’T
KNOW

REFUSED

Help caring for {your/his/her} children or others in the
household?

01

00

02

d

r

Help with {your/his/her} own personal care such as
bathing, dressing, preparing meals, and doing
housework?

01

00

02

d

r

c.

Reliable transportation to and from work?

01

00

02

d

r

d.

Better job skills?

01

00

02

d

r

e.

A job with a flexible work schedule?

01

00

02

d

r

f.

Help with finding and getting a better job?

01

00

02

d

r

g.

Any special equipment or medical devices?
PROGRAMMER: IF D26g=01, GO TO D26g_Other,
ELSE GO TO D26h.

01

00

02

d

r

01

00

02

d

r

a.
b.

h.

Is there anything else that I didn’t mention that would
have helped {you/NAME} to work or earn more during
2016?
PROGRAMMER: IF D26h=01, GO TO D26h_Other,
ELSE GO TO D27

D-14

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

((D1=01 or D2=01) and D26g=01)
D26g_Other What other special equipment or medical devices?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

(D26h)
d (D26h)
r (D26h)

((D1=01 or D2=01) and D26h=01)
D26h_Other What else?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(D1=01 or D2=01)
D27.
One last question about when {you were/NAME was} working in 2016. Because of {your/his/her} work, did
Social Security need to make any changes to the amount of {your/his/her} disability benefits?
PROBE:

Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?
YES ............................................................................................ 01
NO .............................................................................................. 00 (D29)
DON’T KNOW ............................................................................ d (D29)
REFUSED .................................................................................. r (D29)

((D1=01 or D2=01) and D27=01)
D28.
Because of these changes did the Social Security Administration pay {you/NAME} the wrong benefit amount
at any time during 2016?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(D1=01 or D2=02=01)
D29.
In 2016, {were you/was NAME} ever asked to re-pay benefits because the Social Security Administration
overpaid {you/him/her}?
YES ............................................................................................ 01
NO .............................................................................................. 00 (SC1CHECK)
DON’T KNOW ............................................................................ d (SC1CHECK)
REFUSED .................................................................................. r (SC1CHECK)
((D1=01 or D2=01) and D29=01)
D30.
{Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/(he/she) was}
working while receiving benefits?
YES ............................................................................................
NO ..............................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

D-15

01
00 (SC1CHECK)
d (SC1CHECK)
r (SC1CHECK)

SECTION D UNIVERSE: WORKED IN 2016 (B30=01)
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, WORKED IN 2016 (B30), NUMBER OF CURRENT JOBS (C1),
START DATES OF CURRENT JOBS (C4mth, C4yr), BIRTH YEAR (A04_d)
PRELOADED VARIABLES: NONE

(D30=01)
DP3.
Did you change how much you worked because you were asked to re-pay the Social Security
Administration? (NEW)
YES ............................................................................................
NO................................................................................. ..............
DON’T’ KNOW............................................................................
REFUSED ..................................................................................

01
00 (SC1CHECK)
d (SC1CHECK)
r (SC1CHECK)

(DP3=01)
DP3a. What did you change about how much you worked? Did you…. (NEW)
Reduce your work hours by a little..............................................
Reduce your work hours by a lot ................................................
Increase your work hours by a little, or .......................................
Increase your work hours by a lot? .............................................
DON’T’ KNOW............................................................................
REFUSED ..................................................................................
GO TO SC1CHECK1

D-16

01
02
03
04
d
r

SECTION SC UNIVERSE: B24=01 or B24b=01 or B30=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

SECTION SC: SCREEN FOR BENEFIT CONFIRMATION OF SUSPENSE STATUS
SC1CHECK:
IS {NAME} CURRENTLY WORKING, WORKED IN PAST 6 MONTHS, OR WORKED IN 2016 (B24=01 OR B24b=01
OR B30=01)
YES ............................................................................................ 01 (SC1a)
NO .............................................................................................. 00 (EP1)
(C39_2=06 or CB39_2=06 or D25_2=06)
SC1a. Earlier you told me that your Social Security disability benefits were reduced or ended because of a recent
job. During the past year, did you ever completely stop receiving cash disability benefits for a time because
you were working?
PROBE:

This includes stopping cash disability benefits because you were earning too much or working
too many hours.
YES. ........................................................................................... 01 (SC2)
NO................................................................................. .............. 00 (EP1)
DON’T’ KNOW............................................................................ d (EP1)
REFUSED................................................................................ ... r (EP1)

(SC1CHECK=01 and C39_2 NE 06 and CB39_2 NE 06 and D25_2 NE 06
SC1.
Now I would like to ask you about your experiences working and how working has affected your cash
disability benefits. During the past year, did you ever stop receiving cash disability benefits for a time
because you were working? (NEW)
PROBE:

This includes stopping cash benefits because you were earning too much or working too many
hours.
YES. ........................................................................................... 01 (SC2)
NO................................................................................. .............. 00 (EP1)
DON’T’ KNOW............................................................................ d (EP1)
REFUSED................................................................................ ... r (EP1)

(SC1=01 OR SC1a=01)
SC2. Are you currently receiving cash disability benefits?
YES. ........................................................................................... 01 (SA7)
NO................................................................................. .............. 00 (SC3)
DON’T’ KNOW............................................................................ d (SC3)
REFUSED................................................................................ ... r (SC3)
(SC2 =00, d, r)
SC3.
Are you in the process of getting back on cash disability benefits?
INTERVIEWER NOTE:

If respondent indicates that they are planning on getting back on benefits but
have not yet started the process, code as ‘01’.

YES. ........................................................................................... 01 (SA7)
NO................................................................................. .............. 00 (SA7)
DON’T’ KNOW............................................................................ d (SA7)
REFUSED................................................................................ ... r (SA7)

SC-1

SECTION SA UNIVERSE: B24=01 or B24b=01 or B30=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

SA. QUESTIONS APPLICABLE TO ALL EXPERIENCING RECENT SUSPENSE
(SC1a=01 or SC1=01)
Now I would like to ask you about the work that led to {you /his/her} cash benefits ending.
SA7.

Did {you/NAME} know when you started working or earning more that {you/he/she} would stop receiving
cash disability benefits from Social Security? (NEW)
YES. ........................................................................................... 01 (SA8CHECK)
NO................................................................................. .............. 00 (SA8)
DON’T’ KNOW............................................................................ d (SA8CHECK))
REFUSED .................................................................................. r (SA8CHECK))

(SA7=00)
SA8.
If {you/NAME} had known that {you were/ he was / she was} going to stop receiving cash benefits, would
{you/he/she} still have started working or earning more? (NEW)
YES. ........................................................................................... 01
NO................................................................................. .............. 00
DON’T’ KNOW............................................................................ d
REFUSED .................................................................................. r
SA8CHECK:
IS {NAME} STILL IN SUSPENSE AND NOT IN PROCESS OF GETTING BACK ON BENEFITS: SC2=00 AND
SC3=00?
YES ............................................................................................ 01 (SS1)
NO .............................................................................................. 00
IS {NAME} STILL RECEIVING BENEFITS SC2=01 OR IN PROCESS OF GETTING BACK ON BENEFITS
(SC3=01)?
YES ............................................................................................ 01 (SB1)
NO .............................................................................................. 00 (EP1)

SA-1

SECTION SS UNIVERSE: SC2=00 and SC3=00
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

SS. QUESTIONS APPLICABLE TO SUSPENSE SAMPLE MEMBERS IN SUSPENSE AT INTERVIEW
(SC2=00 AND SC3=00)
SS2.

I’m going to ask you about things that might make you have to go back on cash disability benefits in the
future. Are you likely to go back on cash disability benefits because of…
YES

NO

DON’T
KNOW

REFUSED

a. Your health, for example because of worsening
illness or the need to go to medical appointments?

01

00

d

r

b. Your job, for example because of a need for
accommodations or problems with your co-workers?

01

00

d

r

c. Your personal circumstances, for example because
you need child care, do not have reliable
transportation, or worry about losing other benefits?

01

00

d

r

PROGRAMMER NOTE: IF SS2a= 0,D,R and SS2b=00,D,R and SS2c=00, D, R, GO TO SS3.
IF SS2a= 1, GO TO SS2a_1.
IF SS2b= 1, GO TO SS2b_1.
IF SS2c= 1, GO TO SS2c_1.
PROGRAMMER NOTE: SS2a_1 SHOULD BE ASKED IMMEDIATELY AFTER SS2a IF =YES. THEN CYCLE BACK
TO SS2b.
(SS2a=01)
SS2a_1. What about your health makes you think you might go back on benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
EXISTING HEALTH PROBLEM GETS WORSE ........................
NEW HEALTH PROBLEM STARTS ..........................................
GET INJURED............................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH ..........................
NEED TO BE HOSPITALIZED ...................................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE ...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKES TOO LONG ....................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY ...............
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK. ..............................
WORK IS TOO TIRING OR STRESSFUL ..................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED................... ...............................................................

SS-1

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15 (SS2a_1_oth)
d
r

SECTION SS UNIVERSE: SC2=00 and SC3=00
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

(SS2a_1=15)
SS2a_1_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

PROGRAMMER NOTE: SS2b_1SHOULD BE ASKED IMMEDIATELY AFTER SS2b IF =YES. THEN CYCLE BACK
TO SS2c.
(SS2b=01)
SS 2b_1. What is it about your job that makes you think you might go back on benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
JOB DOES NOT PAY ENOUGH ................................................
JOB DOES NOT OFFER HEALTH INSURANCE BENEFITS ....
NEED A DIFFERENT SCHEDULE OR SHIFT ...........................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE ...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ......................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ...............................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(SS2b_1=11)
SS2b_1_oth.

01
02
03
04
05
06
07
08
09
10
11 (SS2b_1_oth)
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

PROGRAMMER NOTE: SS2c_1 SHOULD BE ASKED IMMEDIATELY AFTER SS2c IF =YES.

SS-2

SECTION SS UNIVERSE: SC2=00 and SC3=00
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

(SS2c=01)
SS 2c_1. What is it about your personal circumstances that make you think you might go back on benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
NEED HELP CARING FOR CHILDREN OR OTHERS ..............
NEED PERSONAL ASSISTANCE TO GET READY FOR
WORK EACH DAY .....................................................................
GET INJURED............................................................................
MIGHT LOSE BENEFITS SUCH AS SOCIAL
SECURITY, SNAP, MEDICAID/MEDICARE ..............................
PERSONALITY CONFLICTS WITH OTHERS AT THE JOB......
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB ..................
DO NOT HAVE RELIABLE TRANSPORTATION TO AND
FROM WORK .............................................................................
DRUG/ALCOHOL RELAPSE .....................................................
WOULD RATHER DO OTHER THINGS THAN WORK .............
DO NOT LIKE WORKING... .......................................................
WORK IS TOO TIRING OR STRESSFUL ..................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED. .................................................................................
(SS2c_1=12)
SS2c_1_oth.

01
02
03
04
05
06
07
08
09
10
11
12 (SS2c_1_oth)
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(SC2=00 AND SC3=00)
SS3.
Are there any other things we haven’t talked about that might make you go back on benefits? (NEW)
YES. ........................................................................................... 01 (SS3a)
NO................................................................................. .............. 00 (Section E)
DON’T’ KNOW............................................................................ d (Section E)
REFUSED................................................................................ ... r (Section E)
(SS3=01)
SS3a. What other things might make you go back on benefits?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

GO TO SECTION E.

SS-3

d
r

SECTION SB UNIVERSE: SC2=01 OR SC3=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

SB. QUESTIONS APPLICABLE TO RECENT SUSPENSE SAMPLE MEMBERS RECEIVING BENEFITS AT
INTERVIEW

Earlier you told me that you are {back on benefits/in the process of getting back} on benefits].
(SC2=01) or (SC3=01)
SB1.
{Did you go/are you going} back on benefits because of . . . (NEW)
YES

NO

DON’T
KNOW

REFUSED

a. Your health, for example because of worsening
illness or the need to go to medical appointments?

01

00

d

r

b. Your job, for example because of the need for
accommodations or problems with your co-workers?

01

00

d

r

c. Your personal circumstances, for example because
you need child care, do not have reliable
transportation, or worry about losing other benefits?

01

00

d

r

PROGRAMMER NOTE: IF SB1a= 0,D,R and SB1b=00,D,R and SB1c=00, D, R, GO TO SB2a_other.
IF SB1a= 1, GO TO SB1a_1.
IF SB1b= 1, GO TO SB1b_1.
IF SB1c= 1, GO TO SB1c_1.
PROGRAMMER NOTE: SB1a_1 SHOULD BE ASKED IMMEDIATELY AFTER SB1a IF =YES. THEN CYCLE BACK
TO SB1b.
(SB1a=01)
SB1a_1.
What was it about your health that made you have to go back on benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anything else?
EXISTING HEALTH PROBLEM GETS WORSE ........................
NEW HEALTH PROBLEM STARTS ..........................................
GET INJURED............................................................................
JOB HAS A NEGATIVE IMPACT ON HEALTH ..........................
NEED TO BE HOSPITALIZED ...................................................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE ...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKES TOO LONG ....................................................................
HEALTH STATUS FLUCTUATES UNPREDICTABLY ...............
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK. ..............................
WORK IS TOO TIRING OR STRESSFUL ..................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED................... ...............................................................

SB-1

01
02
03
04
05
06
07
08
09
10
11
12
13
14
15 (SB1a_1_oth)
d
r

SECTION SB UNIVERSE: SC2=01 OR SC3=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

(SB1a_1=15)
SB1a_1_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

PROGRAMMER NOTE: SB1b_1 SHOULD BE ASKED IMMEDIATELY AFTER SB1b IF =YES. THEN CYCLE BACK
TO SB1c.
(SB1b=01)
SB1b_1. What was it about your job that made you have to go back on benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
JOB DOES NOT PAY ENOUGH ................................................
JOB DOES NOT OFFER HEALTH INSURANCE BENEFITS ....
NEED A DIFFERENT SCHEDULE OR SHIFT ...........................
NEED TIME TO GO TO MEDICAL APPOINTMENTS ...............
GET FIRED FOR MISSING TOO MUCH TIME FOR
APPOINTMENTS OR HOSPITALIZATION ................................
HEALTH INTERFERES WITH JOB PERFORMANCE ...............
DO NOT HAVE THE STRENGTH, PHYSICAL ENERGY
OR STAMINA REQUIRED TO WORK .......................................
PAIN INTERFERES WITH WORKING A SET SCHEDULE .......
PERSONAL CARE AND GETTING READY FOR WORK
TAKE TOO LONG ......................................................................
DO NOT HAVE SPECIAL EQUIPMENT OR MEDICAL
DEVICES NEEDED IN ORDER TO WORK ...............................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(SB1b_1=11)
SB1b_1_oth.

01
02
03
04
05
06
07
08
09
10
11 (SB1b _1_oth)
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

PROGRAMMER NOTE: SB1c_1 SHOULD BE ASKED IMMEDIATELY AFTER SB1c IF =YES.

SB-2

SECTION SB UNIVERSE: SC2=01 OR SC3=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

(SB1c=01)
SB1c_1. What was it about your personal circumstances that made you have to go back on benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
NEED HELP CARING FOR CHILDREN OR OTHERS .......... 01
NEED PERSONAL ASSISTANCE TO GET READY
FOR WORK EACH DAY ........................................................ 02
GET INJURED....................................................................... 03
MIGHT LOSE BENEFITS SUCH AS SOCIAL SECURITY,
SNAP, MEDICAID/MEDICARE .............................................. 04
PERSONALITY CONFLICTS WITH OTHERS AT THE JOB.. 05
MIGHT GET FIRED FOR BEHAVIOR AT THE JOB .............. 06
DO NOT HAVE RELIABLE TRANSPORTATION TO AND
FROM WORK ........................................................................ 07
DRUG/ALCOHOL RELAPSE ................................................ 08
WOULD RATHER DO OTHER THINGS THAN WORK ......... 09
DO NOT LIKE WORKING... ................................................... 10
WORK IS TOO TIRING OR STRESSFUL .............................. 11
OTHER ................................................................................... 12 (SB1c_1_oth)
DON’T KNOW .......................................................................... d
REFUSED. ................................................................................ r

(SB1c_1=12)
SB1c_1_oth.

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(SC2=01) or (SC3=01)
SB2.
Are there any other things that we haven’t talked about that explain why you {went/are going} back on
benefits? (NEW)
YES .................................................................................
NO ...................................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
00
d
r

(SB2=01)
SB2a_other. What (things/ SB1a, Sb1b, Sb1c=1: other things) made you go back on benefits?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(SC2=01) or (SC3=01)
SB3.
Is there anything that could have helped you to keep working and earning enough to stay off benefits?
(NEW)
YES .................................................................................
NO ...................................................................................
DON’T’ KNOW ................................................................
REFUSED .......................................................................

SB-3

01
00
d
r

(SB4)
(SB4)
(SB4)

SECTION SB UNIVERSE: SC2=01 OR SC3=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

(SB3=01)
SB3a. What might have helped you keep working and earning enough to stay off benefits? (NEW)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE:

Anything else?
WORKING FEWER HOURS A DAY ..........................................
WORKING FEWER DAYS A WEEK ..........................................
WORKING A DIFFERENT SHIFT ..............................................
HAVING A MORE FLEXIBLE SCHEDULE. ...............................
BEING ABLE TO START LATER IN THE DAY ..........................
HAVING/HAVING MORE SICK OR OTHER LEAVE..................
PERSONAL CARE ATTENDANT/PERSONAL
ASSISTANT TO HELP WITH GETTING READY
AND/OR DO HOUSEHOLD TASKS ...........................................
ASSISTANCE WITH WORK TASKS ..........................................
MORE UNDERSTANDING EMPLOYER ....................................
MORE UNDERSTANDING CO-WORKERS...............................
ASSISTIVE DEVICE AT WORK .................................................
PHYSICAL MODIFICATIONS OF WORKSPACE ......................
JOB COACH...............................................................................
SIGN LANGUAGE INTERPRETER............................................
READER/INTERPRETER FOR THE BLIND ..............................
ON THE JOB TRAINING ............................................................
BEHAVIORAL COACHING ........................................................
BENEFITS COUNSELING .........................................................
TRANSPORTATION ASSISTANCE. ..........................................
CHILD/FAMILY CARE ASSISTANCE ........................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED. .................................................................................

01
02
03
04
05
06

07
08
09
10
11
12
13
14
15
16
17
18
19
20
21 (SB3a_oth)
d
r

(SB3a=21)
SB3a_oth. What other things might have helped {you/NAME} keep working and earning enough to stay off benefits?
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

d
r

(SC2=01) or (SC3=01)
SB4.
{Do you/Does NAME} think you will go back to work in the future? (NEW)
YES ........................................................................................ 01 (EP1)
NO .......................................................................................... 00 (SB4a)
DON’T KNOW .......................................................................... d (SB4b)
REFUSED ................................................................................. r (EP1)

SB-4

SECTION SB UNIVERSE: SC2=01 OR SC3=01
VARIABLES NEEDED FROM OTHER SECTIONS: NONE
PRELOADED VARIABLES: NONE

(SB4=00)
SB4a. Why {don’t you/doesn’t NAME} think {you/he/she} will go back to work?
HEALTH GOES UP AND DOWN ...............................................
HEALTH WILL NOT IMPROVE ENOUGH TO WORK ...............
NOT GETTING MEDICAL TREATMENT, EQUIPMENT, OR
PERSONAL CARE NEED ..........................................................
NOT FINDING RIGHT JOB ........................................................
GETTING HELP CARING FOR
NOT GETTING HELP CARING FOR CHILDREN OR
OTHERS ....................................................................................
NOT GETTING HEALTH INSURANCE ......................................
NOT GETTING TRANSPORTATION .........................................
OTHER (SPECIFY) ....................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(SB4a=08)
SB4a_oth.

01
02
03
04

05
06
07
08 (SB4a_oth)
d
r

INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

(EP1)
d (EP1)
r (EP1)

(SB4 = d)
SB4b. Why {are you/is NAME} unsure about whether {you/he/she} will go back to work?
HEALTH GOES UP AND DOWN ............................................... 01
HEALTH MAY NOT IMPROVE ENOUGH TO WORK ................ 02
MAY NOT GET MEDICAL TREATMENT, EQUIPMENT, OR
PERSONAL CARE NEED .......................................................... 03
MAY NOT FIND RIGHT JOB ...................................................... 04
MAY NOT GET HELP CARING FOR
CHILDREN OR OTHERS ...............................................................05
MAY NOT GET HEALTH INSURANCE ...................................... 06
MAY NOT GET TRANSPORTATION ......................................... 07
OTHER (SPECIFY) .................................................................... 08 (SB4b_oth)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(SB4b=08)
SB4b_oth. INTERVIEWER: PLEASE SPECIFY
Other (SPECIFY)
DON’T KNOW .................................................................
REFUSED .......................................................................

SB-5

(EP1)
d (EP1)
r (EP1)

SECTION E UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: BSTATUS, SSIAGE, SAMPLE AGE, SDATE VRNAME

SECTION E: AWARENESS OF SSA PROGRAMS
(ALL)
EP1.

Now I will ask you some questions about disability benefit programs.
If {you/NAME} needed information about {your/his/her} disability benefits or how work affects {your/his/her}
benefits who would {you/NAME or (his/her) representative} contact to get that information? (adapted from
NBS10 QF1)
INTERVIEWER: CODE ALL THAT APPLY.
PROBE: Anyone or anyplace else?
SOCIAL SECURITY ADMINISTRATION (PHONE
OR IN PERSON) .............................................................
STATE VOCATIONAL REHABILITATION .....................
AGENCY OR {VRNAME} ................................................
BENEFIT SPECIALIST ...................................................
CASEWORKER ..............................................................
FRIEND OR FAMILY MEMBER ......................................
INDEPENDENT LIVING CENTER OR OTHER
DISABILITY SUPPORT ORGANIZATION ......................
MEDICAL DOCTOR OR PROFESSIONAL.....................
SEARCH ON THE INTERNET (E.G., SSA WEBSITE) ...
OTHER............................................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

01
02
03
04
05
06
07
08
09
10
d
r

(ALL)
EP1a. In 2016, did {you/NAME or (his/her) representative} use any of the following to contact the Social Security
Administration (SSA) for information about {your/his/her} disability benefits or how work affects {your/his/her}
benefits…
YES

NO

DON’T
KNOW

REFUSED

a. telephone?

01

00

d

r

b. visiting a Social Security Administration office in
person?

01

00

d

r

c. going online to the Social Security Administration’s
website or by email?

01

00

d

r

PROGRAMMER NOTE: IF all responses in EP1aa – EP1ac =00, D, R, GO TO B23_3.
(EP1aa=01 OR EP1ab=01 OR EP1ac=01)
EP1b. In general, how easy was it for {you/NAME or (his/her) representative} to get the information {you/they}
wanted about {your/his/her} disability benefits or how work affects {your/his/her} benefits from the Social
Security Administration (SSA)? Was it:
Very easy, .......................................................................
Somewhat easy, ..............................................................
Not very easy, or .............................................................
Not at all easy? ...............................................................
DON’T KNOW .................................................................
REFUSED .......................................................................

EP-1

01
02
03
04
d
r

SECTION E UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: BSTATUS, SSIAGE, SAMPLE AGE, SDATE VRNAME

(EP1aa=01 OR EP1ab=01 OR EP1ac=01)
EP1d. Overall, how helpful was the information {you/NAME} got about {your/his/her} disability benefits or how work
affects {your/his/her} benefits from the Social Security Administration (SSA)? Would you say:
Very helpful,................................................................................
Somewhat helpful, ......................................................................
Not very helpful, or .....................................................................
Not at all helpful? ........................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
d
r

NEW ITEM
(ALL)
B23_3. {Have you/Has name} ever used the Internet to access information about {your/his/her} disability, services,
or work from websites other than the SSA’s website?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(ALL)
B23_2. How often {do you/does NAME} access the Internet?
Probe: This includes accessing the Internet by computer, smart phone, tablet, or any other means.
Never ..........................................................................................
Daily ...........................................................................................
A few times a week .....................................................................
Once a week...............................................................................
Less than once a week ...............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
E1.

01
02
03
04
05
d
r

Next, I’m going to read you a list of incentives and supports that Social Security offers to people getting
disability benefits, to encourage them to work. Please tell me if {you have/NAME has} ever {heard of these
incentives or supports.
PRESS 1 TO CONTINUE ........................................................... 01

(All)
E2.

CHECK: IS {NAME} AN SSI BENEFICIARY (BSTATUS = 01,03)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (E14)

(E2=01)
E3.
{Have you/Has NAME} ever heard of a Plan for Achieving Self-Support or a PASS Plan? This is a Social
Security incentive that lets {you/beneficiaries} set aside money to be used to help {you/them} reach a work
goal. The money set aside does not affect {your/their} benefits.
PROBE 1: {Have you/Has NAME} ever heard of this plan?
PROBE 2: If you’re not sure, please just say so.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

EP-2

SECTION E UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: BSTATUS, SSIAGE, SAMPLE AGE, SDATE VRNAME

(E2=01)
E5.
{Have you/Has NAME} ever heard of the earned income exclusion or the 1 for 2 earnings exclusion? This is
a Social Security incentive where one-half of {your/a beneficiary’s} earnings over $85 are not counted when
Social Security figures {your/the} benefit.
PROBE 1: {Have you/Has NAME} ever heard of this exclusion?
PROBE 2: If you’re not sure, please just say so.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E2=01)
E7.
{Have you/Has NAME} ever heard of Property Essential to Self-Support, or PESS? This is a Social Security
incentive where the dollar value of tools, equipment, or other property needed for {your/a beneficiary’s} work
is excluded when Social Security figures {your/the} benefit.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E2=01)
E9.
{Have you/Has NAME} ever heard of Continued Medicaid Eligibility or 1619(b) coverage? This is a Social
Security incentive that lets {you/beneficiaries} keep {your/their} Medicaid insurance after {you/they} go to
work, even if {your/their} benefits have stopped.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(E2=01)
E11. CHECK: IS {NAME} 25 OR YOUNGER {C_Intage < or = 25} AND DID {NAME} RECEIVE SSI BENEFITS
BEFORE AGE 22 {SSIAGE < 22}?
YES ............................................................................................ 01
NO .............................................................................................. 00 (E14)

(E2=01 and E11=01)
E12.
{Have you/Has NAME} ever heard of the student earned-income exclusion? This is a Social Security
incentive where if {you are/a beneficiary is} in school, up to $1,730 of earnings per month are not counted
when Social Security figures {your/the} benefit.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

EP-3

SECTION E UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: BSTATUS, SSIAGE, SAMPLE AGE, SDATE VRNAME

(All)
E14.

CHECK: IS {NAME} A SSDI BENEFICIARY (BSTATUS=02,03)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (E19)

(E14=01)
E15a.

Most people receiving Social Security disability benefits will lose their cash benefits if they work and earn
more than $1,130 in a month for more than nine months. Is this something you knew before today?
KNEW BEFORE TODAY ............................................................ 01
DID NOT KNOW BEFORE TODAY ............................................ 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(E14=01)
E15.
{Have you/Has NAME} ever heard of a Trial Work Period? This is a Social Security incentive that lets
{you/beneficiaries} earn above $780 per month for nine months without losing {your/their} benefits.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E14=01)
E17.
{Have you/Has NAME} ever heard of an Extended Period of Eligibility for Medicare? This is a Social Security
incentive that lets {you/beneficiaries} keep Medicare coverage when {you/they} go to work, even if
{your/their} benefits have stopped.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01 (E19)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(E9=00, d, r OR E17=00, d, r)
EP3.
Most people who start working and lose their disability benefits are able to keep their health insurance. Is
this something you knew before today?
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(ALL)
E19.

{Have you/Has NAME} ever heard of exclusions for Impairment-Related Work Expenses or Blind Work
Expenses? This is a Social Security incentive where the value of certain impairment-related items is not
counted when figuring {your/a person’s} benefits and eligibility.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

EP-4

SECTION E UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: BSTATUS, SSIAGE, SAMPLE AGE, SDATE VRNAME

(ALL)
E20a.

{Have you/Has NAME} ever heard of Expedited Reinstatement? This is a Social Security incentive that lets
beneficiaries restart their benefits without having to complete a new application if their attempts at work are
not successful.
INTERVIEWER: IF ‘NOT SURE’ ANSWER ‘DON’T KNOW’.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(ALL)
E20c.

{Have you/Has NAME} ever heard of Work Incentive and Planning Assistance programs? These are local
organizations that give beneficiaries information about Ticket to Work and other programs and help them
understand how their Social Security benefits are affected by work.
INTERVIEWER: IF ‘NOT SURE’, ANSWER ‘DON’T KNOW’
PROBE: These are sometimes called WIPAs.
YES ............................................................................................ 01
NO .............................................................................................. 00 (E20e)
DON’T KNOW ............................................................................ d (E20e)
REFUSED .................................................................................. r (E20e)

(E20c=01)
E20d. {Have you/Has NAME} ever used a Work Incentive and Planning Assistance program?
INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW
YES ........................................................................................... 01
NO ............................................................................................. 00
DON’T KNOW ........................................................................... d
REFUSED ................................................................................. r
(ALL)
E20e.

{Have you/Has NAME} ever heard of Protection and Advocacy for Beneficiaries of Social Security or
PABSS? This program is focused on protecting beneficiaries’ rights to obtain services.
INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW
YES ............................................................................................ 01
NO .............................................................................................. 00 (E21)
DON’T KNOW ............................................................................ d (E21)
REFUSED .................................................................................. r (E21)

(E20e=01)
E20f.
{Have you/Has NAME} ever used Protection and Advocacy for Beneficiaries of Social Security or PABSS?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

EP-5

SECTION E UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: BSTATUS, SSIAGE, SAMPLE AGE, SDATE VRNAME

(All)
E21.

{Have you/Has NAME} ever heard of the Ticket to Work program?
PROBE:

The Ticket to Work program provides services to help disability beneficiaries achieve steady,
long-term employment by providing them greater choices and opportunities to go to work if they
want to.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

EP-6

SECTION F: REMOVED FROM NBS-GENERAL WAVES

F-1

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2016
SERVICE PROVIDERS
(All)
G1.

Next, I will ask about different types of services that people with disabilities sometimes get in order to
improve their ability to work or live independently. Please think only about services you received in 2016.
First, I will ask about employment services {you/NAME} may have received.

(All)
G2. In 2016, did {you/he/she} receive:
YES

NO

NA

DON’T
KNOW

REF

a. a work or job assessment to determine if a
job is a good fit for you?

01

00

02

d

r

b. help to find a job?

01

00

02

d

r

01

00

02

d

r

01

00

02

d

r

01

00

02

d

r (G2_oth)

c.

advice about modifying {your/his/her} job or
work place?

d. job coaching or support services?
e. any other employment support services to
help you get a job or live independently?
(G2_e=01)
G2_oth.

INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

G2Check: WAS ANY EMPLOYMENT SERVICE RECEIVED (G2a or G2b or G2c or G2d or G2E=01)?
YES ............................................................................................ 01 (GO TO G7)
NO .............................................................................................. 00 (GO TO G10)

G-1

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(G2a or G2b or G2c or G2d or G2d=01)
G7.
Where did you go to get these employment services? Please think about all of the places you went in 2016.
Did you go to a:
INTERVIEWER: MARK ALL THAT APPLY.
PROBE: Anywhere else?
Vocational rehabilitation agency or {VRNAME FROM
{NAME’S} CURRENT STATE}, ..................................................
Welfare agency or {STATE WELFARE AGENCY NAME/
ACRONYM FROM {NAME’S} CURRENT STATE},....................
Mental health agency, ................................................................
Some other state agency, ...........................................................
Workforce center or employment/unemployment office,.............
A school or college, or ...............................................................
A private business, or .................................................................
Some other type of place? ..........................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01 (G10)
02
03
04
05
07
06
07
d
r

(G10)
(G10)
(G9_oth1)
(G10)
(G10)
(G10)
(G7_oth)
(G10)
(G10)

(G7=07)
G7_oth. INTERVIEWER: PLEASE SPECIFY
______________________________________________ (G10)
DON’T KNOW ..............................................................
REFUSED ....................................................................

d (G10)
r (G10)

(G7=04)
G9_oth1. INTERVIEWER: PLEASE SPECIFY
_______________________________________
DON’T KNOW ..............................................................
REFUSED ....................................................................

(NEXT PROVIDER OR G10)

d (NEXT PROVIDER OR G10)
r (NEXT PROVIDER OR G10)

(G1=01 G7=01 and G8=01 and G9=05)
(All)
G10. Sometimes people get training to help them learn new skills so they can get a new job or change careers.
PRESS 1 TO CONTINUE.............................................
(All)
G11. In 2016, did {you/he/she} receive:

a. training to learn a new job or skill?
b. on-the-job training?
c.

G-2

any other training or certification to help you
learn new skills or get a job that I didn’t
mention?

1

YES
01

NO
00

NA
02

DON’T
KNOW
d

REF
r

01

00

02

d

r

01

00

02

d

r (G11_oth)

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(G11_d = 01)
G11_oth.
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

G10Check: WAS ANY EMPLOYMENT TRAINING RECEIVED (G11a or G11b or G11c=01)?
YES ............................................................................................ 01 (GO TO G13)
NO .............................................................................................. 00 (GO TO G15)
(G11a or G11b, or G11=01)
G13.
Where did you go to get this training? Please think about all of the places you went in 2016. Did you go to a:
INTERVIEWER: MARK ALL THAT APPLY.
PROBE: Anywhere else?
Vocational rehabilitation agency or {VRNAME FROM
{NAME’S} CURRENT STATE}, ..................................................
Welfare agency or {STATE WELFARE AGENCY NAME/
ACRONYM FROM {NAME’S} CURRENT STATE},....................
Mental health agency, ................................................................
Some other state agency, ...........................................................
Workforce center or employment/unemployment office,.............
A private business, .....................................................................
A school or college, or ...............................................................
Some other type of place? .........................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................
*Note:

01 (G15)
02
03
04
05
06
07
08
d
r

(G15)
(G15)
(G13_oth1)
(G15)
(G15)
(G15)*
(G13_oth)
(G15)
(G15)

G13=4 is a category added at R2 and R3; value of “other” category (G13=3) maintained for comparability
across rounds.

(G13=04)
G13_oth1. INTERVIEWER: PLEASE SPECIFY
____________________________________________________ (G15)
DON’T KNOW ..............................................................
REFUSED ....................................................................

d (G15)
r (G15)

(G13=08)
G13_oth. INTERVIEWER: PLEASE SPECIFY
____________________________________________________ (G15)
DON’T KNOW ..............................................................
REFUSED ....................................................................
(All)
G15.

Sometimes people with disabilities receive medical services to improve their ability to work or help them live
independently. Some examples of these services are physical therapy, surgery, and help getting special
equipment or devices.
PRESS 1 TO CONTINUE.............................................

G-3

d (G15)
r (G15)

1

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(ALL)
G16. In 2016, did {you/he/she} receive:

YES

NO

NA

DON’T
KNOW

REF

a. physical therapy?

01

00

02

d

r

b. occupational therapy? PROBE: Occupation therapy is
treatment that helps people achieve independence in all
areas of their lives and can include home and job site
evaluations, skills assessments, equipment
recommendations, and other treatment to help improve a
person’s ability to perform daily activities

01

00

02

d

r

c.

01

00

02

d

r

01

00

02

d

r

01

00

02

d

r

01

00

02

d

r
(G16_oth)

speech therapy?

d. special equipment or devices?
e. prescription medications?
PROBE: Prescription medications are medications
prescribed by a doctor and do not include over-thecounter medications.
f.

G16_oth.

any other medical services to improve your ability to work
or live independently that I didn’t mention?
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

G16Check: WAS ANY MEDICAL SERVICE RECEIVED (G16a or G16b or G16c or G16d or G16e or G16f=01)?
YES ............................................................................................ 01 (GO TO G18)
NO .............................................................................................. 00 (GO TO G20)
(G16a or G16b or G16c or G16d or G16e or G16f=01)
G18.
Where did you go to receive these medical services? Please think about all of the places you went in 2016.
Did you go to:
INTERVIEWER: MARK ALL THAT APPLY.
PROBE: Anywhere else?
A clinic or doctor’s office, ............................................................ 01 (G20)
A hospital or................................................................................ 02 (G20)
Some other type of place? .......................................................... 03 (G18_oth)
DON’T KNOW ............................................................................ d (G20)
REFUSED .................................................................................. r (G20)
(G18=03)
G18_oth. INTERVIEWER: PLEASE SPECIFY
______________________________________________ (G20)
DON’T KNOW .................................
REFUSED .......................................
G-4

d
r

(G20)
(G20)
NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(All)
G20.

Sometimes people go to a mental health professional to get therapy or counseling to improve their ability to
work or live independently. In 2016, did {you/he/she} receive:
YES

NO

NA

DON’T
KNOW

REF

a. personal counseling or therapy?

01

00

02

d

r

b. group therapy?

01

00

02

d

r

01

00

02

d

r (G20_oth)

c.

G20_oth.

any other mental health services to help you
work or live independently that I didn’t
mention?
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

G20Check: WAS ANY MENTAL HEALTH SERVICE RECEIVED (G20a or G20b or G20c or G20d=01)?
YES ............................................................................................ 01 (GO TO G22)
NO .............................................................................................. 00 (GO TO G23)

(G20a or G20b or G20c or G20d=01)
G22.
Where did you receive this mental health therapy or counseling? Please think about all of the places you
went in 2016. Did you go to:
INTERVIEWER: MARK ALL THAT APPLY.
A mental health agency, .............................................................
A clinic or doctor’s office, ............................................................
A hospital or,...............................................................................
Some other type of place? ..........................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
d
r

(G23)
(G23)
(G23)
(G22_oth)
(G23)
(G23)

(G22=04)
G22_oth. INTERVIEWER: PLEASE SPECIFY
________________________________________________(G23)
DON’T KNOW ...............................................................
REFUSED .....................................................................

G-5

d (G23)
r (G23)

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(All)
G23.

At any time in 2016, did {you/ NAME} enroll in school or take any classes to help {you/him/her} get a new job
or change careers? Please do not include any training you have already told me about.
PROBE 1: This could include vocational training in high school, college classes, or other instructional
programs.
YES ............................................................................... 01
NO ................................................................................. 00
DON’T KNOW ............................................................... d
REFUSED .....................................................................
r

(G23=01)
G26.
{Are you/Is NAME} currently enrolled in school or taking any classes?
YES ............................................................................................ 01 (G27)
NO .............................................................................................. 00 (G52)
DON’T KNOW ............................................................................ d (G52)
REFUSED .................................................................................. r (G52)
(G26=01)
G27.
{Are you/Is NAME} working toward a degree, a certificate or license, or {are you/is (he/she)} just taking
classes?
WORKING TOWARD DEGREE ................................................. 01 (G28)
WORKING TOWARD CERTIFICATE/LICENSE ........................ 02 (G28)
ONLY TAKING CLASSES .......................................................... 03 (G52)
DON’T KNOW ............................................................................ d (G52)
REFUSED .................................................................................. r (G52)

(G27=01,02)
G28.
PROGRAMMER: IF G27=01 USE “DEGREE” AND IF G27=02 USE “CERTIFICATE OR LICENSE”
Toward what type of {degree/certificate or license} {are you/is NAME} working?
INTERVIEWER: CODE ONE ONLY.
GED OR HIGH SCHOOL EQUIVALENCE
PROGRAM/COURSES ..............................................................
VOCATIONAL PROGRAM .........................................................
ASSOCIATE DEGREE PROGRAM (AA DEGREE) ...................
UNDERGRADUATE DEGREE PROGRAM (BA, BS DEGREE)
GRADUATE DEGREE PROGRAM (e.g., MA, MS, MD, EdD)....
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
d
r

(G29)
(G28b_oth)
(G29)
(G29)
(G29)
(G28f_oth)
(G29)
(G29)

(G28=02)
G28b_oth. INTERVIEWER: PLEASE SPECIFY

(G29)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

G-6

d (G29)
r (G29)

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(G28=06)
G28f_oth.

INTERVIEWER: PLEASE SPECIFY

(G29)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d (G29)
r (G29)

(G10=01 or G23=01 and G26=01 and G27=01 or 02)
G29.
{Are you/Is NAME} a full-time or part-time student?
FULL-TIME ................................................................................. 01 (G52)
PART-TIME ................................................................................ 02 (G52)
DON’T KNOW ............................................................................ d (G52)
REFUSED .................................................................................. r (G52
G43. DELETED
G44. DELETED
G45. DELETED
G45_oth. DELETED
G46. DELETED
G47. DELETED
G47_week.DELETEDG47_month.DELETEDG47_year. DELETED
WHY USED SERVICES IN 2016
(All)
G52.

CHECK: DID {NAME} USE ANY SERVICES IN 2016 (at least one item in G2=01 or G11=01 or G16=01 or
G20=01 or G23=01)
YES ............................................................................................ 01 (G53)
NO .............................................................................................. 00 (G58)

G-7

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

(G52=01)
G53.
The next question is about why {you/NAME} decided to use the employment, job training, medical, or
therapy services {you/he/she} used in 2016.
Thinking only about the services {you/NAME} used in 2016, what are the main reasons {you/he/she} decided
to use these services?
INTERVIEWER: CODE ALL THAT APPLY.
TO FIND A JOB/GET A BETTER JOB .......................................
TO INCREASE INCOME ............................................................
TO IMPROVE HEALTH/ WELL BEING ......................................
TO IMPROVE ABILITY TO DO DAILY ACTIVITIES...................
TO AVOID A CONTINUING DISABILITY REVIEW ....................
SOMEONE PRESSURED {NAME} TO PARTICIPATE ..............
WANTED ACCESS TO A SPECIFIC PROGRAM/SERVICE/
RESOURCE ...............................................................................
OTHER .......................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06

(G58)
(G58)
(G58)
(G58)
(G58)
(G58)

07
08
d
r

(G58)
(G53h_oth)
(G58)
(G58)

(G52=01 and G53=08)
G53h_oth. INTERVIEWER: PLEASE SPECIFY

(G58)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

INFORMATION ABOUT SERVICES IN 2016
(All)
G58.

Now I want to ask you about how easy it is to get information about services. This includes both services
{you/NAME} used and did not use.
Thinking only about 2016, did {you/NAME} or {your/his/her} representative contact anyone to try to get
information about services to help {you/NAME} work or live independently?
YES ............................................................................................ 01 (G60)
NO .............................................................................................. 00 (G60)
DON’T KNOW ............................................................................ d (G60)
REFUSED .................................................................................. r (G60)

G-8

NBS ROUND 4 INSTRUMENT

SECTION G UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: AGE OF DISABILITY ONSET VARIABLES: BIRTHYEAR

SERVICES NEEDED BUT NOT RECEIVED IN 2016
(All)
G60.

In 2016, were there any services, equipment, or other supports that {you/NAME} needed but did not receive
that would have improved {your/his/her} ability to work or live independently?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I1)
DON’T KNOW ............................................................................ d (I1)
REFUSED .................................................................................. r (I1)

(G60=01)
G61.
Why {were you/was NAME} unable to get these services?

(I1)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

G-9

d (I1)
r (I1)

NBS ROUND 4 INSTRUMENT

SECTION H

SECTION H: REMOVED FROM NBS GENERAL WAVES

H-1

NBS ROUND 4 INSTRUMENT

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

SECTION I: HEALTH AND FUNCTIONAL STATUS
GENERAL HEALTH STATUS
(ITEMS I1 through I8 constitute the SF-8)
(All)
I1.

The next questions are about {your/NAME’s} health.
Overall, how would you rate {your/NAME’s} health during the past 4 weeks?
Excellent, ....................................................................................
Very good, ..................................................................................
Good, ..........................................................................................
Fair, ............................................................................................
Poor, or .......................................................................................
Very poor ....................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I2.

During the past 4 weeks, how much did physical health problems limit {your/NAME’s} usual physical
activities (such as walking or climbing stairs?)
Not at all, ....................................................................................
Very little, ....................................................................................
Somewhat,..................................................................................
Quite a lot, or ..............................................................................
Could {you/he/she} not do physical activities? ............................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I3.

01
02
03
04
05
d
r

How much bodily pain {have you/has NAME} had in the past 4 weeks?
None, ..........................................................................................
Very mild, ...................................................................................
Mild, ............................................................................................
Moderate, ...................................................................................
Severe, or ...................................................................................
Very severe? ..............................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

I-1

01
02
03
04
05
d
r

During the past 4 weeks, how much difficulty did {you/NAME} have doing {your/his/her} daily work, both at
home and away from home, because of {your/his/her} physical health?
None at all, .................................................................................
A little bit, ....................................................................................
Some, .........................................................................................
Quite a lot, or ..............................................................................
Could {you/he/she} not do daily work? .......................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I4.

01
02
03
04
05
06
d
r

01
02
03
04
05
06
d
r

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(All)
I5.

During the past 4 weeks, how much energy did {you/NAME} have?
Very much, .................................................................................
Quite a lot, ..................................................................................
Some, .........................................................................................
A little, or ....................................................................................
None? .........................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I6.

During the past 4 weeks, how much did {your/NAME’s} physical health or emotional problems limit
{your/his/her} usual social activities with family or friends?
Not at all, ....................................................................................
Very little, ....................................................................................
Somewhat,..................................................................................
Quite a lot, or ..............................................................................
Could {you/he/she} not do social activities? ...............................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I7.

01
02
03
04
05
d
r

During the past 4 weeks, how much {have you/has NAME} been bothered by emotional problems (such as
feeling anxious, depressed or irritable?)
Not at all, ....................................................................................
Slightly, .......................................................................................
Moderately .................................................................................
Quite a lot, or ..............................................................................
Extremely?..................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I8.

01
02
03
04
05
d
r

01
02
03
04
05
d
r

During the past 4 weeks, how much did personal or emotional problems keep {you/NAME} from doing
{your/his/her} usual work, school or other daily activities?
Not at all, ....................................................................................
Very little, ....................................................................................
Somewhat,..................................................................................
Quite a lot, or ..............................................................................
Could {you/he/she} not do daily activities? .................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
d
r

(ALL)
IP1. {Do you/Does NAME} have a physical or mental health condition that gets worse every now and then that
requires more than a few days to recover from? (NEW)
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-2

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(All)
I9.

Compared to {THIS MONTH, LAST YEAR}, how would you rate {your/NAME’s} health in general now?
Much better now, ........................................................................
Somewhat better now, ................................................................
About the same, .........................................................................
Somewhat worse now, or ...........................................................
Much worse now? .......................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
d
r

Unmet Health Needs
(ALL)
IP2. Sometimes people delay or skip getting the health care they need for different reasons. Please tell me if any
time in the past 12 months {you/NAME} delayed or skipped getting . . . (NHIS 2011 AAU section and NHIS 1996
access questions modified)

(ALL)
IP5.

YES

NO

DON’T
KNOW

REFUSED

a.

prescription medicines

01

00

d

r

b.

special equipment or medical devices

01

00

d

r

c.

mental health care or counseling

01

00

d

r

d.

any other type of medical care I didn’t mention

01

00

d

r

During the past 12 months, about how many days did illness or injury keep {you/NAME} in bed more than
half of the day (include days while an overnight patient in a hospital)? (NHIS 2011 item AHS 050)
INTERVIEWER: ENTER THE NUMBER OF DAYS
INTERVIEWER: IF ‘0’ DAYS, ENTER 0.
PROBE: Half a day means more than half of the time you are awake.
|

I-3

|

| (0-60)
(0-365)

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

Informal Supports
(ALL)
IP7.

a.

b.

c.

d.

e.

People sometimes look to others for support. For each of the following kinds of support, please tell me how
often {you are/NAME is} able to get it when {you need/he needs/she needs} it. Would you say . . . none of
the time, a little of the time, some of the time, most of the time, or all of the time? (NSHA item SC-2
modified)
NONE
OF
THE
TIME

A
LITTLE
OF THE
TIME

SOME
OF
THE
TIME

MOST
OF THE
TIME

ALL
OF
THE
TIME

NA

DON’T
KNOW

REFUSED

Someone to help {you/NAME}
with bathing, dressing, or
preparing meals if
{you/NAME} needed it

01

02

03

04

05

NA

d

r

Someone to give {you/NAME}
good advice about a crisis or a
personal problem if
{you/NAME} needed it

01

02

03

04

05

NA

d

r

Someone to take {you/NAME}
to the doctor if {you/he/she}
needed it

01

02

03

04

05

NA

d

r

Someone to help {you/NAME}
with {your/his/her} daily chores
if {you/NAME} needed it

01

02

03

04

05

NA

d

r

Someone to help {you/NAME}
with {your/his/her} expenses if
{you/NAME} needed it

01

02

03

04

05

NA

d

r

(All)
IP8a.

In a typical week, how many times do you talk on the telephone with family, friends, or neighbors?
(Berkman-Syme SNI)
INTERVIEWER: ENTER THE NUMBER OF CONTACTS
INTERVIEWER: IF ‘0’ CONTACTS, ENTER 0.
|

(All)
IP8b.

|

|

In a typical week, how often do you get together with friends or relatives? (Berkman-Syme SNI)
PROBE: I mean things like going out together or visiting in each other’s homes.
INTERVIEWER: ENTER THE NUMBER OF CONTACTS
INTERVIEWER: IF ‘0’ TIMES, ENTER 0.
|

|

|

(All)
IP8c.

In a typical week, how often do you attend church or religious services? (Berkman-Syme SNI)
INTERVIEWER: ENTER THE NUMBER OF TIMES
INTERVIEWER: IF ‘0’ TIMES, ENTER 0.
|

I-4

|

|

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(All)
IP8d.

In a typical week, how often do you attend meetings of clubs or organizations you belong to? (BerkmanSyme SNI)
PROBE: These include church groups, unions, fraternal or athletic groups or school groups.
INTERVIEWER: ENTER THE NUMBER OF TIMES
INTERVIEWER: IF ‘0’ TIMES, ENTER 0.
|

(ALL)
IP9.

|

|

Can {you/NAME} drive {yourself/himself/herself} when {you need/he needs/she needs} to go places? (NSHA
SC-16)
YES ............................................................................................ 01 (IP10)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d (IP10)
REFUSED .................................................................................. r (IP10)

(IP9=00)
IP9.a. {Do you/Does NAME} have some way of getting to places when {you need/he needs/she needs} to go such
as having someone else drive or using public transportation? (NSHA SC-17)
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(ALL)
IP10.

Overall, how satisfied or dissatisfied {are you/is NAME} with {your/his/her} ability to get transportation when
{you need/he needs/she needs} it? Would you say . . . (NSHA SC-18; SIPP96 adult wellbeing item AW12
modified)
Very satisfied, .............................................................................
Somewhat satisfied, ...................................................................
Somewhat dissatisfied, or ...........................................................
Very dissatisfied .........................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I10.

01
02
03
04
d
r

{Do you/Does NAME} take any prescription medications for any ongoing physical health conditions?
PROBE: Please do not include over the counter medication such as cold or headache medication, vitamins,
or herbal supplements.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
I11.

{Do you/Does NAME} take any prescription medications for any ongoing mental or emotional conditions?
PROBE: Please do not include over the counter medication such as cold or headache
medication, vitamins, or herbal supplements.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-5

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(All)
I12.

Since {THIS MONTH, LAST YEAR}, {have you/has NAME} received any treatment for a mental or emotional
condition at a hospital, clinic, or doctor’s office?
PROBE: Do not include medications.
YES ............................................................................................ 01 (I17a)
NO .............................................................................................. 00 (I17a)
DON’T KNOW ............................................................................ d (I17a)
REFUSED .................................................................................. r (I17a)

ADL, IADL, AND FUNCTIONAL LIMITATIONS
(All)
I17a.

Now I’d like to ask you some questions about everyday activities and how much difficulty {you have/NAME
has} doing these activities. Our study requires that all beneficiaries be asked these questions. Please give
me your best answer even if the questions don’t seem to apply to {you/NAME}.
PRESS 1 TO CONTINUE ...........................................................

1

(All)
I17b.

{Are you/Is NAME} blind or do {you/ does he/she} have serious difficulty seeing even when wearing
glasses?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I21)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I17b=01,d, r)
I19.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
seeing, such as telescopic lenses, adapted computer equipment, Braille, a guide dog, or a white cane?
PROBE: Do not include glasses or contact lenses.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I21)
DON’T KNOW ............................................................................ d (I21)
REFUSED .................................................................................. r (I21)
(I19=01)
I20.
What devices, equipment, or other types of assistance {do you/does NAME} use?
PROBE:

Anything else?

INTERVIEWER: CODE ALL THAT APPLY.
TELESCOPIC LENSES .............................................................. 01
ADAPTED COMPUTER EQUIPMENT ....................................... 02
BRAILLE ..................................................................................... 03
READERS .................................................................................. 04
GUIDE DOG ............................................................................... 05
WHITE CANE ............................................................................. 06
OTHER SEEING ASSISTANCE ................................................. 07
MAGNIFYING GLASS ................................................................ 08
SCREEN READERS ................................................................... 09
TEXT-TO-VOICE DEVICES ........................................................ 10
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-6

(I21)
(I21)
(I21)
(I21)
(I21)
(I21)
(I20_Other)
(I21)
(I21)
(I21)
(I21)
(I21)

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I20=07)
I20_Other.

What other seeing assistance?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
I21.

d
r

{Are you/is NAME} deaf or do {you/he/she} have serious difficulty hearing?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I25)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I21=01,d, r)
I22.
{Are you/Is NAME} able to hear what is said in normal conversation at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I21=01,d, r)
I23.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
hearing? This includes a hearing aide, a phone amplifier, TTY or teletype Relay, an assistive listening or
signaling device, or an interpreter.
INTERVIEWER NOTE: If person reports cochlear implant, code ‘01’.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I25)
DON’T KNOW ............................................................................ d (I25)
REFUSED .................................................................................. r (I25)

I-7

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I21=01,d, r and I23=01)
I24.
What devices, equipment, or other types of assistance {do you/does NAME} use?
PROBE:

Anything else?

INTERVIEWER: CODE ALL THAT APPLY.
HEARING AID ............................................................................
PHONE AMPLIFIER ...................................................................
TYY OR TELETYPE / TTD .........................................................
CLOSED CAPTION TV ..............................................................
ASSISTIVE LISTENING/SIGNALING DEVICE ..........................
INTERPRETER ..........................................................................
OTHER HEARING ASSISTANCE ..............................................
INSTANT MESSAGING .............................................................
SKYPE OR OTHER VIDEO MESSAGING .................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
04
05
06
07
08
09
10
d
r

(I25)
(I25)
(I25)
(I25)
(I25)
(I25)
(I24_Other)
(I25)
(I25)
(I25)
(I25)

(I21=01,d, r and I23=01 and I24=08)
I24_Other. What other hearing assistance?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I25.

d
r

{Do you/Does NAME} have any difficulty having {your/his/her} speech understood because of a health
condition or problem?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I29)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I25=01,d, r)
I26.
{Are you/Is NAME} able to have {your/his/her} speech understood at all?
PROBE:

This applies only to spoken speech and does not include sign language ‘speech’.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I25=01,d, r)
I27.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
speaking or having {your/his/her} speech understood, such as a voice synthesizer or voice amplifier?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I29)
DON’T KNOW ............................................................................ d (I29)
REFUSED .................................................................................. r (I29)

I-8

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I25=01,d, r and I27=01)
I28.
What devices, equipment, or other types of assistance {do you/does NAME} use?
PROBE: Anything else?
INTERVIEWER: CODE ALL THAT APPLY.
VOICE SYNTHESIZER ..............................................................
VOICE AMPLIFIER ....................................................................
SIGN LANGUAGE INTERPRETER............................................
OTHER SPEECH ASSISTANCE................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
d
r

(I29)
(I29)
(I29)
(I28_Other)
(I29)
(I29)

(I25=01,d, r and I27=01 and I28=04)
I28_Other. What other speech assistance?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I29.

d
r

{Do you/Does NAME} have serious difficulty walking or climbing stairs?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I35)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I29=01,d, r)
I30.
{Are you/Is NAME} able to walk without assistance at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I33=01,d, r)
I34.
{Are you/Is NAME} able to climb stairs at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I29=01,d, r)
I31.
{Do you/Does NAME} use any devices, special equipment, or other special assistance because of difficulty
walking, such as a cane, walker, wheelchair, scooter, prosthetic device, or a personal care attendant?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I35)
DON’T KNOW ............................................................................ d (I35)
REFUSED .................................................................................. r (I35)

I-9

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I29=01,d, r and I31=01)
I32.
What devices, equipment, or other types of assistance {do you/does NAME} use?
PROBE:

Anything else?

INTERVIEWER: CODE ALL THAT APPLY.
BRACES, CRUTCHES, CANE, OR WALKER............................
WHEELCHAIR OR SCOOTER...................................................
PROSTHETIC DEVICE ..............................................................
SPECIAL CHAIR (NOT WHEELCHAIR) ....................................
PERSONAL CARE ASSISTANT ................................................
VEHICLE HAND CONTROLS ....................................................
LIFT (HOME OR VEHICLE) .......................................................
SPECIAL SHOES OR INSERTS ................................................
BREATHING DEVICES ..............................................................
OTHER MOBILITY ASSISTANCE..............................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
09
10
08
d
r

(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I35)
(I32_Other)
(I35)
(I35)

(I29=01,d, r and I31=01 and I32=08)
I32_Other. What other mobility assistance?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
I35.

d
r

{Do you/Does NAME} have any difficulty lifting and carrying something as heavy as 10 pounds, such as a
full bag of groceries?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I37)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I35=01,d, r)
I36.
{Are you/Is NAME} able to lift and carry 10 pounds at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-10

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(All)
I37.

{Do you/Does NAME} have any difficulty using {your/his/her} hands and fingers to do things such as picking
up a glass or grasping a pencil?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I39)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I37=01,d, r)
I38.
{Are you/Is NAME} able to use {your/his/her} hands and fingers to grasp and handle at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I39.

{Do you/Does NAME} have any difficulty reaching over {your/his/her} head?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I41)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I39=01,d, r)
I40.
{Are you/Is NAME} able to reach over {your/his/her} head at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I41.

{Do you/Does NAME} have any difficulty standing or being on {your/his/her} feet for one hour?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I43)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I41=01,d, r)
I42.
{Are you/Is NAME} able to stand on {your/his/her} feet at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I43.

{Do you/Does NAME} have any difficulty stooping, crouching or kneeling?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I45)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-11

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I43=01,d, r)
I44.
{Are you/Is NAME} able to stoop, crouch, or kneel at all?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I45.

{Do you/Does NAME} have any difficulty getting around inside {your/his/her} home?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I47)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I45=01,d, r)
I46.
{Do you/Does NAME} need the help of another person in order to get around inside {your/his/her} home?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I47.

Because of a physical, mental, or emotional condition, {do you/does NAME} have difficulty doing errands
alone such as visiting a doctor’s office or shopping?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I49)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I47=01,d, r)
I48.
{Do you/Does NAME} need the help of another person in order to get around outside {your/his/her} home?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I49.

{Do you/Does NAME} have any difficulty getting into and out of bed or a chair?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I51)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I49=01,d, r)
I50.
{Do you/Does NAME} need the help of another person in order to get into and out of bed or a chair?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-12

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(All)
I51.

{Do you/Does NAME} have difficulty dressing or bathing?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I53)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I51=01,d, r)
I52.
{Do you/Does NAME} need the help of another person in order to bathe or dress?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I53.

{Do you/Does NAME} have any difficulty shopping for personal items, such as toilet items or medicine?
YES ............................................................................................ 01
NO .............................................................................................. 00 (I55)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I53=01,d, r)
I54.
{Do you/Does NAME} need the help of another person in order to shop for personal items?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I55.

{Do you/Does NAME} have any difficulty preparing {your/his/her} own meals?
PROBE: IF {NAME} DOES NOT PREPARE MEALS: If you do not prepare meals, is this because you have
difficulty with this task?
INTERVIEWER: IF RESPONDENT SAYS NO, CODE AS NO.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I57)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I55=01,d, r)
I56.
{Do you/Does NAME} need the help of another person in order to prepare {your/his/her} meals?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I57.

{Do you/Does NAME} have any difficulty eating?
PROBE: This includes difficulty chewing, swallowing, or using utensils.
YES ............................................................................................ 01
NO .............................................................................................. 00 (I59)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-13

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I57=01,d, r)
I58.
{Do you/Does NAME} need the help of another person in order to eat?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(All)
I59.

Because of a physical, mental, or emotional condition, {do you/does NAME} have serious difficulty
concentrating, remembering, or making decisions?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
I60.

{Do you/Does NAME} have a lot of trouble coping with day-to-day stresses?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
I61.

{Do you/Does NAME} have a lot of trouble getting along with other people and making or keeping
friendships?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

ALCOHOL ABUSE
(All)
I62.

These next questions are about {your/NAME’s} use of alcohol. Please remember that your answers are
confidential. If {you do/NAME does} not drink alcohol at all, just say so.
In the past 12 months, have {you/ friends or family} ever felt {you/NAME} ought to cut down on {your/his/her}
drinking?
YES ............................................................................................ 01
NO .............................................................................................. 00
IF VOLUNTEERED: I DON’T DRINK ......................................... 02 (I72)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I62=01,00,d, r)
I63.
In the past 12 months, have people annoyed {you/NAME} by criticizing {your/his/her} drinking?
YES ............................................................................................ 01
NO .............................................................................................. 00
IF VOLUNTEERED: I DON’T DRINK ......................................... 02 (I72)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-14

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I62=01,00,d, r and I63=01,00,d, r)
I64.
In the past 12 months, {have you/has NAME} ever felt bad or guilty about {your/his/her} drinking?
YES ............................................................................................ 01
NO .............................................................................................. 00
IF VOLUNTEERED: I DON’T DRINK ......................................... 03 (I72)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I62=01,00,d, r and I63=01,00,d, r and I64=01,00,d, r)
I65.
In the past 12 months, {have you/has NAME} ever had a drink first thing in the morning to steady
{your/his/her} nerves, get rid of a hangover, or get the day started?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I62=01,00,d, r and I63=01,00,d, r and I64=01,00,d, r)
I66.
During the past 12 months, has {your/NAME’s} doctor or another health professional advised {you/NAME} to
stop using alcohol or recommended that {you/he/she} participate in a program to help {you/him/her} stop
using alcohol?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(I62=01,00,d, r and I63=01,00,d, r and I64=01,00,d, r)
I67.
During the past 12 months, {have you/has NAME} received treatment or counseling for {your/his/her} use of
alcohol?
YES ............................................................................................ 01 (I72)
NO .............................................................................................. 00 (I72)
DON’T KNOW ............................................................................ d (I72)
REFUSED .................................................................................. r (I72)
DRUG ABUSE
(All)
I72.

The next questions are about the use of prescription and non-prescription drugs. I will be asking if {you
have/NAME has} ever used these drugs on {your/his/her} own. By ‘on {your/his/her} own’ I mean using nonprescription drugs or using prescription drugs in a non-prescribed manner, such as using larger quantities
than prescribed or for longer periods than prescribed. Examples of non-prescription drugs are marijuana or
pot, speed, crack or cocaine, LSD, or Ecstasy.
During the past 12 months, {have you/has NAME} used drugs on {your/his/her} own more than 5 times?
PROBE:

Have you used drugs to get high or used drugs without a prescription or in larger amounts than
prescribed?
YES ............................................................................................ 01
NO .............................................................................................. 00 (J1)
DON’T KNOW ............................................................................ d (J1)
REFUSED .................................................................................. r (J1)

I-15

SECTION I UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: NONE
PRELOADED INFORMATION: THIS MONTH, LAST YEAR

(I72=01)
I73.
During the past 12 months, did {you/NAME} find {you/he/she} needed larger amounts of these drugs to get
an effect or that {you/he/she} could no longer get high on the amount {you/he/she} had used before?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I72=01)
I74.
During the past 12 months, did {you/NAME} have emotional or physical problems from using drugs – such
as withdrawal symptoms, inability to work, feeling crazy, paranoid, depressed or uninterested in things,
craving, or wanting to stop and being unable to?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I72=01)
I75.
During the past 12 months has {your/NAME’s} doctor or another health professional advised {you/NAME} to
stop using non-prescription drugs or recommended that {you/he/she} participate in a program to help
{you/him/her} stop using non-prescription drugs or prescription drugs in a non-prescribed manner?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(I72=01)
I76.
During the past 12 months, {have you/has NAME} received treatment or counseling for {your/his/her} use of
non-prescription drugs or of prescription drugs in a non-prescribed manner?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

I-16

SECTION J UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: STATEMED

SECTION J: HEALTH INSURANCE
(All)
J1.

Now, I’m going to ask you about different types of health insurance coverage {you/NAME} might have.
{Are you/Is NAME} currently covered by Medicare?
PROBE: Medicare is health insurance coverage provided nationally to certain disabled people under age 65,
including Social Security Disability Insurance beneficiaries that have been receiving benefits for more than
24 months.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
J2.

PROGRAMMER: IF STATEMED IS EQUAL TO “MEDICAID” USE FOLLOWING TEXT:
There is a program called Medicaid that pays for health care for persons in need. {Are you/Is NAME}
currently covered by Medicaid?
OTHERWISE USE:
There is a program called Medicaid that pays for health care for persons in need. In {your/NAME’S} state,
you may also hear it called {STATE MED FROM {NAME’S} CURRENT STATE}. {Are you/Is NAME}
currently covered by Medicaid?
PROBE:

Medicaid is a state medical assistance program that serves low-income people and Social
Security Income recipients with disabilities.
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
J4.

{Are you/Is NAME} currently covered by military health care, through Armed Forces retirement benefits, the
VA, or TRICARE?
PROBE:

TRICARE is a managed health care program for active duty and retired members of the
uniformed services, their families and survivors’
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
J5.

{Are you/Is NAME} currently covered by private health insurance, for example, private insurance that {you
get/(he/she) gets} through an employer, a family member, or that {you purchase/(he/she) purchases} on
{your/his/her} own including private insurance through the Affordable Care Act, sometimes called
HealthCare.gov or ObamaCare?
YES ............................................................................................ 01
NO .............................................................................................. 00 (J7)
DON’T KNOW ............................................................................ d (J7)
REFUSED .................................................................................. r (J7)

J-1

SECTION J UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: STATEMED

(J5=01)
J6.
{Do you/Does NAME} currently receive {your/his/her} private health insurance through a present or former
employer of {yours/his/hers}, through a present or former employer of {your/his/her} spouse, partner or
parent, or some other source?
INTERVIEWER: IF THE RESPONDENT SAYS THAT THEY OR SOMEONE IN THEIR FAMILY PAYS
FOR THEIR HEALTH INSURANCE, CODE ‘PAID BY SELF/FAMILY’.
OWN EMPLOYER ......................................................................
SPOUSE’S/PARTNER’S/PARENT’S EMPLOYER.....................
PAID BY SELF/FAMILY .............................................................
OTHER SOURCE (SPECIFY) ...................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
d
r

(J7)
(J7)
(J7)
(J6_Other)
(J7)
(J7)

(J5=01 and H6=04)
J6_Other. What is the Other Source?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
J7.

d
r

CHECK: DOES {NAME} HAVE ANY TYPE OF INSURANCE (J1=01 OR J2=01 OR J4=01 OR J5=01)?
YES ............................................................................................ 01 (J10)
NO .............................................................................................. 00

(J7=00)
J8.
It appears that {you do/NAME does} not currently have any health insurance coverage to help pay for
services from hospitals, doctors, and other health professionals. Is that correct?
YES ............................................................................................ 01 (J10)
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d (J10)
REFUSED .................................................................................. r (J10)
(J7=00 and J8=00)
J9.
What kinds of health insurance coverage {do you/does NAME} have?
PROBE:

Any other kind?

INTERVIEWER: IF RESPONDENT SAYS “OBAMACARE” OR “AFFORDABLE CARE ACT”
PROBE:

“Is this a plan you pay for on your own? (IF YES, CODE AS PRIVATE INSURANCE PAID
BY SELF/FAMILY). (IF NO), “Is this provided through Medicaid?” (IF YES, CODE AS
MEDICAID)

INTERVIEWER: CODE ALL THAT APPLY.
MEDICAID/{STATEMED} .........................................................................
MEDICARE ..............................................................................................
TRICARE, VA, OTHER MILITARY ...........................................................
INDIAN HEALTH SERVICE .....................................................................
MEDI-GAP................................................................................................
STATE PROGRAM ..................................................................................
PRIVATE INSURANCE THROUGH OWN EMPLOYER ..........................
PRIVATE INSURANCE THROUGH SPOUSE/PARTNER/PARENT........
PRIVATE INSURANCE PAID BY SELF/FAMILY .....................................
OTHER PLAN (SPECIFY) .........................................................
DON’T KNOW ..........................................................................................
REFUSED ................................................................................................
J-2

01
02
03
04
05
06
07
08
09
10
d
r

(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J10)
(J9_Other)
(J10)
(J10)

SECTION J UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: STATEMED

(J7=00 and J8=00 and J9=10)
J9_Other. What is the Other Plan?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
J10.

d
r

Now, I’d like you to think back to 2016. In 2016, {were you/was NAME} covered by any type of health
insurance?
PROBE:

Answer ‘yes’ if {you were/NAME was} covered for any part of the year.
YES ............................................................................................ 01
NO .............................................................................................. 00 (K1)
DON’T KNOW ............................................................................ d (K1)
REFUSED .................................................................................. r (K1)

(J10=01)
J11.
What kinds of health coverage did {you/NAME} have?
PROBE:

Any other kind?

INTERVIEWER: IF RESPONDENT SAYS “OBAMACARE” OR “AFFORDABLE CARE ACT”
PROBE:

“Is this a plan you pay for on your own? (IF YES, CODE AS PRIVATE INSURANCE PAID
BY SELF/FAMILY). (IF NO), “Is this provided through Medicaid?” (IF YES, CODE AS
MEDICAID)

INTERVIEWER: CODE ALL THAT APPLY.
MEDICAID/{STATMED} ...........................................................................
MEDICARE ..............................................................................................
TRICARE, VA, OTHER MILITARY ...........................................................
INDIAN HEALTH SERVICE .....................................................................
MEDI-GAP................................................................................................
STATE PROGRAM ..................................................................................
PRIVATE INSURANCE THROUGH OWN EMPLOYER ..........................
PRIVATE INSURANCE THROUGH SPOUSE/PARTNER/PARENT........
PRIVATE INSURANCE PAID BY SELF/FAMILY .....................................
PRIVATE INSURANCE, NOT SPECIFIED WHO THROUGH ..................
OTHER PLAN (SPECIFY) .........................................................
DON’T KNOW ..........................................................................................
REFUSED ................................................................................................

01
02
03
04
05
06
07
08
09
11
10
d
r

(J10=01 and J11=10)
J11_Other. What is the other plan?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

J-3

d
r

(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(K1)
(J11_Other)
(K1)
(K1)

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

SECTION K: INCOME AND OTHER ASSISTANCE
(All)
K1.

The next set of questions is about income {you/NAME} received last month, that is, in [INSERT LAST
MONTH, THIS YEAR]. This includes earnings from work and benefits from different programs. When
answering these questions, please think only about {your/NAME’s} own earnings and benefits, and don’t
include earnings or benefits that other family members may have received.
PRESS 1 TO CONTINUE ........................................................... 01

(All)
K2.

CHECK 1: IS {NAME} CURRENTLY WORKING (B24a=01)?
YES ............................................................................................ 01 (K2CHECK2)
NO .............................................................................................. 00 (K2CHECK3)

(K2=01)
K2CHECK2.

CHECK 2: DID {NAME} START AT LEAST ONE JOB PRIOR TO OR DURING LAST MONTH
((C4MTH < OR = LAST MONTH THIS YEAR AND C4YR = 2016) OR (C4YR < 2016))?
YES ............................................................................................ 01 (K3)
NO .............................................................................................. 00 (K2A)

PROGRAMMER: IF {NAME} IS CURRENTLY WORKING (B24=01) AND STARTED JOB AFTER LAST MONTH
THIS YEAR - (C4MTH > LAST MONTH THIS YEAR AND C4YR =2016), GO TO K2A

(K2=00 and K2CHECK2=01)
K2CHECK 3. HAS {NAME} EVER WORKED (B36=01, D, OR R) OR (B22=01, D, OR R) OR (B30=01, D, OR R)
OR IS EVER WORKED MISSING (B36=.)?
YES ............................................................................................ 01 (K2A)
NO .............................................................................................. 00 (K4)
(K2CHECK2=00 and K2CHECK3=01)
K2A.
Did {you/NAME} work last month?
YES ............................................................................................ 01 (K3)
NO .............................................................................................. 00 (K4)
(K2CHECK3=01 and K2A=01)
K3.
First thinking about the jobs {you/NAME} had last month, including all jobs {you/he/she} had, how much did
{you/he/she} earn last month, that is, in [INSERT LAST MONTH, THIS YEAR] before taxes and deductions?
INTERVIEWER:

ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(0 – 12,500)
(0 – 40,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

K-1

d
r

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

(K2CHECK3=01 and K2A=01 and K3 > or = 0)
K3b.
SOFT EDIT: LAST MONTH INCOME SHOULD BE WITHIN 30% OF TOTAL CURRENT MONTHLY PAY
AS REPORTED IN SECTION C. IF K3 NE D OR R AND C_CURMNTHPAY NE D OR R, AND THE
ABSOLUTE VALUE OF (K3 - C_CurMnthPay/ K3 >.30) AND THE ABSOLUTE VALUE OF (C_CurMnthPay
- K3/ C_CurMnthPay >.30), TRIGGER EDIT, AND DISPLAY FOLLOWING TEXT: INTERVIEWER, LAST
MONTH INCOME IS AT LEAST 30% HIGHER OR LOWER THAN AMOUNT REPORTED AS TOTAL
MONTHLY PAY IN SECTION C. CHECK ENTRY. IF NECESSARY READ: I may have recorded an
incorrect answer. Earlier we calculated that {you are/NAME is} currently paid about (C_CurMnthPay) on all
jobs combined. Is this correct or should I change the amount {you/NAME} earned last month before taxes
and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
SUPPRESS ................................................................................ 03

(K2CHECK3=01 and K2A=01 and (K3 > or = 0 or d or r)
K3a.
Including all jobs {you/NAME} had, how much was left last month, that is in [INSERT LAST MONTH, THIS
YEAR], as take-home pay after taxes and other deductions?
INTERVIEWER:

ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(1 – 11,250)
(1 – 36,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(K2CHECK3=01 and K2A=01 and K3 > or = 0 and K3a > 0)
K3b1. SOFT EDIT: AMOUNT OF TAKE-HOME PAY (K3a) MUST BE LESS THAN OR EQUAL TO AMOUNT PAID
BEFORE TAXES AND OTHER DEDUCTIONS (K3). IF K3A NE D OR R AND K3 NE D OR R, AND K3A >
K3, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, TAKE HOME PAY IS GREATER
THAN PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an incorrect
answer. You said that {you are/NAME is} paid (K3) before taxes and other deductions and that (K3a) is left
as take-home pay after taxes and other deductions. Based on what I recorded, your take home pay is more
than your pre-tax pay. Should I change the amount {you are/NAME is} paid before taxes and other
deductions or the amount {you take/NAME takes} home after taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE K3a)
SUPPRESS ................................................................................ 03

(K2CHECK3=01 and K2A=01 and K3> or = 0 and K3a > 0)
K3b2. SOFT EDIT: IF K3 GREATER THAN 0, K3A SHOULD BE GREATER THAN 0. IF K3 >0 AND K3A =0,
TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER: AMOUNT OF TAKE HOME PAY=0,
CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. I have recorded that
you are paid (K3) before taxes and deductions but that your take home pay is 0. Should I change the
amount {you are/NAME is} paid before taxes and other deductions or the amount {you take/NAME takes}
home after taxes and other deductions?
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE K3a)
SUPPRESS ................................................................................ 03
K-2

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

(K2CHECK3=01 and K2A=01 and K3> 0 and K3a > 0)
K3b3. SOFT EDIT: DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN
30%. IF AMOUNT OF TAKE HOME PAY (K3A) NE D OR R, AND AMOUNT OF PRE-TAX PAY (K3) NE D
OR R, AND (K3 – K3A) / K3A > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER,
DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN 30%. CHECK
ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said that {you are/NAME
is} paid (K3) before taxes and other deductions and that (K3A) is left as take-home pay after taxes and other
deductions. Is this correct or should I change the amount {you are/NAME is} paid before taxes and other
deductions or the amount {you take/NAME takes} home after taxes and other deductions
CHANGE AMOUNT PAID BEFORE TAXES AND OTHER
DEDUCTIONS ........................................................................... 01 (CHANGE K3)
CHANGE AMOUNT OF TAKE-HOME PAY ............................... 02 (CHANGE K3a)
SUPPRESS ................................................................................ 03
(All)
K4.

Thinking about the benefits {you/NAME} received last month, did {you/he/she} receive any income from
Social Security?
INTERVIEWER:

SHOULD INCLUDE ANY SSI AND SSDI PAYMENTS
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
K5.

K-3

PROGRAMMER: IF {NAME} RECEIVED INCOME FROM ANY SOURCE BELOW (K6a-h=01), ASK K7
THROUGH K10 IMMEDIATELY AFTER EACH ‘YES’. OTHERWISE, ASK ABOUT NEXT SOURCE OF
INCOME IN K6.

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

(All)
K6.

Last month did {you/NAME} receive any income from…
PROBE:

IF RESPONDENT MENTIONS FOOD STAMPS: I will ask you about food stamps in a
separate question. Do {you/he/she} receive any other income on a regular basis that
does not come from jobs or social security?

PROBE:

Examples include child support, interest from savings or checking accounts, or
dividends?
YES

NO

DON’T
KNOW

REFUSED

Private disability insurance (sometimes called longterm care disability insurance)?

01

00

d

r

b.

Workers’ compensation?

01

00

d

r

c.

Veterans’ benefits?

01

00

d

r

d.

Public assistance or welfare payments?

01

00

d

r

e.

Unemployment benefits?

01

00

d

r

f.

Private pensions or government employee pensions?

01

00

d

r

g.

Other sources on a regular basis but not from jobs or
Social Security?

01

d

r

(K6_g_oth)

d

r

(K6_h_oth)

a.

00

PROBE: IF RESPONDENT MENTIONS FOOD
STAMPS: I will ask you about food stamps in a
separate question. Do you receive any other income
on a regular basis that does not come from jobs or
Social Security?
PROBE: Examples include child support, interest
from savings or checking accounts, or dividends?
h.

Other sources not on a regular basis?

01

00

(K6_g=01)
K6_g_oth What were they?
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(K6_h=01)
K6_h_oth What were they?
INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

K-4

d
r

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

(K6=01)
K7.
How much income did {you/NAME} receive last month from {SOURCE FROM K6}?
INTERVIEWER:

ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(1 – 1,000)
(1 – 15,000)

(GO TO K6 FOR NEXT SOURCE OR K11)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(K6=01 and K7=d, r)
K8.
Was it more than or less than $300?
$300 OR MORE ......................................................................... 01 (K9)
LESS THAN $300 ...................................................................... 02 (K10)
DON’T KNOW ............................................................................ d (K6 FOR NEXT SOURCE
OR K11)
REFUSED .................................................................................. r (K6 FOR NEXT SOURCE
OR K11)
(K6=01 and K7=d, r and K8=01)
K9.
Was it more than or less than $500?
$500 OR MORE ......................................................................... 01
LESS THAN $500....................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO K6 FOR NEXT SOURCE OR K11.

(K6=01 and K7=d, r and K8=02)
K10.
Was it more than or less than $150?
$150 OR MORE ......................................................................... 01
LESS THAN $150....................................................................... 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO K6 FOR NEXT SOURCE OR K11.
(All)
K11.

Did {you/NAME} receive any food stamps last month? You may know this as SNAP benefits. Please include
only food stamps {you/NAME} received for {you/NAME} and {your/NAME’s} family. Do not include food
stamps received separately by other members of [your/NAME’s} household.
YES ............................................................................................ 01
NO .............................................................................................. 00 (K13)
DON’T KNOW ............................................................................ d (K13)
REFUSED .................................................................................. r (K13)

K-5

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

(K11=01)
K12.
What was the dollar value of the food stamps {you/NAME} received last month? Please include only food
stamps {you/NAME} received by {you/NAME} for {your/NAME’s} family.
INTERVIEWER:

ROUND TO NEAREST DOLLAR
$|___| , |___|___|___| . 00
(0 – 400)
(0 – 950)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
K13.

d
r

Did {you/NAME} receive assistance from any other government program last month? For example, housing
or energy assistance.
YES ............................................................................................ 01
NO .............................................................................................. 00 (KP1)
DON’T KNOW ............................................................................ d (KP1)
REFUSED .................................................................................. r (KP1)

(K13=01)
K14.
What other assistance did {you/NAME} receive?
INTERVIEWER:

PROGRAM:

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(K13=01)
K15.
How much income did {you/NAME} receive last month from the assistance you just told me about?
PROBE: Your best estimate is fine.
INTERVIEWER:

ROUND TO NEAREST DOLLAR
$|___|___| , |___|___|___| . 00
(0 – 500)
(0 – 10,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(ALL)
KP1.

Which of the following best describes {your/NAME’s} current financial situation? (NOD Harris 2010 item
Q1430)
INTERVIEWER: CODE ALL THAT APPLY.
Struggling to meet your basic needs ...............................
Meeting your basic needs, but not able to save or
improve your standard of living .......................................
Able to save a little, but not completely
financially comfortable .....................................................
Financially comfortable with few worries about money....
DON’T KNOW .................................................................
REFUSED .......................................................................

K-6

d
r

01
02
03
04
d
r

SECTION K UNIVERSE: ALL
VARIABLES FROM OTHER SECTIONS: RTYPE, B22, B24, B30, B36, C4MTH, C4YR
PRELOADED INFORMATION: LAST MONTH, THIS YEAR

(ALL)
KP2.

If {you/NAME} had to support {yourself/himself/herself} for three months without any income or gifts from
others, would {you/he/she} have enough money in savings to get by? (NOD Harris 2010 item Q1435
modified)
PROBE: By income I mean money from earnings, disability benefits, or from any other source except
savings.
PROBE: Your best estimate is fine.
YES ................................................................................. 01
NO ................................................................................... 00
DON’T KNOW ................................................................. d
REFUSED ....................................................................... r

K-7

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

SECTION L: SOCIODEMOGRAPHIC INFORMATION
(All)
L1.

I have a few more questions about {you/NAME}.
What is {your/NAME’s} ethnic background? {Are you/Is (he/she)}:
Hispanic or Latino, or .................................................................. 01
Not Hispanic or Latino? .............................................................. 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
L2.

What is {your/NAME’s} race? {Are you/Is (he/she)}:
INTERVIEWER:

CODE ALL THAT APPLY.
Alaska Native or American Indian,..............................................
Asian, .........................................................................................
Black or African American, .........................................................
Native Hawaiian or Other Pacific Islander, or .............................
White ..........................................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
L3.

01
02
03
04
05
d
r

What is the highest year or grade {you/NAME} finished in school?
INTERVIEWER:

READ LIST IF NECESSARY. CODE ONE ANSWER.

INTERVIEWER:

IF ATTENDED SCHOOL BUT COMPLETED LESS THAN HIGH SCHOOL, CODE AS
1. IF NEVER ATTENDED SCHOOL, CODE AS 10.

INTERVIEWER:

IF RESPONDENT SAYS THEY WERE HOME SCHOOLED, PROBE FOR HIGHEST
YEAR, GRADE, DEGREE, OR CERTIFICATE COMPLETED.
DID NOT COMPLETE HIGH SCHOOL OR GED .........................................
HIGH SCHOOL: GED ..................................................................................
HIGH SCHOOL: DIPLOMA ..........................................................................
HIGH SCHOOL: CERTIFICATE OF COMPLETION ....................................
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL
COURSES ...................................................................................................
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE)
OR VOCATIONAL SCHOOL DIPLOMA.......................................................
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) ............................
SOME GRADUATE WORK/NO GRADUATE DEGREE ..............................
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D.,
J.D., M.D.) ....................................................................................................
NEVER ATTENDED SCHOOL ....................................................................
SPECIAL EDUCATION WITH NO CERTIFICATE OF COMPLETION.........
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................

L-1

01
02
03
04
05
06
07
08
09
10
11
d
r

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(All)
L4.

What is the highest year or grade {your/NAME’s} father finished in school?
INTERVIEWER:

READ LIST IF NECESSARY. CODE ONE ANSWER.

INTERVIEWER:

IF ATTENDED SCHOOL BUT COMPLETED LESS THAN HIGH SCHOOL, CODE AS 1.
IF NEVER ATTENDED SCHOOL, CODE AS 10.

INTERVIEWER:

IF RESPONDENT SAYS THEY WERE HOME SCHOOLED, PROBE FOR HIGHEST
YEAR, GRADE, DEGREE, OR CERTIFICATE COMPLETED.
DID NOT COMPLETE HIGH SCHOOL OR GED .........................................
HIGH SCHOOL: GED ..................................................................................
HIGH SCHOOL: DIPLOMA ..........................................................................
HIGH SCHOOL: CERTIFICATE OF COMPLETION ....................................
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL
COURSES ...................................................................................................
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE)
OR VOCATIONAL SCHOOL DIPLOMA.......................................................
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) ............................
SOME GRADUATE WORK/NO GRADUATE DEGREE ..............................
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D.,
J.D., M.D.) ....................................................................................................
NEVER ATTENDED SCHOOL ....................................................................
SPECIAL EDUCATION WITH NO CERTIFICATE OF COMPLETION.........
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................

(All)
L5.

05
06
07
08
09
10
11
d
r

What is the highest year or grade {your/NAME’s} mother finished in school?
INTERVIEWER:

READ LIST IF NECESSARY. CODE ONE ANSWER.

INTERVIEWER:

IF ATTENDED SCHOOL BUT COMPLETED LESS THAN HIGH SCHOOL, CODE AS 1.
IF NEVER ATTENDED SCHOOL, CODE AS 10.

INTERVIEWER:

IF RESPONDENT SAYS THEY WERE HOME SCHOOLED, PROBE FOR HIGHEST
YEAR, GRADE, DEGREE, OR CERTIFICATE COMPLETED.
DID NOT COMPLETE HIGH SCHOOL OR GED .........................................
HIGH SCHOOL: GED ..................................................................................
HIGH SCHOOL: DIPLOMA ..........................................................................
HIGH SCHOOL: CERTIFICATE OF COMPLETION ....................................
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL
COURSES ...................................................................................................
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE)
OR VOCATIONAL SCHOOL DIPLOMA.......................................................
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) ............................
SOME GRADUATE WORK/NO GRADUATE DEGREE ..............................
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D.,
J.D., M.D.) ....................................................................................................
NEVER ATTENDED SCHOOL ....................................................................
SPECIAL EDUCATION WITH NO CERTIFICATE OF COMPLETION.........
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................

L-2

01
02
03
04

01
02
03
04
05
06
07
08
09
10
11
d
r

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(All)
L6ft.

How tall {are you/is NAME}?
INTERVIEWER:

ENTER FEET
|__| FEET
(3-8)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
L6in.

d
r

(How tall {are you/is NAME}?)
PROBE: ROUND TO NEAREST WHOLE NUMBER (E.G., ENTER 6 FOR 5 ½ INCHES)
INTERVIEWER:

ENTER INCHES.
|__|__| INCHES
(0-12)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
L7.

d
r

How much {do you/does NAME} weigh?
|__|__|__| POUNDS (50-300)
(50-600)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

(All)
L8.

d
r

{Are you/Is NAME} now married, partnered (but not married), widowed, divorced, separated, or {have
you/has (he/she)} never been married?
MARRIED ...................................................................................
UNMARRIED PARTNER ............................................................
WIDOWED .................................................................................
DIVORCED.................................................................................
SEPARATED ..............................................................................
NEVER MARRIED......................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
d
r

(L10)
(L10)
(L10)
(L10)
(L10)
(L10)

(L8=01, 02)
L9.
Do {you/NAME} and {your/his/her} {spouse/partner} live in the same household?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
GO TO L11
(L8=03,04,05,06,d,r)
L10.
{Do you/Does NAME} have a long-term partner who lives in the same household with {you/him/her} in a
marriage-like relationship?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
L-3

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(All)
L11.

Which of the following best describes {your/NAME’s} living situation?
INTERVIEWER:

READ LIST. CODE ONE ANSWER. ‘LIVE WITH CHILDREN’ SHOULD BE CODED
AS ‘2’
PROGRAMMER DISPLAY ONLY IF L9≠01 {You live/NAME lives}
alone. ...........................................................................................................
{You live/NAME lives} with {your/his/her} parents, guardians, a
spouse/partner,
or other relative ............................................................................................
{You live/NAME lives} with friends or roommates ........................................
{You live/NAME lives} in another group setting with people not related to
{you/him/her} ................................................................................................
{You live/NAME lives} in some other living situation.....................................
DON’T KNOW ..............................................................................................
REFUSED ....................................................................................................

01

(L11a)

02 (L11a)
03 (L11a)
04 (L11a)
05 (L11_Other)
d (L11a)
r (L11a)

(L11=05)
L11_Other. What is the other living situation?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
L11a.

d
r

SOFT EDIT: RESPONDENT CANNOT LIVE IN SAME HOUSEHOLD WITH SPOUSE (L9=01) OR LIVE IN
SAME HOUSEHOLD WITH LONG-TERM PARTNER (L10=01) AND LIVE ALONE (L11=01).
IF
RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that
{you live/NAME lives} in the same household with {your/his/her} spouse or partner and {you live/NAME lives}
alone? Could you verify which is correct?
LIVE WITH SPOUSE OR PARTNER ......................................... 01 (CHANGE L9 OR L10)
LIVE ALONE............................................................................... 02 (CHANGE L11)
SUPPRESS ................................................................................ 03

(All)
L12.

The next question is about the place {you live/NAME lives}. Is this place a…
INTERVIEWER:

CODE ONE ANSWER.

INTERVIEWER:

IF RESPONDENT SAYS TOWNHOUSE OR CONDO, CODE AS 1.
Single family home .....................................................................
Mobile home ...............................................................................
Regular apartment ......................................................................
Supervised apartment ................................................................
Group home................................................................................
Halfway house ............................................................................
Personal care or board and care home ......................................
Assisted living facility ..................................................................
Nursing or convalescent home ...................................................
Center for Independent Living ....................................................
Some other type of supervised group residence or facility .........
Something else ...........................................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

L-4

01
02
03
04
05
06
07
08
09
10
11
12
d
r

(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12a)
(L12_Other)
(L12a)
(L12a)

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(L12=12)
L12_Other. What is the other type of place?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
L12a.

d
r

SOFT EDIT: RESPONDENT CANNOT LIVE ALONE (L11=01) AND LIVE IN A GROUP SETTING
(L12=04-11). IF RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect
answer. I show that {you/NAME} live alone in a {FILL ANSWER FROM L12}? Which is correct?
LIVE ALONE............................................................................... 01 (CHANGE L12)
LIVE IN GROUP SETTING ........................................................ 02 (CHANGE L11)
SUPPRESS ................................................................................ 03

(All)
L13.

CHECK: DOES {NAME} LIVE IN A GROUP SETTING (L12 = 04 – 12)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (L14)

(L13=01)
L15.

Is this place primarily for people with hearing or vision impairments, mental illness, intellectual disabilities, or
developmental disabilities?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(L12=01,0 2, 03,0 4, 12, d, r)
L21b. {Do you/Does NAME} own or rent {your/his/her} home?
Interviewer note: If respondent says they pay a mortgage, code as ‘01’.
OWN ........................................................................................... 01
RENT .......................................................................................... 02
LIVE WITH OTHERS RENT FREE ............................................ 03
Don’t know .................................................................................. d
Refused ...................................................................................... r
(All)
L14.

CHECK: DOES {NAME} LIVE ALONE (L11 = 01) OR LIVE IN GROUP SETTING (L12=4-12)?
ALONE ....................................................................................... 01 (L20)
GROUP ...................................................................................... 00

(L14=00)
L16.
How many adults 18 years of age or older live in {your/NAME’s} household, including {yourself/NAME}?
PROBE: This includes all adults who usually live there, even if they are temporarily away on business,
vacation, in a hospital, away at school or on military duty.
|__|__| ADULTS

(1-4)

(1-20)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

L-5

d
r

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(L14=00)
L17.
How many children under 18 years of age live in {your/NAME’s} household?
PROBE: This includes all children who usually live there, even if they are temporarily away on vacation, in a
hospital, or away at school.
|__|__| CHILDREN

(0-6)
(0-20)

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(L14=00)
L18.
CHECK: DO NO CHILDREN LIVE IN THE HOUSEHOLD (L17=0)?
YES ............................................................................................ 01 (L20)
NO .............................................................................................. 00
(L14=00 and L18=00)
L19.
How many of these children are {your/NAME’s} own? Please include biological, adopted, step, and foster
children.
|__|__| CHILDREN

(0-6)
(0-20)

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
L20.

d
r

{Do you/Does NAME} have children of {your/his/her} own under the age of 18 living outside of {your/his/her}
household?
PROBE: Please include biological, adopted, step, and foster children.
YES ............................................................................................ 01
NO .............................................................................................. 00 (L22a)
DON’T KNOW ............................................................................ d (L22a)
REFUSED .................................................................................. r (L22a)

(L20=01)
L21.
How many children under 18 not living in {your/NAME’s} household {do you/does (he/she)} have?
|__|__| CHILDREN

(1-6)
(1-20)

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
L22a.

d
r

CHECK: DOES {NAME} HAVE ANY CHILDREN (L17>=1 AND L19>=1) OR (L21>=1)?
YES ............................................................................................ 01
NO .............................................................................................. 00 (LP23)

(L22a=01)
L22.
Are any of {your/NAME’s} children, either living with {you/him/her} or not, under the age of six?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

L-6

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(ALL)
LP23.

{Have you/Has NAME} ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard?
(ACS)
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(All)
L23Aamt. PROGRAMMER: IF L11=01, 03, or 04, ASK:
What was {your/NAME’s} total income in 2016, before taxes or other deductions? Please include money
{you/NAME} received from all sources.
PROGRAMMER: IF L11=02, or 05, d, r, ASK:
What was the total combined income of all members of {your/NAME’s} household in 2016, before taxes or
other deductions? Please include money all members of {your/NAME’s} household received from all
sources.
PROBE: IF RESPONDENT CANNOT PROVIDE AN ANNUAL AMOUNT: If it is hard to calculate an
annual amount can you tell me what your income was per day, week, bi-weekly, twice a month
or monthly in 2016.
INTERVIEWER: ROUND TO NEAREST DOLLAR
$|___|___|___| , |___|___|___| . 00 AMOUNT
(10,000-75,000)
(0-500,000)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d (L24)
r (L24)

(L23Aamt = numeric response)
L23Ahop. PROBE: PROGRAMMER: IF L11=01, 03, or 04, DISPLAY:
What was {your/NAME’s} total income in 2016, before taxes or other deductions? Please include money
{you/NAME} received from all sources.
PROBE: PROGRAMMER: IF L11=02, or 05, d, r, DISPLAY:
What was the total combined income of all members of {your/NAME’s} household in 2016, before taxes or
other deductions? Please include money all members of {your/NAME’s} household received from all
sources.
PROBE: IF RESPONDENT CANNOT PROVIDE AN ANNUAL AMOUNT: If it is hard to calculate an
annual amount can you tell me what your household income was per day, week, bi-weekly,
twice a month or monthly in 2016.
PROBE: Is that daily, weekly, bi-weekly, twice a month, or annually?
INTERVIEWER: ENTER HOW OFTEN PAID
ANNUALLY.................................................................................
MONTHLY ..................................................................................
TWICE A MONTH ......................................................................
WEEKLY ....................................................................................
BI-WEEKLY ................................................................................
DAILY .........................................................................................
OTHER .......................................................................................

L-7

01
02
03
04
05
06
07

(L25)
(L23b)
(L23b)
(L23b)
(L23b)
(L23b)

SECTION L UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE
PRELOADED VARIABLES: NONE

(L23Aamt = numeric response and L23Ahop =07)
L23Ahop_Other.
INTERVIEWER: ENTER OTHER

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

GO TO L24

(L23Aamt = numeric response and L23Ahop = 02, 03, 04, 05, 06)
L23b. PROGRAMMER: USE “{YOUR/NAME’S} HOUSEHOLD” IF L11=02 OR 05, OTHERWISE USE
“{YOUR/NAME}”
How many {days/weeks/months} did {{you/NAME}/{your household/NAME’s household}} receive this income
in 2016?
|__|__|__| DAYS/WEEKS/MONTHS
(1-365) (1-52) (1/12)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

GO TO L25

(L23Aamt =d, r or L23Ahop=07)
L24.
PROGRAMMER: USE “HOUSEHOLD” IF L11=02 OR 05
Could you please tell me if {your/NAME’S} annual (household) income before taxes and other deductions in
2016 was...
$2,500 or less, ............................................................................ 01
$2, 501 to $5,000,....................................................................... 02
$5,001 to $10,000,...................................................................... 03
$10,001 to $20,000,.................................................................... 04
$20,001 to $30,000,.................................................................... 05
$30,001 to $40,000,.................................................................... 06
$40,001 to $50,000,.................................................................... 07
$50,001 to $75,000,.................................................................... 08
$75,001 to $100,000, or ............................................................. 09
More than $100,000? ................................................................. 10
DON’T KNOW ............................................................................ d
REFUSED ..................................................................................
L25.
L26.

DELETED
DELETED

GO TO M1

L-8

r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

SECTION M: CLOSING INFORMATION AND OBSERVATIONS
(All)
M1.

PROGRAMMER:

IF WE HAVE NAME, ADDRESS, AND PHONE NUMBER FROM EITHER THE
SCREENER OR FROM THE OTHER PRELOADED INFORMATION DISPLAY THAT
NAME, ADDRESS, AND PHONE NUMBER.

That concludes this interview. Can you please verify (your/NAME’S) current contact information?
NAME: {FULL NAME FROM SCREENER OR PRELOADED INFORMATION}
STREET ADDRESS 1: {FIRST LINE OF ADDRESS FROM SCREENER OR
INFORMATION}
STREET ADDRESS 2: {SECOND LINE OF ADDRESS FROM SCREENER OR
INFORMATION}

PRELOADED
PRELOADED

STREET ADDRESS 3: {THIRD LINE OF ADDRESS FROM SCREENER OR PRELOADED
INFORMATION}
CITY OR TOWN: {CITY OR TOWN FROM SCREENER OR PRELOADED INFORMATION}
STATE: {STATE FROM SCREENER OR PRELOADED INFORMATION}
ZIP CODE: {ZIP CODE FROM SCREENER OR PRELOADED INFORMATION}
TELEPHONE NUMBER: {TELEPHONE NUMBER FROM SCREENER OR PRELOADED INFORMATION}
SAME AS PROVIDED................................................................ 00 (M1a)
INCORRECT INFORMATION ABOVE, NEED TO ENTER
NEW INFORMATION ......................................................... 01 (M1_Firstname)
DON’T KNOW ............................................................................ d (M1a)
REFUSED .................................................................................. r (M1a)
M1 {PROVIDE BOX FOR DATA ENTRY. 1, 0, d, r ARE THE ONLY POSSIBLE RESPONSES; IF M1=01,
THEN GO TO QUESTIONS BELOW, OTHERWISE SKIP TO M1a}
(M1=01)
M1_FirstName.
NAME: {DISPLAY FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH FIRST NAME
BOLDED}
First name?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_MiddleName.
NAME: {DISPLAY FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH MIDDLE
INITIAL BOLDED}
Middle initial?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-1

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M1=01)
M1_LastName.
NAME: {DISPLAY FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH LAST NAME
BOLDED}
Last name?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_Confirm.
NAME: {DISPLAY FULL NAME}
INTERVIEWER: PRESS 1 TO CONTINUE
(M1=01)
M1_Address1.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
LINE 1 BOLD}
Street and number?
INTERVIEWER:

REFUSED AND DON’T KNOW ALLOWED, WILL SKIP REST OF ADDRESS
QUESTIONS.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_Address2.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
LINE 2 BOLD}
PROBE: READ IF NECESSARY: Second part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_Address3.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
LINE 3 BOLD}
PROBE: READ IF NECESSARY: Third part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-2

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M1=01)
M1_City.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
CITY BOLD}
Town or city?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_State.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
STATE BOLD}
State?
INTERVIEWER:

USE TWO CHARACTER ABBREVIATION.

INTERVIEWER:

ENTER ZZ TO ENTER INTERNATIONAL CITY AND COUNTRY BELOW.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_ZipCode.
ADDRESS: {DISPLAY ENTIRE ADDRESS FROM SCREENER OR PRELOADED INFORMATION WITH
ZIP CODE BOLD}
Zip code?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M1=01)
M1_Confirm.
ADDRESS: {DISPLAY FULL ADDRESS}
INTERVIEWER:

PRESS 1 TO CONTINUE

(M1=01)
M1_PhoneNumber.
TELEPHONE: {TELEPHONE NUMBER FROM SCREENER OR PRELOADED INFORMATION}
Please give me the telephone number, area code first?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-3

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

PROGRAMMER: ASK M1_TIMEZONE IF TIME ZONE IS NOT CURRENTLY ENTERED
(M1=01)
M1_TimeZone.
What time zone is that in?
INTERVIEWER:

CURRENT TIME ZONE: {DISPLAY TIME ZONE BASED ON}
HAWAII/ALEUTIAN TIME ZONE ................................................
ALASKA TIME ZONE .................................................................
PACIFIC TIME ZONE .................................................................
MOUNTAIN TIME ZONE ............................................................
CENTRAL TIME ZONE ..............................................................
EASTERN TIME ZONE ..............................................................
ATLANTIC TIME ZONE ..............................................................
NEWFOUNDLAND TIME ZONE ................................................
OTHER INTERNATIONAL TIME ZONE .....................................

02
03
04
05
06
07
08
09
98

(M1=01)
M1_Confirm.
TELEPHONE NUMBER: {TELEPHONE NUMBER FROM SCREENER OR PRELOADED INFORMATION}
TIME ZONE: {TIME ZONE FROM SCREENER OR PRELOADED INFORMATION}
INTERVIEWER:
(All)
M1a.

PRESS 1 TO CONTINUE

{Do you have/Does NAME have} an email address?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M2A)
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(M1a=01)
M2_.
What is {your/NAME’s} email address?

DON’T KNOW ............................................................................
REFUSED ..................................................................................
(All)
M2A.

d
r

CHECK: IS INTERVIEWER SPEAKING WITH {NAME} OR A PROXY?
{NAME} ....................................................................................... 01 (M2CHECK)
PROXY ....................................................................................... 02

(M2A=02)
Confirm. What is your first name?
INTERVIEWER:

PRESS 1 TO CONTINUE

(M2A=02)
M2a_FirstName.
NAME: {DISPLAY PROXY’S FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH
FIRST NAME BOLD}
First name?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-4

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M2A=02)
M2a_MiddleName.
NAME: {DISPLAY PROXY’S FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH
MIDDLE INITIAL BOLD}
Middle initial?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
M2a_LastName.
NAME: {DISPLAY PROXY’S FULL NAME FROM SCREENER OR PRELOADED INFORMATION WITH
LAST NAME BOLD}
Last name?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
Confirm. NAME: {DISPLAY PROXY’S FULL NAME}
INTERVIEWER:

PRESS 1 TO CONTINUE

(M2A=02)
M2a_Address1.
ADDRESS:
Street and number?
INTERVIEWER:

REFUSED OR DON’T KNOW ALLOWED. WILL SKIP REST OF ADDRESS
QUESTIONS.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
M2a_Address2.
ADDRESS: {DISPLAY ADDRESS1 FROM PREVIOUS QUESTION}
PROBE: READ IF NECESSARY: Second part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
M2a_Address3.
ADDRESS: {DISPLAY ADDRESS1 AND ADDRESS2 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Third part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-5

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M2A=02)
M2a_Address4.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, AND ADDRESS3 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Fourth part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
M2a_City.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, AND ADDRESS4 FROM PREVIOUS
QUESTIONS}
Town or City?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
M2a_State.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, ADDRESS4, AND TOWN/CITY FROM
PREVIOUS QUESTIONS}
State?
INTERVIEWER:

USE TWO CHARACTER ABBREVIATION.

INTERVIEWER:

ENTER ZZ TO ENTER INTERNATIONAL CITY AND COUNTRY BELOW.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
M2a_ZipCode.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, ADDRESS4, TOWN/CITY, AND STATE
FROM PREVIOUS QUESTIONS}
Zip code?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02)
Confirm.
NAME: {DISPLAY PROXY’S FULL ADDRESS}
INTERVIEWER:

PRESS 1 TO CONTINUE

(M2A=02)
M2a_PhoneNumber.
TELEPHONE NUMBER:
Please give me the telephone number, area code first?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-6

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

PROGRAMMER: ASK M2A_TIMEZONE IF TIME ZONE IS NOT CURRENTLY ENTERED
(M2A=02)
M2A_TimeZone.
What time zone is that in?
INTERVIEWER:

CURRENT TIME ZONE: {DISPLAY TIME ZONE BASED ON}
HAWAII/ALEUTIAN TIME ZONE ................................................
ALASKA TIME ZONE .................................................................
PACIFIC TIME ZONE .................................................................
MOUNTAIN TIME ZONE ............................................................
CENTRAL TIME ZONE ..............................................................
EASTERN TIME ZONE ..............................................................
ATLANTIC TIME ZONE ..............................................................
NEWFOUNDLAND TIME ZONE ................................................
OTHER INTERNATIONAL TIME ZONE .....................................

02
03
04
05
06
07
08
09
98

(M2A=02)
M2A_Confirm.
TELEPHONE NUMBER: {PROXY’S TELEPHONE NUMBER}
TIME ZONE: {PROXY’S TIME ZONE}
INTERVIEWER:

PRESS 1 TO CONTINUE

(M2A=02)
M2a_Rlshp. How are you related to {NAME}?
{NAME’S} SPOUSE....................................................................
{NAME’S} MOTHER ...................................................................
{NAME’S} FATHER ....................................................................
{NAME’S} CHILD ........................................................................
GRANDPARENT OF {NAME} ....................................................
BROTHER/SISTER (NATURAL/STEP) OF {NAME} ..................
AUNT/UNCLE OF {NAME} .........................................................
FRIEND ......................................................................................
CASEWORKER/CAREGIVER/PAYEE .......................................
GIRLFRIEND/BOYFRIEND/PARTNER ......................................
GUARDIAN/FOSTER/STEP PARENT .......................................
IN-LAW .......................................................................................
OTHER RELATIVE OF {NAME} .................................................
NOT RELATED ..........................................................................
STAFF AT RESIDENCE .............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
11
12
13
14
15
08
09
10
d
r

(M2A=02 and M2a_Rlshp=08)
M2a_oth1. INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2A=02 and M2a_Rlshp=09)
M2a_oth2. INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-7

d
r

(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_email)
(M2a_Rlshp_oth2)
(M2a_email)
(M2a_email)
(M2a_email)

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M2A=02)
M2a_email. Do you have an email address?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M2CHECK)
DON’T KNOW ............................................................................ d (M2CHECK)
REFUSED .................................................................................. r (M2CHECK)
(M2A=02 and M2a_email=01)
M2b.
What is your email address?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(SampGrp=02 Successful worker sample members)
M2c.
Are you planning to move within the next two years?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r
(SampGrp=02 Successful worker sample members)
M2c1. Where will you be moving to?
Probe:

Can you tell me the city and state?

Street Address 1
(STRING 200)
Street Address 2
(STRING 200)
City
(STRING 200)
State/Territory

Select▼ (INSERT STATE DROPDOWN)
Zip
(STRING 10)
NO RESPONSE ......................................................................... M

PROGRAMMER NOTE: IF FIELD LOCATOR CALL-IN (MAKEDIALPHONE=8):
M2field_callin.

M-8

The field locator will now give you a $30 Walmart gift card (if M2_prepay=0, .D, .R)_GO TO
M2_Field_Amount.

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

PROGRAMMER NOTE: IF CAPI FIELD COMPLETE, CASE, THEN DISPLAY TEXT BELOW INSTEAD
M2_INC_FIELD:. ELSE, M3
M2_INC_FIELD: ARE YOU GIVING THE GIFT CARD TO THE RESPONDENT?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M3)
(M2_INC_FIELD=00)
M3.
Would you like us to send the $ (15/20) gift card to {you/NAME} or someone else?
{YOU/NAME} .............................................................................. 01
SEND GIFT CARD TO SOMEONE ELSE ................................. 02
DON’T KNOW ............................................................................ d
REFUSED .................................................................................. r

(M3a)
(M3a)
(M3a)
(M3a)

(M2_INC_FIELD=01,02,d,r)
M3a. Would {you/ NAME} like a Walmart or an Amazon gift card?
WALMART GIFT CARD ............................................................. 01 (M10a)
AMAZON GIFT CARD ................................................................ 02 (M10a)

PROGRAMMER: IF M3=2, THEN M4. ELSE, M10a.
(M2_PrePay=00,d,r or M3=02,d,r)
M4.
PROGRAMMER: WE WOULD LIKE THE FOLLOWING FORMAT TO BE USED FOR THE DISPLAY ON
TOP HALF OF SCREEN (IF POSSIBLE, THIS DISPLAY SHOULD CHANGE AS THE INTERVIEWER
ENTERS NEW INFORMATION):
What is the name and address of the person to whom we should send the gift card?
NAME: {FULL NAME FROM M1}
STREET ADDRESS 1: {FIRST LINE OF ADDRESS FROM M1}
STREET ADDRESS 2: {SECOND LINE OF ADDRESS FROM M1}
STREET ADDRESS 3: {THIRD LINE OF ADDRESS FROM M1}
CITY OR TOWN: {CITY OR TOWN FROM M1}
STATE: {STATE FROM M1}
ZIP CODE: {ZIP CODE FROM M1}
TELEPHONE NUMBER: {TELEPHONE NUMBER FROM M1}
SAME AS PROVIDED................................................................ 00 (M6)
INCORRECT INFORMATION ABOVE, NEED TO ENTER
NEW INFORMATION ......................................................... 01 (M4Fname)
DON’T KNOW ............................................................................ d (M6)
REFUSED .................................................................................. r (M6)
PROGRAMMER: SEE M1 FOR FORMATTING TO USE FOR BOTTOM OF SCREEN
(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Firstname.
NAME:
First name?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-9

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Middlename.
NAME: {DISPLAY FIRST NAME FROM QUESTION M4_FIRSTNAME}
Middle initial?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Lastname.
NAME: {DISPLAY FIRST NAME FROM QUESTION M4_FIRSTNAME AND MIDDLE NAME FROM
M4_MIDDLENAME}
Last name?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d, r or M3=02,d,r and M4=01)
Confirm.
NAME: {DISPLAY NAME FROM PREVIOUS QUESTIONS}
INTERVIEWER:

PRESS 1 TO CONTINUE

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Address1.
ADDRESS:
Street and number?
INTERVIEWER:

REFUSED OR DON’T KNOW ALLOWED. WILL SKIP REST OF ADDRESS
QUESTIONS.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Address2.
ADDRESS: {DISPLAY ADDRESS1 FROM PREVIOUS QUESTION}
PROBE: READ IF NECESSARY: Second part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Address3.
ADDRESS: {DISPLAY ADDRESS1 AND ADDRESS2 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Third part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-10

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Address4.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, AND ADDRESS3 FROM PREVIOUS QUESTIONS}
PROBE: READ IF NECESSARY: Fourth part of the address.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d, r or M3=02,d,r and M4=01)
M4_City.
ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, AND ADDRESS4 FROM PREVIOUS
QUESTIONS}
Town or city?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_State. ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3 ADDRESS4, AND TOWN/CITY FROM
PREVIOUS QUESTIONS}
State?
INTERVIEWER:

USE TWO CHARACTER ABBREVIATION.

INTERVIEWER:

ENTER ZZ TO ENTER INTERNATIONAL CITY AND COUNTRY BELOW.

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Zip. ADDRESS: {DISPLAY ADDRESS1, ADDRESS2, ADDRESS3, ADDRESS4, TOWN/CITY, AND STATE
FROM PREVIOUS QUESTIONS}
Zip code?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
Confirm. ADDRESS: {DISPLAY FULL ADDRESS}
INTERVIEWER:

PRESS 1 TO CONTINUE

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Telephone.
TELEPHONE NUMBER:
Please give me the telephone number, area code first?

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-11

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

PROGRAMMER: ASK M4_TIMEZONE IF TIME ZONE IS NOT CURRENTLY ENTERED
(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_TimeZone.
What time zone is that in?
INTERVIEWER:

CURRENT TIME ZONE: {DISPLAY TIME ZONE BASED ON}
HAWAII/ALEUTIAN TIME ZONE ................................................
ALASKA TIME ZONE .................................................................
PACIFIC TIME ZONE .................................................................
MOUNTAIN TIME ZONE ............................................................
CENTRAL TIME ZONE ..............................................................
EASTERN TIME ZONE ..............................................................
ATLANTIC TIME ZONE ..............................................................
NEWFOUNDLAND TIME ZONE ................................................
OTHER INTERNATIONAL TIME ZONE .....................................

02
03
04
05
06
07
08
09
98

(M2_PrePay=00,d,r or M3=02,d,r and M4=01)
M4_Confirm.
TELEPHONE NUMBER: {DISPLAY TELEPHONE NUMBER}
TIME ZONE: {DISPLAY TIME ZONE}
INTERVIEWER:
M7.
(All)
M10a.

PRESS 1 TO CONTINUE

DELETED
Thank you very much for taking part in this survey. Because people like you are such a valued part of what
we do, I’d like you to think about the survey you just participated in. On a scale from 1 to 10 where one
means 'it was not a good use of time' and ten means “it was a good use of time,” which number between
1 and 10 best describes how you feel about your experience today?
|___|___|
(01-10)
DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(All)
M11_Thanks.
Thank you for your cooperation. This completes the survey! Thank you again.
PRESS 1 TO CONTINUE ..........................................................

01

INTERVIEWER OBSERVATIONS
NEW ITEM
(All)
M11a.

How was this interview conducted?
Over the telephone .....................................................................
In person ....................................................................................
Using TTY...................................................................................
Other: Specify .............................................................................

(M11a=04)
M11a_Other.
INTERVIEWER:

M-12

PLEASE SPECIFY

01
02
03
04

(M11)
(M11)
(M11)
(M11a_Other)

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

M11.

INTERVIEWER: INTERVIEWER OBSERVATIONS:
Who was the respondent to this interview?
INTERVIEWER:

PLEASE CODE THE PERSON WITH WHOM YOU CONDUCTED MOST OF THE
INTERVIEW.
{NAME} HIMSELF/HERSELF ..................................................... 01
PROXY FOR {NAME} ................................................................. 02 (M13)

(M11=01)
M12.
Was {NAME} assisted by anyone during this interview? That is, did anyone help {NAME} in interpreting the
questions or giving answers?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M15)
(M11=02 or M12=01)
M13.
PROGRAMMER: IFM12=01 FILL “ASSISTANT” AND IF M11=02 FILL “PROXY”
How is the {assistant/proxy} related to (NAME)?
INTERVIEWER:

IF MORE THAN ONE ASSISTANT OR PROXY, INDICATE THE RELATIONSHIP OF
THE ONE YOU CONSIDER TO BE THE MAIN ASSISTANT OR PROXY.
{NAME’S} SPOUSE....................................................................
{NAME’S} MOTHER ...................................................................
{NAME’S} FATHER ....................................................................
{NAME’S} CHILD ........................................................................
GRANDPARENT OF {NAME} ....................................................
BROTHER/SISTER (NATURAL/STEP) OF {NAME} ..................
AUNT/UNCLE OF {NAME} .........................................................
FRIEND ......................................................................................
CASEWORKER/CAREGIVER/PAYEE .......................................
GIRLFRIEND/BOYFRIEND/PARTNER ......................................
GUARDIAN/FOSTER/STEP PARENT .......................................
IN-LAW .......................................................................................
OTHER RELATIVE OF {NAME} .................................................
NOT RELATED ..........................................................................
STAFF AT RESIDENCE .............................................................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

*Note:

01
02
03
04
05
06
07
11
12
13
14
15
08
09
10
d
r

M14=11 is a category added at R2; value of “other” category (M14=10) maintained for comparability across
rounds.

(M11=02 or M12=01 and M13=08)
M13_h_oth. INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

(M11=02 or M12=01 and M13=09)
M13_i_oth. INTERVIEWER: PLEASE SPECIFY

DON’T KNOW ............................................................................
REFUSED ..................................................................................

M-13

(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M14)
(M13_h_oth)
(M13_i_oth)
(M14)
(M14)
(M14)

d
r

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(M11=02 or M12=01)
M14.
PROGRAMMER: IFM12=01 FILL “ASSISTANT” AND IF M11=02 FILL “PROXY”
PROGRAMMER: ONLY DISPLAY RESPONSE OPTION 10, IF M11=02
Why was an {assistant/proxy} needed?
INTERVIEWER:

*Note:

MARK ONLY ONE.
{NAME} DIDN’T KNOW HOW TO ANSWER..............................
{NAME} HOSPITALIZED ............................................................
{NAME} INSTITUTIONALIZED ...................................................
{NAME} HAS HEARING PROBLEM ...........................................
{NAME} HAS SPEECH PROBLEM ............................................
{NAME} HAS LANGUAGE PROBLEM .......................................
{NAME} HAS POOR MEMORY OR CONFUSION .....................
{NAME} HAS OTHER MENTAL CONDITION ............................
{NAME} HAS PHYSICAL ILLNESS OR DISABILITY .................
{NAME} FAILED COGNITIVE TEST ..........................................
OTHER NON-HEALTH RELATED REASON .............................
DON’T KNOW ............................................................................
REFUSED ..................................................................................

01
02
03
04
05
06
07
08
09
11
10
d
r

DON’T KNOW ............................................................................
REFUSED ..................................................................................

d
r

In general, do you feel the respondent was intellectually capable of responding?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d

(All)
M16.

In general, do you feel the respondent’s answers were reasonably accurate?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d

(All)
M17.

In general, do you feel the respondent understood the questions?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d

(All)
M18.

In general, how tiring did the interview seem to be for the respondent?
VERY TIRING............................................................................. 01
A LITTLE TIRING ....................................................................... 02
NOT TIRING ............................................................................... 03
DON’T KNOW ............................................................................ d

M-14

(M15)
(M15)

M14=11 is a new category added at R2 and R3; value of “other” category (M14=10) maintained for
comparability across rounds.

(M11=02 or M12=01 and M14=10)
M14_j_oth. INTERVIEWER: PLEASE SPECIFY

(All)
M15.

(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)
(M15)*

SECTION M UNIVERSE: ALL
VARIABLES NEEDED FROM OTHER SECTIONS: RTYPE, {NAME’S} ADDRESS FROM SECTION A
PRELOADED VARIABLES: EXPTYPE, TSTATUS

(All)
M19.

In general, did the respondent have difficulty hearing you during the interview?
YES ............................................................................................ 01
NO .............................................................................................. 00 (M21)
DON’T KNOW ............................................................................ d (M21)

(M19=01)
M20.
In general, do you feel the respondent’s hearing difficulty affected the interview?
YES ............................................................................................ 01
NO .............................................................................................. 00
DON’T KNOW ............................................................................ d
(All)
M21.

M-15

INTERVIEWER: Record any special circumstances encountered while interviewing respondent.