Form 1 Baseline Survey
Child Support Noncustodial Parent Employment Demonstration (CSPED)
IC 7 Baseline survey_final
Baseline Survey
OMB: 0970-0439
OMB No.: xxxx-xxx
Expiration Date: xx/xx/20xx
CSPED
Baseline Survey
July 2, 2013
National Child Support Noncustodial Parent Employment Demonstration (CSPED)
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is [FILL NUMBER]. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: ACF Reports Clearance Officer [FILL ADDRESS]. |
CONTENTS
Section Page
i. INTRODUCTION i
A. CONTACT INFORMATION 1 1
B. DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS 3
C. biological child roster 6
D. RELATIONSHIPS 17
E. ECONOMIC STABILITY 26
F. FATHER BACKGROUND AND WELL BEING 29
G. Motivation to participate in program 34
H. contact information 2 35
INTERVIEWER SELECT STAFF NAME, SITE NAME AND RESPONDENT GENDER FROM DROP DOWN MENU.
PROGRAMMER: PRELOAD STAFF NAMES, GENDER AND SITE NAMES.
1. Hello, my name is [INTERVIEWER NAME], and I work for the University of Wisconsin Survey Center. I understand that you are interested in [INSERT STATE PROGRAM NAME HERE] and the National Child Support Noncustodial Parent Employment Demonstration study which is called CSPED for short. Is that correct?
YES 1
NO 0 GO TO 6a
2. Great. Thanks for taking the time to talk to me today. I would like to tell you a little bit more about the study. Please stop me at any time if you have a question.
[PROGRAM NAME] is part of the CSPED study, a national study being conducted by the U.S. Department of Health and Human Services. The Department of Health and Human Services has asked a research team from the University of Wisconsin and Mathematica Policy Research to help with the study.
The main purpose of this study is to better understand if [ INSERT PROGRAM NAME HERE] helps parents like you. We are interested in whether the program helps noncustodial parents meet their child support obligations by providing additional services that work better together. These include child support services, employment services, and parenting activities. Through the study, we hope to learn if these extra services address families’ needs and how they could be improved.
The chance to receive extra services through the [INSERT STATE PROGRAM NAME HERE] is available only to those who agree to participate in the study. If you want to be eligible to receive these extra services, you have to agree to be a part of the CSPED study. If you decide that you do not want to be a part of the study, you will not have a chance to receive the extra services and will receive the regular or “usual” services that you would have received even if the study was not being done.
If you decide to participate in the study, I will ask you to complete a short interview on the telephone with me today. This will take about 30 minutes. If you choose to be a part of the study, you will receive a $10 gift card for your participation in today’s interview.
Do you have any questions about what I’ve said so far?
YES 1
NO 0 GO TO 3
2a. What is your question?
___________________________________________________________
INTERVIEWER: PRESS F10 TO ACCESS FAQ
3. Because space is limited and we cannot provide extra services to all the parents who would like to receive them, the research team created a computer program to randomly select which parents will be able to participate in our program. If you agree to participate in the study, the computer will place you into one of two groups: one group will receive extra services through the [INSERT STATE PROGRAM NAME HERE] at no cost to them; the other group will not receive services beyond the services they would have received even if the study was not being conducted. The computer works like a flip of a coin; you would have 50 percent chance of being assigned to the group that receives the extra services and a 50 percent chance of being assigned to the group who receives the regular or “usual” services. The process is random and the chance of being selected to receive extra services is not influenced by what you say to me or to program staff.
A staff member from [INSERT STATE PROGRAM NAME HERE] will let you know which group you are in after today’s interview.
It is important you understand that even if you are not randomly selected to receive extra services, you will still be part of the study so that researchers can compare your experiences to those who are selected to receive them. In order to be able to do this, the researchers will collect and track information about you.
Do you have any questions at this time?
YES 1
NO 0 GO TO 4
3a. What is your question?
___________________________________________________________
INTERVIEWER: PRESS F10 TO ACCESS FAQ
4. Whether or not you are selected to receive the extra services, we will contact you again in about one year to update some of the information you give us today and ask some new questions. We hope to use this information and the information you provide today to learn if [INSERT PROGRAM NAME HERE] helps families and learn how it could be improved. You will receive an additional $25 gift card if you participate in the follow-up interview.
You may also be asked to participate in focus groups as a part of this study. You would receive a $20 gift card as a token of appreciation for the time you spend in these activities.
Whether or not you take part in the follow-up survey and focus groups is up to you and will have no effect on the services you receive.
Do you have any questions now?
YES 1
NO 0 GO TO 5
4a. What is your question?
___________________________________________________________
INTERVIEWER: PRESS F10 TO ACCESS FAQ
5. If you agree to be in the study, regardless of whether you are assigned to the group that receives the extra services or the group who receives regular or “usual” services , it means you agree it is ok for [INSERT PROGRAM NAME HERE] to share information with the study team about you and the services you receive. The study team will contact federal and state agencies for information about your employment and earnings, child support orders, experiences with the criminal justice system and child welfare system, and other benefits or services you may receive from public programs, and will obtain a copy of your credit report.. This information and everything you tell the program staff or the interviewers will be kept private and will not be shared with anyone. However, if you tell a person on the study team about child abuse or if you threaten to harm yourself or someone else, it must be reported by law.
At any time, after you have been placed in a group, you can call our study helpline to say that you no longer want the program to share information about you with the researchers, and that will have no effect on the services available to you. By agreeing now to be in the study, even if later you tell us you want to withdraw from the study, you are authorizing researchers to use information that was collected about you before you withdrew.
Do you have any questions now?
YES 1
NO 0 GO TO 6
5a. What is your question?
___________________________________________________________
INTERVIEWER: PRESS F10 TO ACCESS FAQ
6.
This study also has a Certificate of Confidentiality from the National Institutes of Health. This means that we will not share information that could identify you, even if a court asks us to, unless the U.S. Government demands information to audit or evaluate federal projects or to meet the Food and Drug Administration’s requirements. This certificate does not stop you from choosing to share information about yourself or your part in this study.
The information from all study participants will be combined and written up in a report to the U.S. Department of Health and Human Services. Researchers might use information from this study in journals, books or presentations. However, nothing will be said about you as an individual. Instead, information about you will be combined with information about everybody else in the study, so the researchers can say things like “30 percent of parents in the program have two children.”
Do you have any questions now?
YES 1
NO 0 GO TO 7
6a. What is your question?
___________________________________________________________
INTERVIEWER: PRESS F10 TO ACCESS FAQ
7. If you are assigned to the group that receives the extra services, you will receive these services, which could better enable you to meet your child support obligations. If you are assigned to the group that receives regular or “usual” services, you will not benefit from the extra services provided through [INSERT STATE PROGRAM NAME]. However, your participation will help the Department of Health and Human Services learn how to better provide services in the future to other parents like you.
There is minimal risk related to taking part in this study. In the unlikely event that there is a breach in confidentiality, your participation in this program could become known. There is also a risk that you may feel uncomfortable answering some questions in the interview about your relationships, income, program participation, and barriers to employment (such as drug or alcohol use and past contact with the criminal justice system). You can refuse to answer those questions if you wish, and it will not change the services you receive.
You can ask any questions about the study at any time. If you have questions about the study, you can contact the Principal Investigators, Maria Cancian or Dan Meyer at the University of Wisconsin. If you are not satisfied with their answers, have more questions, or want to talk with someone about your rights as a participant in this study, you can contact the Education Research and Social & Behavioral Science IRB Office at the University of Wisconsin. These telephone numbers are listed in the “Consent Information Sheet” provided to you today by program staff.
Do you have any questions now?
YES 1
NO 0 GO TO 8
7a. What is your question?
___________________________________________________________
INTERVIEWER: PRESS F10 TO ACCESS FAQ
8. Do you agree to be in the CSPED study?
YES 1 GO TO 0
NO 0 GO TO 10
9. For quality control purposes, this interview may be recorded. The recording will not be shared with anyone outside of the research team and will be destroyed after the study is finished. May I have your permission to record the interview?
YES, PERMISSION GRANTED 1 GO TO A1
NO, PERMISSION DENIED 0
10. Thank you very much for your time. Can you please hand the phone back to the staff person at [PROGRAM NAME]?
INTERVIEWER: INFORM PROGRAM STAFF THAT RESPONDENT WILL NOT BE PART OF THE CSPED STUDY.
Thank you for agreeing to participate in the study. I would like to start by asking you some questions about yourself.
A1. What is your full name? Please spell that for me.
INSTRUCTION: CONFIRM LAST NAME GIVEN IS THEIR FULL LEGAL NAME (i.e. ARE THERE TWO LAST NAMES OR HYPHENATED LAST NAME).
FIRST NAME
MIDDLE INITIAL/NAME
LAST NAME
A1a. I want to make sure that we call you by the correct name. Do you go by another name?
YES 1
NO 0 GO TO A2
DON’T KNOW d GO TO A2
REFUSED r GO TO A2
A1b. Please spell that name for me.
NAME
DON’T KNOW d
REFUSED r
A2. What is your date of birth?
| | | / | | | / | | | | |
MONTH DAY YEAR
HARD CHECK: CALCULATE AGE BY COMPARING DOB TO CURRENT DATE. IF <18 YEARS, GO TO END2. IF AGE≥18, CONTINUE TO A3.
A3. What is your Social Security Number? | | | | - | | | -| | | | |
A4. What is your address?
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
A5. What is your home telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO LANDLINE AT HOME, ONLY CELL PHONE 0
DON’T KNOW d
REFUSED r
A6a. Do you have a cell phone?
YES 1
NO 0 GO TO B1
DON’T KNOW d GO TO B1
REFUSED r GO TO B1
A6b. What is your cell phone number?
| | | | - | | | | -| | | | | TELEPHONE
DON’T KNOW d
REFUSED r
A
Youthbuild
|
|
|||
|
YES |
NO |
DK |
REF |
a. Do you have a contract? |
1 |
0 |
d |
r |
b. Do you have a ‘pay as you go’ plan? |
1 |
0 |
d |
r |
c. Do you have unlimited calling? |
1 |
0 |
d |
r |
d. Do you have unlimited texting? |
1 |
0 |
d |
r |
e. OTHER (SPECIFY) |
1 |
0 |
d |
r |
|
|
|
|
|
ASK IF A7d=0
A
PACT
YES 1
NO 0
DON’T KNOW d
REFUSED r
Next, I would like to ask you some questions about your background.
B1. Are you Hispanic, Latino, or of Spanish origin?
OMB
NO, NOT OF HISPANIC, LATINO OR SPANISH ORIGIN 0
YES, MEXICAN, MEXICAN AMERICAN, CHICANO 1
YES, PUERTO RICAN 2
YES, CUBAN 3
YES, ANOTHER HISPANIC, LATINO OR SPANISH ORIGIN 4
DON’T KNOW d
REFUSED r
B
OMB
AMERICAN INDIAN OR ALASKA NATIVE 1
ASIAN 2
BLACK OR AFRICAN AMERICAN 3
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4
WHITE 5
DON’T KNOW d
REFUSED r
B3. Were you born in the United States?
Y
BSF
NO 0
B4. When did you first come to live in the United States?
I
BSF
SPECIFY YEAR 1
SPECIFY NUMBER OF YEARS AGO 2
| | | | | YEAR
OR
| | | NUMBER OF YEARS AGO
DON’T KNOW d
REFUSED r
B
OMB
tailored for CSPED
Married, 1
Divorced, 2
Widowed, 3
Separated, or 4
Have you never been married? 5
DON’T KNOW d
REFUSED r
B
CBRA
tailored for CSPED
INSTRUCTION: IF RESPONDENT SAYS “HIGH SCHOOL,” PROBE: Did you receive a diploma or GED?
DID NOT COMPLETE HIGH SCHOOL OR GED 1
HIGH SCHOOL: DIPLOMA 2
HIGH SCHOOL: GENERAL EDUCATION DEVELOPMENT OR GED 3
SOME COLLEGE/SOME POSTSECONDARY VOCATIONAL COURSES 4
2-YEAR OR 3-YEAR COLLEGE DEGREE (ASSOCIATE’S DEGREE) 5
VOCATIONAL SCHOOL DIPLOMA 6
4-YEAR COLLEGE DEGREE (BACHELOR’S DEGREE) 7
SOME GRADUATE WORK/NO GRADUATE DEGREE 8
GRADUATE OR PROFESSIONAL DEGREE (e.g., MA, MBA, Ph.D., JD, MD) 9
NEVER ATTENDED SCHOOL 10
DON’T KNOW d
REFUSED r
B
CPS
tailored for CSPED
YES 1
NO 0 GO TO C1
B
CPS
tailored for CSPED
YES 1
NO 0
Now I’d like to start by asking you some questions about your biological children.
C
PACT
IF NUMBER OF CHILDREN=0, SKIP TO END2.
|
|
| CHILDREN
(0-10)
SOFT CHECK: IF R ANSWERS 0, SAY, “I have recorded that you do not have any biological children, including children who may not currently live with you. Is that correct?”
SOFT CHECK: IF R ANSWERS “DON’T KNOW,” SAY: “If you aren’t sure, please tell me how many children you have that you know of.” IF NECESSARY: One of the most important parts of this study is learning about how this program can help noncustodial parents and their relationship with their children. In order to do that, we need to ask a few questions about each of your children.”
SOFT CHECK: IF RESPONDENT REFUSES, SAY: “One of the most important parts of this study is learning about how this program can help noncustodial parents and their relationship with their children. In order to do that, we need to ask a few questions about each of your children. All of the information you tell me will be kept confidential. Can you please tell me how many children you have?” IF R REFUSES AGAIN, CODE AS REFUSED.
DON’T KNOW d STATUS AS REFUSAL AND SKIP TO END2
REFUSED r STATUS AS REFUSAL AND SKIP TO END2
|
CHILD 1 |
CHILD 2 |
CHILD 3 |
C
BSF |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
C
BSF |
YES 1 NO 0 GO TO C5 DON’T KNOW d GO TO C5 REFUSED r GO TO C5 |
YES 1 NO 0 GO TO C5 DON’T KNOW d GO TO C5 REFUSED r GO TO C5 |
YES 1 NO 0 GO TO C5 DON’T KNOW d GO TO C5 REFUSED r GO TO C5 |
C
BSF |
NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY
NICKNAME DON’T KNOW d REFUSED r |
NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY
NICKNAME DON’T KNOW d REFUSED r |
NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY
NICKNAME DON’T KNOW d REFUSED r |
C5. Do you have another child? |
YES 1 GO TO C2, CHILD 2 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C2, CHILD 3 NO 0 GO TO C6, CHILD 1 DON’T KNOW d REFUSED r |
YES 1 GO TO C2, CHILD 4 NO 0 GO TO C6, CHILD 1 DON’T KNOW d REFUSED r |
N
PACT CODE SEX. IF NECESSARY ASK: C6.Is [CHILD FIRST NAME] a boy or girl? |
BOY 1 GIRL 2 DON’T KNOW d REFUSED r |
BOY 1 GIRL 2 DON’T KNOW d REFUSED r |
BOY 1 GIRL 2 DON’T KNOW d REFUSED r |
C
PACT |
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C9 MONTH DAY YEAR DECEASED 1 GO TO C6, CHILD 2, IF C5, CHILD 1 =1, OR GO TO END2 IF C5, CHILD 1=0 INTERVIEWER: IF C7=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C9 MONTH DAY YEAR DECEASED 1 GO TO C6, CHILD 3, IF C5, CHILD 2 =1 INTERVIEWER: IF C7=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C9 MONTH DAY YEAR DECEASED 1 GO TO C6, CHILD 4, IF C5, CHILD 3 =1 INTERVIEWER: IF C7=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
C
PACT Is that weeks, months or years? |
| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C6, CHILD 2, IF C5, CHILD 1 =1 OR GO TO END2 IF C5, CHILD 1=0 INTERVIEWER: IF C8=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C6, CHILD 3, IF C5, CHILD 2 =1 INTERVIEWER: IF C8=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C6, CHILD 4, IF C5, CHILD 3 =1 INTERVIEWER: IF C8=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
|
CHILD 4 |
CHILD 5 |
CHILD 6 |
C
BSF |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
C
BSF |
YES 1 NO 0 GO TO C5 DON’T KNOW d GO TO C5 REFUSED r GO TO C5 |
YES 1 NO 0 GO TO C5 DON’T KNOW d GO TO C5 REFUSED r GO TO C5 |
YES 1 NO 0 GO TO C5 DON’T KNOW d GO TO C5 REFUSED r GO TO C5 |
C
BSF |
NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY
NICKNAME DON’T KNOW d REFUSED r |
NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY
NICKNAME DON’T KNOW d REFUSED r |
NOTE: IF NICKNAME, USE AS FILL FOR [CHILD FIRST NAME] IN REMAINDER OF SURVEY
NICKNAME DON’T KNOW d REFUSED r |
C5.Do you have another child? |
YES 1 GO TO C2, CHILD 5 NO 0 GO TO C6, CHILD 1 DON’T KNOW d REFUSED r |
YES 1 GO TO C2, CHILD 6 NO 0 GO TO C6, CHILD 1 DON’T KNOW d REFUSED r |
YES 1 GO TO C2, CHILD 7 NO 0 GO TO C6, CHILD 1 DON’T KNOW d REFUSED r |
N
PACT CODE SEX. IF NECESSARY ASK: C6.Is [CHILD FIRST NAME] a boy or girl? |
BOY 1 GIRL 2 DON’T KNOW d REFUSED r |
BOY 1 GIRL 2 DON’T KNOW d REFUSED r |
BOY 1 GIRL 2 DON’T KNOW d REFUSED r |
C
PACT |
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C9 MONTH DAY YEAR DECEASED 1 GO TO C6, CHILD 5, IF C5, CHILD 4 =1 , INTERVIEWER: IF C7=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TO C9 MONTH DAY YEAR DECEASED 1 GO TO C6, CHILD 6, IF C5, CHILD 5 =1 , INTERVIEWER: IF C7=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
PROGRAMMER NOTE: ALLOW REFUSAL IN MM/DD/YYYY | | |/| | |/| | | | | GO TOC9 MONTH DAY YEAR DECEASED 1 GO TO C6, CHILD 7, IF C5, CHILD 6 =1 , INTERVIEWER: IF C7=1, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
C
PACT Is that weeks, months or years? |
| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C6, CHILD 5, IF C5, CHILD 4 =1 INTERVIEWER: IF C8=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C6, CHILD 6, IF C5, CHILD 5 =1 , INTERVIEWER: IF C8=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
| | | | WEEKS 1 MONTHS 2 YEARS 3 DECEASED 4 GO TO C6, CHILD 7, IF C5, CHILD 6 =1 , INTERVIEWER: IF C8=4, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
|
CHILD 1 |
CHILD 2 |
CHILD 3 |
C
PACT PROBE: Please spell that for me. IF R=MALE, FILL “MOTHER;” IF R=FEMALE, FILL “FATHER” |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
|
|
C
PACT |
|
[CHILD 1]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r |
[CHILD 1]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 2]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r |
C
PACT PROBE: Please spell that for me. |
|
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
ASK C12 FOR THE LAST CHILD LISTED AT C2. C12.Is there another child? |
IF C5, CHILD 1=0 AND C12, CHILD 1=1, GO TO C2, CHILD 2 YES 1 NO 0 DON’T KNOW d REFUSED r |
IF C5, CHILD 2=0 AND C12, CHILD 2=1, GO TO C2, CHILD 3 YES 1 NO 0 DON’T KNOW d REFUSED r |
IF C5, CHILD 3=0 AND C12, CHILD 3=1, GO TO C2, CHILD 4 YES 1 NO 0 DON’T KNOW d REFUSED r |
|
CHILD 4 |
CHILD 5 |
CHILD 6 |
C
PACT PROBE: Please spell that for me. |
|
|
|
C
PACT |
[CHILD 1]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 2]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 3]? YES 1 GO TO C12 NO 0
DON’T KNOW d REFUSED r |
[CHILD 1]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 2]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 3]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 4]? YES 1 GO TO C12 NO 0
DON’T KNOW d REFUSED r |
[CHILD 1]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 2]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 3]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 4]? YES 1 GO TO C12 NO 0 DON’T KNOW d REFUSED r
[CHILD 5]? YES 1 GO TO C12 NO 0
DON’T KNOW d REFUSED r |
C
PACT PROBE: Please spell that for me. |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
FIRST NAME
LAST NAME DON’T KNOW d REFUSED r |
ASK C12 FOR THE LAST CHILD LISTED AT C2. C12.Is there another child? |
IF C5, CHILD 4=0 AND C12, CHILD 4=1, GO TO C2, CHILD 5 YES 1 NO 0 DON’T KNOW d REFUSED r |
IF C5, CHILD 5=0 AND C12, CHILD 5=1, GO TO C2, CHILD 6 YES 1 NO 0 DON’T KNOW d REFUSED r |
IF C5, CHILD 6=0 AND C12, CHILD 6=1, GO TO C2, CHILD 7 YES 1 NO 0 DON’T KNOW d REFUSED r |
|
CHILD 1 |
CHILD 2 |
CHILD 3 |
C
BSF |
YES 1 GO TO C18, CHILD 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C18, CHILD 2 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C18, CHILD 3 NO 0 DON’T KNOW d REFUSED r |
I
BSF C14.Were you and [MOTHER FIRST NAME/FATHER FIRST NAME] living together when [CHILD FIRST NAME] was born? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
I
BSF C15.Did you and [MOTHER FIRST NAME] ever sign a birth certificate or document that identifies you as the legal father of [CHILD FIRST NAME]? |
YES 1 GO TO C17, CHILD 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C17, CHILD 2 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C17, CHILD 3 NO 0 DON’T KNOW d REFUSED r |
I
BSF C16.Has a court ruled that you are [CHILD FIRST NAME]’s father? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
A
FFCWS
tailored for CSPED
C17.Have you ever lived with [CHILD FIRST NAME]? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED C18.In the past 30 days, how many nights did you and [CHILD FIRST NAME] stay in the same place? |
| | | NIGHTS GO TO C20aDON’T KNOW d REFUSED r |
| | | NIGHTS GO TO C20a DON’T KNOW d REFUSED r |
| | | NIGHTS TIMES GO TO C20a DON’T KNOW d REFUSED r
|
WFNJ
tailored for CSPED IF C18 = DK, REF ASK C19.I just need to know a range, can you tell me if it was…? |
1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r |
1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r |
1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r |
C
FFCWS
tailored for CSPED |
YES 1 GO TO C21 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C21 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C21 NO 0 DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED ASK IF IF C20a≠1 C20b.In the past 30 days, what adults did [CHILD] stay with most nights? SELECT ALL THAT APPLY
|
RESPONDENT 1 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER PARENT 9
OTHER (SPECIFY) 99
DON’T KNOW d REFUSED r |
RESPONDENT 1 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER PARENT 9
OTHER (SPECIFY) 99
DON’T KNOW d REFUSED r
|
RESPONDENT 1 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER PARENT 9
OTHER (SPECIFY) 99
DON’T KNOW d REFUSED r |
|
CHILD 4 |
CHILD 5 |
CHILD 6 |
C
BSF |
YES 1 GO TO C18 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C18 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C18 NO 0 DON’T KNOW d REFUSED r |
I
BSF
BSF C14.Were you and [MOTHER FIRST NAME/FATHER FIRST NAME] living together when [CHILD FIRST NAME] was born? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
I
BSF
C15.Did you and [MOTHER FIRST NAME] ever sign a birth certificate or document that identifies you as the legal father of [CHILD FIRST NAME]? |
YES 1 GO TO C17, CHILD 4 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C17, CHILD 5 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C17, CHILD 6 NO 0 DON’T KNOW d REFUSED r |
I
BSF
BSF C16.Has a court ruled that you are [CHILD FIRST NAME]’s father? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED |
|
|
|
C13 ≠ 1 OR C14 ≠ 1 C17.Have you ever lived with [CHILD FIRST NAME]? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
C
FFCWS
tailored for CSPED |
| | | NIGHTS GO TO C20a DON’T KNOW d REFUSED r |
| | | NIGHTS GO TO C20a DON’T KNOW d REFUSED r |
| | | NIGHTS GO TO C20a DON’T KNOW d REFUSED r
|
WFNJ
tailored for CSPED IF C18 = DK, REF ASK C19.I just need to know a range, can you tell me if it was…? |
1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r |
1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r |
1-5 nights, 1 6-10 nights, 2 11-15 nights, 3 16-20 nights, or 4 More than 20 nights 5 DON’T KNOW d REFUSED r |
C
FFCWS
tailored for CSPED |
YES 1 GO TO C21 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C21 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO C21 NO 0 DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED ASK IF IF C20a≠1 C20b.In the past 30 days, what adults did [CHILD] stay with most nights? SELECT ALL THAT APPLY
|
RESPONDENT 1 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER PARENT 9
OTHER (SPECIFY) 99
DON’T KNOW d REFUSED r |
RESPONDENT 1 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER PARENT 9
OTHER (SPECIFY) 99
DON’T KNOW d REFUSED r
|
RESPONDENT 1 PATERNAL GRANDPARENTS 3 MATERNAL GRANDPARENTS 4 AUNT, UNCLE, GREAT AUNT OR GREAT UNCLE 5 OTHER ADULT RELATIVE 6 SOME OTHER ADULT 7 ADOPTIVE PARENT 8 FOSTER PARENT 9
OTHER (SPECIFY) 99
DON’T KNOW d REFUSED r |
|
CHILD 1 |
CHILD 2 |
CHILD 3 |
I
EHS
tailored for CSPED C21.In the past 30 days, how many days did you have any contact with [CHILD FIRST NAME], either in person, over the telephone, or through letters, emails, or text messages? |
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
I
EHS
tailored for CSPED
C22.On how many of these [FILL DAYS FROM C21] days did you have contact with [CHILD FIRST NAME] in person?
|
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
GO
TO C6, CHILD 2 IF C5, CHILD 1 =1 OR C12, CHILD 1 =1,
OR GO
TO D1, IF C5, CHILD 1=0 OR C12, CHILD 1=0.
GO
TO C6, CHILD 3 IF C5, CHILD 2 =1 OR C12, CHILD 2 =1,
OR
GO
TO D1, IF C5, CHILD 2=0 OR C12, CHILD 2=0.
GO
TO C6, CHILD 4 IF C5, CHILD 3 =1 OR C12, CHILD 3 =1,
OR
GO
TO D1, IF C5, CHILD 3=0 OR C12, CHILD 3=0.
EHS
tailored for CSPED C23. In general, would you say your relationship with [CHILD FIRST NAME] is excellent, very good, good, fair, or poor? |
EXCELLENT……………………... 1 VERY GOOD…………………….. 2 GOOD………………………….....3 FAIR ……………………………….4 POOR ……………………………..5 DON’T KNOW ……………………d REFUSED …………………………r |
EXCELLENT……………………... 1 VERY GOOD…………………….. 2 GOOD………………………….....3 FAIR ……………………………….4 POOR ……………………………..5 DON’T KNOW ……………………d REFUSED …………………………r |
EXCELLENT……………………... 1 VERY GOOD…………………….. 2 GOOD………………………….....3 FAIR ……………………………….4 POOR ……………………………..5 DON’T KNOW ……………………d REFUSED …………………………r |
|
CHILD 4 |
CHILD 5 |
CHILD 6 |
I
EHS
tailored for CSPED C21.In the past 30 days, how many days did you have any contact with [CHILD FIRST NAME], either in person, over the telephone, or through letters, emails, or text messages? |
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
I
EHS
tailored for CSPED
C22.On how many of these [FILL DAYS FROM C21] days did you have contact with [CHILD FIRST NAME] in person?
|
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
| | | DAYS DON’T KNOW d REFUSED r |
GO
TO C6, CHILD 5 IF C5, CHILD 4 =1 OR C12, CHILD 4 =1,
OR GO
TO D1, IF C5, CHILD 4=0 OR C12, CHILD 4=0.
GO
TO C6, CHILD 6 IF C5, CHILD 5=1 OR C12, CHILD 5 =1,
OR GO
TO D1, IF C5, CHILD 5=0 OR C12, CHILD 5=0.
GO
TO C6, CHILD 7 IF C5, CHILD 6 =1 OR C12, CHILD 6 =1,
OR GO
TO D1, IF C6, CHILD 1=0 OR C6, CHILD 1=0.
EHS
tailored for CSPED C23. In general, would you say your relationship with [CHILD FIRST NAME] is excellent, very good, good, fair, or poor? |
EXCELLENT……………………... 1 VERY GOOD…………………….. 2 GOOD………………………….....3 FAIR ……………………………….4 POOR ……………………………..5 DON’T KNOW ……………………d REFUSED …………………………r
|
EXCELLENT……………………... 1 VERY GOOD…………………….. 2 GOOD………………………….....3 FAIR ……………………………….4 POOR ……………………………..5 DON’T KNOW ……………………d REFUSED …………………………r
|
EXCELLENT……………………... 1 VERY GOOD…………………….. 2 GOOD………………………….....3 FAIR ……………………………….4 POOR ……………………………..5 DON’T KNOW ……………………d REFUSED …………………………r |
PROGRAMMING NOTE: GO THROUGH THE COMPLETE SERIES OF QUESTIONS FOR UP TO 10 CHILDREN.
I’d like to talk to you about some of the relationships in your life, thinking about the [women/men] you have had children with. You told us [Fill MOTHER FIRST NAME/FATHER FIRST NAME AND LAST NAME(S) OR FATHER FIRST NAME AND LAST NAME from C9 OR C11.] (is/are) the [mother(s)/father(s)] of your (child/children).
|
[MOTHER/FATHER] 1 |
[MOTHER/FATHER] 2 |
[MOTHER/FATHER] 3 |
D1. Is there anyone we missed? PROGRAMMER NOTE: FILL [MOTHER FIRST AND LAST NAME/FATHER FIRST AND LAST NAME] FROM C9 AND C11 AS ADDITIONAL SCREEN FOR DUPLICATE NAMES. |
YES 1 GO TO C2, CHILD 7 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2 |
YES 1 GO TO C2, CHILD 8 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2 |
YES 1 GO TO C2, CHILD 9 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2 |
BSF
tailored for CSPED ASK IF B5≠5
D2. Let’s talk about [MOTHER FIRST NAME/FATHER FIRST NAME]. Are you and [MOTHER FIRST NAME/FATHER FIRST NAME] now married, divorced, separated, or have you never been married to each other? |
MARRIED 1 GO TO D4 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, [MOTHER/FATHER] 2 IF C11=MOTHER NAME WRITTEN OR GO TO D19 IF C11=NO MOTHER/FATHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
DELETE MARRIED OPTION ONLY IF D2, [MOTHER/FATHER] 1 = 1 OR 3 MARRIED 1 GO TO D4 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, [MOTHER/FATHER] 3 IF C11= HAS TWO MOTHER NAMES WRITTEN OR GO TO D19 IF C11=NO MOTHER/FATHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
DELETE MARRIED OPTION ONLY IF D2, [MOTHER/FATHER] 1 OR 2 = 1 OR 3 MARRIED 1 GO TO D4 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, [MOTHER/FATHER] 4 IF C11= HAS THREE MOTHER NAMES WRITTEN OR GO TO D19 IF C11=NO MOTHER/FATHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
I
BSF
tailored for CSPED D3. Currently, are you and [MOTHER FIRST NAME/FATHER FIRST NAME] romantically involved on a steady basis, involved in an on- again, off-again romantic relationship, or not in a romantic relationship? |
ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 GO TO D5 DON’T KNOW d REFUSED r |
ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 GO TO D5 DON’T KNOW d REFUSED r |
ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 GO TO D5 DON’T KNOW d REFUSED r |
BSF
tailored for CSPED ASK IF D3≠3 D4.Do you live with [MOTHER FIRST NAME/FATHER FIRST NAME] all of the time? By this I mean you do not have another place that you consider your home. PROBE: This is where you receive your mail, have keys, pay rent, and keep most or all of your belongings. |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
|
[MOTHER/FATHER] 4 |
[MOTHER/FATHER] 5 |
[MOTHER/FATHER] 6 |
D1. Is there anyone we missed? PROGRAMMER NOTE: FILL [MOTHER FIRST AND LAST NAME/FATHER FIRST AND LAST NAME] FROM C12 AND C13 AS ADDITIONAL SCREEN FOR DUPLICATE NAMES. |
YES 1 GO TO C2, CHILD 10 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2 |
YES 1 GO TO C2, CHILD 11 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2 |
YES 1 GO TO C2, CHILD 12 NO 0 GO TO D2 DON’T KNOW d GO TO D2 REFUSED r GO TO D2 |
BSF
tailored for CSPED ASK IF B5≠5 D2. Let’s talk about [MOTHER FIRST NAME/FATHER FIRST NAME]. Are you and [MOTHER FIRST NAME/FATHER FIRST NAME] now married, divorced, separated, or have you never been married to each other? |
DELETE MARRIED OPTION ONLY IF D2, [MOTHER/FATHER] 1, 2 OR 3 = 1 OR 3 MARRIED 1 GO TO D4 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, [MOTHER/FATHER] 5 IF C11= HAS FOUR MOTHER/FATHER NAMES WRITTEN OR GO TO D19 IF C11=NO MOTHER/FATHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
DELETE MARRIED OPTION ONLY IF D2, [MOTHER/FATHER] 1, 2, 3 OR 4 = 1 OR 3 MARRIED 1 GO TO D4 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, [MOTHER/FATHER] 6 IF C11= HAS FIVE MOTHER/FATHER NAMES WRITTEN OR GO TO D19 IF C11=NO MOTHER/FATHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
DELETE MARRIED OPTION ONLY IF D2, [MOTHER/FATHER] 1, 2, 3, 4, OR 5 = 1 OR 3 MARRIED 1 GO TO D4 DIVORCED 2 SEPARATED 3 ANNULLED 4 NEVER MARRIED 5 DECEASED 6 GO TO D2, [MOTHER/FATHER] 7 IF C11= HAS SIX MOTHER/FATHER NAMES WRITTEN OR GO TO D19 IF C11=NO MOTHER/FATHER NAME WRITTEN INTERVIEWER: IF D2=6, THEN SAY: I’m very sorry to hear that. Our condolences for your loss. DON’T KNOW d REFUSED r |
I
BSF
tailored for CSPED D3. Currently, are you and [MOTHER FIRST NAME/FATHER FIRST NAME] romantically involved on a steady basis, involved in an on- again, off-again romantic relationship, or not in a romantic relationship? |
ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 GO TO D5 DON’T KNOW d REFUSED r |
ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 GO TO D5 DON’T KNOW d REFUSED r |
ROMANTICALLY INVOLVED ON STEADY BASIS 1 INVOLVED ON-AND-OFF AGAIN 2 NOT IN ROMANTIC RELATIONSHIP 3 GO TO D5 DON’T KNOW d REFUSED r |
BSF
tailored for CSPED ASK IF D3≠3 D4.Do you live with [MOTHER FIRST NAME/FATHER FIRST NAME] all of the time? By this I mean you do not have another place that you consider your home. PROBE: This is where you receive your mail, have keys, pay rent, and keep most or all of your belongings. |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
|
[MOTHER/FATHER] 1 |
[MOTHER/FATHER] 2 |
[MOTHER/FATHER] 3 |
D
PACT
tailored for CSPED |
| | | NIGHTS DON’T KNOW d REFUSED r |
| | | NIGHTS DON’T KNOW d REFUSED r |
| | | NIGHTS DON’T KNOW d REFUSED r |
WFNJ
tailored for CSPED ASK IF D4≠1 D6.Does [MOTHER FIRST NAME/FATHER FIRST NAME] live with a romantic partner other than you? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
FFCWS D7.In general, would you say your relationship with [MOTHER FIRST NAME/FATHER FIRST NAME] is excellent, very good, good, fair, or poor? |
EXCELLENT 1 VERY GOOD 2 GOOD 3 FAIR 4 POOR 5 DON’T KNOW d REFUSED r |
EXCELLENT 1 VERY GOOD 2 GOOD 3 FAIR 4 POOR 5 DON’T KNOW d REFUSED r |
EXCELLENT 1 VERY GOOD 2 GOOD 3 FAIR 4 POOR 5 DON’T KNOW d REFUSED r |
N
PAM D8. For the following statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree. [MOTHER FIRST NAME/FATHER FIRST NAME] and I are a good parenting team. |
STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r |
STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r |
STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r |
|
[MOTHER/FATHER] 4 |
[MOTHER/FATHER] 5 |
[MOTHER/FATHER] 6 |
D
PACT
tailored for CSPED |
| | | NIGHTS DON’T KNOW d REFUSED r |
| | | NIGHTS DON’T KNOW d REFUSED r |
| | | NIGHTS DON’T KNOW d REFUSED r |
WFNJ
tailored for CSPED ASK IF D4≠1 D6.Does [MOTHER FIRST NAME/FATHER FIRST NAME] live with a romantic partner other than you? |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
YES 1 NO 0 DON’T KNOW d REFUSED r |
FFCWS D7.In general, would you say your relationship with [MOTHER FIRST NAME/FATHER FIRST NAME] is excellent, very good, good, fair, or poor? |
EXCELLENT 1 VERY GOOD 2 GOOD 3 FAIR 4 POOR 5 DON’T KNOW d REFUSED r |
EXCELLENT 1 VERY GOOD 2 GOOD 3 FAIR 4 POOR 5 DON’T KNOW d REFUSED r |
EXCELLENT 1 VERY GOOD 2 GOOD 3 FAIR 4 POOR 5 DON’T KNOW d REFUSED r |
N
PAM D8. For the following statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree. [MOTHER FIRST NAME/FATHER FIRST NAME] and I are a good parenting team. |
STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r |
STRONGLY AGREE 1 AGREE 2 NOT SURE 3 DISAGREE 4 STRONGLY DISAGREE 5 DON’T KNOW d REFUSED r |
NOT AT ALL 1 A LITTLE 2 SOMEWHAT 3 VERY 4 EXTREMELY 5 DON’T KNOW d REFUSED r |
|
[MOTHER/FATHER] 1 |
[MOTHER/FATHER] 2 |
[MOTHER/FATHER] 3 |
BSF
tailored for CSPED Now, I’m going to ask you some questions about the financial support you may provide to your (child/children). D9.Do you have a legal arrangement or child support order that requires you to provide financial support for any children you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? |
SKIP D9-18 IF D2, [MOTHER/FATHER] 1=1 YES 1 NO 0 GO TO D13 DON’T KNOW d GO TO D13 REFUSED r GO TO D13 |
SKIP D9-18 IF D2, [MOTHER/FATHER] 2=1 YES 1 NO 0 GO TO D13 DON’T KNOW d GO TO D13 REFUSED r GO TO D13 |
SKIP D9-18 IF D2, [MOTHER/FATHER] 3=1 YES 1 NO 0 GO TO D13 DON’T KNOW d GO TO D13 REFUSED r GO TO D13 |
D
BSF
tailored for CSPED
SOFT CHECK: IF D10 AMOUNT GTE 2000, “I have recorded that you are required to pay [D16 AMOUNT] for that order each month. Is that correct?” |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
A
BSF
tailored for CSPED D11. I just need to know about how much it is each month. Can you tell me if it was: |
$500 or less per month……………1 $501- $1000 per month………….2 $1001-$1499 per month………….3 $1500-$2000 per momth…….….4 Or more than $2000 per month?.5
DON’T KNOW d REFUSED r
|
$500 or less per month……………1 $501- $1000 per month………….2 $1001-$1499 per month………….3 $1500-$2000 per momth…….….4 Or more than $2000 per month?.5
DON’T KNOW d REFUSED r
|
$500 or less per month……………1 $501- $1000 per month………….2 $1001-$1499 per month………….3 $1500-$2000 per momth…….….4 Or more than $2000 per month?.5
DON’T KNOW d REFUSED r
|
A
BSF
tailored for CSPED D12. In the past month, how much did you pay for the order you have for your child[ren] with [MOTHER FIRST NAME /FATHER FIRST NAME]?
SOFT CHECK: IF D12 AMOUNT GTE 2000, “I have recorded that you spent [D16 AMOUNT] for the order you have for your child[ren] with [MOTHER FIRST NAME/FATHER FIRST NAME]. Is that correct?” |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
IF
D13 = 0, D, R:
Go
to D2, MOTHER 2 if C11
=
one mother name
Or Go
to D19 if C11 = no mother name
If
D13 = 0, d, r:
Go
to D2, Mother 3 if C11 = two mother names
Or Go
to D19 if C11 = one mother name
If
D13 = 0, d, r:
Go
to D2, Mother 4 if C11 = three mother names
Or Go
to D19 if C11 = two mother names
FFCWS
tailored for CSPED D13. The next questions are about money or items you may have provided for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME], not including any money you paid as formal child support. First I will ask you about money you may have provided. Later I will ask you about items that you might have bought. In the past 30 days, not including any money that you paid as formal child support, have you given any money to pay for things like food, diapers, clothing, or school supplies for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? INTERVIEWER: IF NEEDED, SAY: This includes money or items you gave to someone else to provide for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME], or money you gave to directly to the children you have with [MOTHER FIRST NAME/FATHER FIRST NAME]. |
YES 1 NO 0 GO TO D15 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D15 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D15 DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED ASK IF D13≠ 0 D14. In the past 30 days, how much money did you give to pay for things like food, diapers, clothing, or school supplies, for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME] ? SOFT CHECK: IF D14 AMOUNT GTE 2000, “I have recorded that you spent [D16 AMOUNT] on things like food, diapers, clothing, or school supplies for the children you have with [MOTHER FIRST NAME/FATHER FIRST NAME]. Is that correct?” |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED D15. The next question is about items you bought for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]. Not including any money you may have paid as formal child support, did you buy any items such as food, diapers, clothing, or school supplies, for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? |
YES 1 NO 0 GO TO D17 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D17 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D17 DON’T KNOW d REFUSED r |
Go
to D2, Mother 6 if C9a
= five mother names
Or Go
to D15 if C9a
= four mother names
Go
to D2, Mother 7 if C9a
= six mother names
Or Go
to D15 if C9a
= five mother names
FFCWS
tailored for CSPED ASK IF D15≠ 0 D16. In the past 30 days, how much money did you spend on items that you bought for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? SOFT CHECK: IF D16 AMOUNT GTE 2000, “I have recorded that you spent [D16 AMOUNT] on items that you bought for the children you have with [MOTHER FIRST NAME/FATHER FIRST NAME]. Is that correct?” |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
D
EHS
tailored for CSPED |
YES 1 GO TO D19 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO D19 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO D19 NO 0 DON’T KNOW d REFUSED r r |
A
EHS
tailored for CSPED D18. What were the main reasons you didn’t spend as much time as you wanted to with [that child/those children]?
(INTERVIEWER: PROBE WITH “ANY OTHER REASONS?” UNTIL THE RESPONDENT INDICATES NO OTHER REASONS) |
RESPONDENT TOO BUSY WITH WORK/SCHOOL/ETC 1 KIDS LIVE TOO FAR AWAY 2 RESPONDENT HAS NO ACCESS TO TRANSPORTATION/NO WAY TO GET THERE/CAN’T AFFORD TO TRAVEL THERE 3 [MOTHER/FATHER] PREVENTS IT/MAKES IT HARD TO SEE KIDS………………………………..……...4 [MOTHER/FATHER]’S FRIENDS OR FAMILY PREVENT IT/MAKE IT HARD TO SEE KIDS…………………………………….....5 KIDS DON’T WANT TO SEE RESPONDENT …………………..…6 PROBLEMS WITH WHERE RESPONDENT LIVES/WOULDN’T WANT KIDS TO COME THERE 7 EMBARASSED TO SEE KIDS BECAUSE NO JOB/NO MONEY 8 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r |
RESPONDENT TOO BUSY WITH WORK/SCHOOL/ETC 1 KIDS LIVE TOO FAR AWAY 2 RESPONDENT HAS NO ACCESS TO TRANSPORTATION/NO WAY TO GET THERE/CAN’T AFFORD TO TRAVEL THERE 3 [MOTHER/FATHER] PREVENTS IT/MAKES IT HARD TO SEE KIDS………………………………..……...4 [MOTHER/FATHER]’S FRIENDS OR FAMILY PREVENT IT/MAKE IT HARD TO SEE KIDS…………………………………….....5 KIDS DON’T WANT TO SEE RESPONDENT …………………..…6 PROBLEMS WITH WHERE RESPONDENT LIVES/WOULDN’T WANT KIDS TO COME THERE 7 EMBARASSED TO SEE KIDS BECAUSE NO JOB/NO MONEY 8 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r |
RESPONDENT TOO BUSY WITH WORK/SCHOOL/ETC 1 KIDS LIVE TOO FAR AWAY 2 RESPONDENT HAS NO ACCESS TO TRANSPORTATION/NO WAY TO GET THERE/CAN’T AFFORD TO TRAVEL THERE 3 [MOTHER/FATHER] PREVENTS IT/MAKES IT HARD TO SEE KIDS………………………………..……...4 [MOTHER/FATHER]’S FRIENDS OR FAMILY PREVENT IT/MAKE IT HARD TO SEE KIDS…………………………………….....5 KIDS DON’T WANT TO SEE RESPONDENT …………………..…6 PROBLEMS WITH WHERE RESPONDENT LIVES/WOULDN’T WANT KIDS TO COME THERE 7 EMBARASSED TO SEE KIDS BECAUSE NO JOB/NO MONEY 8 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r |
|
[MOTHER/FATHER] 4 |
[MOTHER/FATHER] 5 |
[MOTHER/FATHER] 6 |
BSF
tailored for CSPED Now, I’m going to ask you some questions about the financial support you may provide to your (child/children). D9.Do you have a legal arrangement or child support order that requires you to provide financial support for any children you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? |
SKIP D9-18 IF D2, MOTHER 4=1 YES 1 NO 0 GO TO D13 DON’T KNOW d GO TO D13 REFUSED r GO TO D13 |
SKIP D9-18 IF D2, MOTHER 5=1 YES 1 NO 0 GO TO D13 DON’T KNOW d GO TO D13 REFUSED r GO TO D13 |
SKIP D9-18 IF D2, MOTHER 6=1 YES 1 NO 0 GO TO D13 DON’T KNOW d GO TO D13 REFUSED r GO TO D13 |
D
BSF
tailored for CSPED |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r
PER WEEK…………………………1 PER MONTH……………………….2 PER YEAR……………………….3
|
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r
PER WEEK…………………………1 PER MONTH……………………….2 PER YEAR……………………….3
|
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r
PER WEEK…………………………1 PER MONTH……………………….2 PER YEAR……………………….3
|
I
BSF
tailored for CSPED D11. I just need to know about how much it is each month. Can you tell me if it is: |
$500 or less per month……………1 $501- $1000 per month………….2 $1001-$1499 per month………….3 $1500-$2000 per momth…….….4 Or more than $2000 per month?.5
DON’T KNOW d REFUSED r
|
$500 or less per month……………1 $501- $1000 per month………….2 $1001-$1499 per month………….3 $1500-$2000 per momth…….….4 Or more than $2000 per month?.5
DON’T KNOW d REFUSED r
|
$500 or less per month……………1 $501- $1000 per month………….2 $1001-$1499 per month………….3 $1500-$2000 per momth…….….4 Or more than $2000 per month?.5
DON’T KNOW d REFUSED r
|
A
BSF
tailored for CSPED D12. In the past month, how much did you pay for the order you have for your child[ren] with [MOTHER FIRST NAME /FATHER FIRST NAME]? |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
If
D13 = 0, d, r:
Go
to D2, [Mother/FATHER] 5 if C11 = four [mother/FATHER] names
Or Go
to D19 if C11 = three [mother/FATHER] names.
If
D13 = 0, d, r:
Go
to D2, [Mother/FATHER] 5 if C11 = four [mother/FATHER] names
Or
Go
to D19 if C11 = three [mother/FATHER] names.
If
D13 = 0, d, r:
Go
to D2, [Mother/FATHER] 5 if C11 = four [mother/FATHER] names
Or
Go
to D19 if C11 = three [mother/FATHER] names.
FFCWS
tailored for CSPED D13. The next questions are about money or items you may have provided for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME], not including any money you paid as formal child support. First I will ask you about money you may have provided. Later I will ask you about items that you might have bought. In the past 30 days, not including any money that you paid as formal child support, have you given any money to pay for things like food, diapers, clothing, or school supplies for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? INTERVIEWER: IF NEEDED, SAY: This includes money or items you gave to someone else to provide for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME], or money you gave to directly to the children you have with [MOTHER FIRST NAME/FATHER FIRST NAME]. |
YES 1 NO 0 GO TO D15 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D15 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D15 DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED ASK IF D13≠ 0 D14. In the past 30 days, how much money did you give to pay for things like food, diapers, clothing, or school supplies, for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME] ? |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
FFCWS
tailored for CSPED D15.The next question is about items you bought for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]. Not including any money you may have paid as formal child support,did you buy any items such as food, diapers, clothing, or school supplies ,for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? |
YES 1 NO 0 GO TO D17 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D17 DON’T KNOW d REFUSED r |
YES 1 NO 0 GO TO D17 DON’T KNOW d REFUSED r |
Go
to D2, Mother 6 if C9a
= five mother names
Or Go
to D15 if C9a
= four mother names
Go
to D2, Mother 7 if C9a
= six mother names
Or Go
to D15 if C9a
= five mother names
Go
to D2, Mother 5 if C11 = four mother names
Or Go
to D19 if C11 = THREE MOTHER names
Go
to D2, Mother 6 if C11 = five mother names
Or Go
to D19 if C11 = four mother names
Go
to D2, Mother 7 if C11 = six mother names
Or Go
to D19 if C11 = five mother names
FFCWS
tailored for CSPED ASK IF D15≠ 0 D16. In the past 30 days, how much money did you spend on items that you bought for the child[ren] you have with [MOTHER FIRST NAME/FATHER FIRST NAME]? |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
$| | |,| | | | AMOUNT DON’T KNOW d REFUSED r |
D
EHS
tailored for CSPED |
YES 1 GO TO D19 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO D19 NO 0 DON’T KNOW d REFUSED r |
YES 1 GO TO D19 NO 0 DON’T KNOW d REFUSED r |
A
EHS
tailored for CSPED D18. What were the main reasons you didn’t spend as much time as you wanted to with [that child/those children]?
(INTERVIEWER: PROBE WITH “ANY OTHER REASONS?” UNTIL THE RESPONDENT INDICATES NO OTHER REASONS) |
RESPONDENT TOO BUSY WITH WORK/SCHOOL/ETC 1 KIDS LIVE TOO FAR AWAY 2 RESPONDENT HAS NO ACCESS TO TRANSPORTATION/NO WAY TO GET THERE/CAN’T AFFORD TO TRAVEL THERE 3 [MOTHER/FATHER] PREVENTS IT/MAKES IT HARD TO SEE KIDS………………………………..……...4 [MOTHER/FATHER]’S FRIENDS OR FAMILY PREVENT IT/MAKE IT HARD TO SEE KIDS…………………………………….....5 KIDS DON’T WANT TO SEE RESPONDENT …………………..…6 PROBLEMS WITH WHERE RESPONDENT LIVES/WOULDN’T WANT KIDS TO COME THERE 7 EMBARASSED TO SEE KIDS BECAUSE NO JOB/NO MONEY 8 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r |
RESPONDENT TOO BUSY WITH WORK/SCHOOL/ETC 1 KIDS LIVE TOO FAR AWAY 2 RESPONDENT HAS NO ACCESS TO TRANSPORTATION/NO WAY TO GET THERE/CAN’T AFFORD TO TRAVEL THERE 3 [MOTHER/FATHER] PREVENTS IT/MAKES IT HARD TO SEE KIDS………………………………..……...4 [MOTHER/FATHER]’S FRIENDS OR FAMILY PREVENT IT/MAKE IT HARD TO SEE KIDS…………………………………….....5 KIDS DON’T WANT TO SEE RESPONDENT …………………..…6 PROBLEMS WITH WHERE RESPONDENT LIVES/WOULDN’T WANT KIDS TO COME THERE 7 EMBARASSED TO SEE KIDS BECAUSE NO JOB/NO MONEY 8 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r |
RESPONDENT TOO BUSY WITH WORK/SCHOOL/ETC 1 KIDS LIVE TOO FAR AWAY 2 RESPONDENT HAS NO ACCESS TO TRANSPORTATION/NO WAY TO GET THERE/CAN’T AFFORD TO TRAVEL THERE 3 [MOTHER/FATHER] PREVENTS IT/MAKES IT HARD TO SEE KIDS………………………………..……...4 [MOTHER/FATHER]’S FRIENDS OR FAMILY PREVENT IT/MAKE IT HARD TO SEE KIDS…………………………………….....5 KIDS DON’T WANT TO SEE RESPONDENT …………………..…6 PROBLEMS WITH WHERE RESPONDENT LIVES/WOULDN’T WANT KIDS TO COME THERE 7 EMBARASSED TO SEE KIDS BECAUSE NO JOB/NO MONEY 8 OTHER (SPECIFY) 99 DON’T KNOW d REFUSED r |
IF B5=1 AND OR D4=1, SKIP TO E1
Now, I’m going to ask about [women/men] you may have romantic relationships with who are not the [mothers/fathers] of your children.
IF D2=1 OR D3=1 OR 2, THEN FILL [with someone other than MOTHER/FATHER’S NAME/MOTHERS/FATHERS’ NAMES].
D
PACT
tailored for CSPED
YES 1
NO 0 GO TO E1
DON’T KNOW d GO TO E1
REFUSED r GO TO E1
Some people may have a romantic relationship with more than one partner. If you have a relationship with more than one partner that we haven’t already talked about, please think about the romantic relationship that you consider to be the most serious.
PROBE: If you would rather not share the name, you can just tell me this person’s initials
D
WFNJ
tailored for CSPED
FIRST NAME
DON’T KNOW d
REFUSED r
IF D2, [MOTHER/FATHER 1], [MOTHER 2/FATHER], [MOTHER 3/FATHER], [MOTHER/FATHER 4], [MOTHER/FATHER 5], OR [MOTHER/FATHER 6] ≠ 1 OR 3 FILL MARRIED.
D
BSF
tailored for CSPED
MARRIED 1 GO TO D23
DIVORCED 2
SEPARATED 3
ANNULLED 4
NEVER MARRIED 5
DON’T KNOW d
REFUSED r
D
BSF
tailored for CSPED
PROBE: This is where you receive your mail, have keys, pay rent, or keep all or most of your belongings.
YES 1 GO TO D24
NO 0
DON’T KNOW d
REFUSED r
ASK D23 IF D22≠1
D
CSPED-
developed
| | | NIGHTS
DON’T KNOW d
REFUSED r
ASK D24 IF D21=1, D22= 1, OR D23= ≤15
D24. Does [D20 NAME] have any children under the age of 18?
Y
PACT
tailored for CSPED
NO 0 GO TO E1
DON’T KNOW d GO TO E1
REFUSED r GO TO E1
D
PACT
tailored for CSPED
| | | CHILDREN
DON’T KNOW d
REFUSED r
The next questions are about work you have done for pay.
E
WFNJ
tailored for CSPED
YES 1 GO TO E3
NO 0
DON’T KNOW d
REFUSED r
E
WFNJ
tailored for CSPED
|___|___| / |___|___|___|___| GO TO E10
MONTH YEAR
NEVER WORKED FOR PAY 0 SKIP TO E10
DON’T KNOW d GO TO E10
REFUSED r GO TO E10
E
WFNJ
tailored for CSPED
$ | | | | , | | | | AMOUNT GO TO E9
DON’T KNOW d
REFUSED r
SOFT CHECK: IF e3 amount gt 5000; I have recorded that before taxes and other deductions, your tips, bonuses, commissions, regular pay, and overtime pay from all of the jobs you worked in the past 30 days was [E3 AMOUNT]. Is that correct?
E
WFNJ
tailored for CSPED
$0 - $500, 1 GO TO E9
$501 - $1,000, 2 GO TO E9
$1,001 to $2,000, 3 GO TO E9
$2,001 to $3,000, 4 GO TO E9
$3,001 to $4,000, 5 GO TO E9
$4,001 to $5,000, or 6 GO TO E9
more than $5,000? 7 GO TO E9
DON’T KNOW d
REFUSED r
E
WFNJ
tailored for CSPED
| | | WEEKS
DON’T KNOW d GO TO E9
REFUSED r GO TO E9
E
RWTW
tailored for CSPED
| | | HOURS PER WEEK
99 OR MORE HOURS PER WEEK 99
DON’T KNOW d GO TO E9
REFUSED r GO TO E9
E
RWTW
tailored for CSPED
$ | | | | . | | | PER HOUR
DON’T KNOW d GO TO E9
REFUSED r GO TO E9
SOFT CHECK: IF e7 amount gt 99; I have recorded that your current hourly rate of pay is [E7 AMOUNT]. Is that correct?
E
RWTW
tailored for CSPED
YES 1
NO 0
DON’T KNOW d
REFUSED r
NOTE: IF E8=NO, DON’T KNOW, OR REFUSED TWICE, GO TO E9.
E
RWTW
tailored for CSPED
|___|___|
DAYS 1
WEEKS 2
MONTHS 3
YEARS 4
DON’T KNOW d
REFUSED r
E
FFCWS,
BSF tailored for CSPED
|
|
|
|
|
|
|
|
|
NOT AT ALL |
A LITTLE |
SOMEWHAT |
VERY |
EXTREMELY |
DK |
REF |
a. Problems getting to work, such as not having a car or access to public transportation |
0 |
1 |
2 |
3 |
4 |
d |
r |
b. Not having the kinds of skills employers are looking for |
0 |
1 |
2 |
3 |
4 |
d |
r |
c. Having to take care of a family member (Has this made finding and keeping a job extremely hard, very hard, somewhat hard, a little bit hard, or not hard at all?) (Has this made finding and keeping a job extremely hard, very hard, somewhat hard, a little bit hard, or not hard at all?) |
0 |
4 |
d |
r |
r |
r |
r |
d. Not having a steady place to live |
0 |
1 |
2 |
3 |
4 |
d |
r |
e. AProblems with alcohol or drug use3s |
0 |
1 |
2 |
3 |
4 |
d |
r |
f. Trouble getting along with other people or controlling your anger (Has this made finding and keeping a job extremely hard, very hard, somewhat hard, a little bit hard, or has this not made it hard at all?) (Has this made finding and keeping a job extremely hard, very hard, somewhat hard, a little bit hard, or has this not made it hard at all?) |
0 |
1 |
2 |
3 |
4 |
d |
r |
g. Your physical health |
0 |
1 |
2 |
3 |
4 |
d |
r |
h. Having a criminal record |
0 |
1 |
2 |
3 |
4 |
d |
r |
E
ACS
tailored for CSPED
YES 1
NO 0
DON’T KNOW d
REFUSED r
E
ACS
tailored for CSPED
|
|
|||
|
YES |
NO |
DK |
REF |
a. ASK IF E1=1 A health insurance plan provided through your current employer or union? |
1 |
0 |
d |
r |
b. ASK IF E1=1 AND E12_a= 1 Are any of your children currently covered by this health insurance plan? |
1 |
0 |
d |
r |
c. ASK IF B5=1 Are you currently covered by a health insurance plan provided through your spouse’s current employer or union? |
1 |
0 |
d |
r |
d. Insurance you or someone else purchased directly from an insurance company? |
1 |
0 |
d |
r |
e. ASK IF E12_a=0 [FILL STATE MEDICAID NAME], Medicaid, Medical Assistance, or any kind of government health insurance plan for those with low incomes or a disability? |
1 |
0 |
d |
r |
f. Any other type of health insurance or health coverage plan? (SPECIFY) |
1 |
0 |
d |
r |
The next questions are about where you live.
E
WFNJ
OWN OR HAVE MORTGAGE 1
RENT 2
PAY SOME OF THE RENT 3
LIVE RENT FREE (SOMEONE ELSE RENTS/OWNS HOUSE) 4
LIVE IN SHELTER 5
LIVE ON STREETS 6
LIVE IN ABANDONED BUILDING/CAR 7
OTHER (SPECIFY) 99
DON’T KNOW d
REFUSED r
E
CSPED-developed
YES 1
NO 0 GO TO E16
DON’T KNOW d GO TO E16
REFUSED r GO TO E16
E
CSPED-developed
MOTHER 1
FATHER 2
STEP-MOTHER 3
STEP-FATHER 4
GRANDMOTHER 5
GRANDFATHER 6
OTHER (SPECIFY) 99
DON’T KNOW d
REFUSED r
ASK E16 IF D4≠1 OR D22≠1
E
HII
tailored for CSPED
PROBE: This is where you receive your mail, have keys, pay rent, or keep all or most of your belongings.
YES 1
NO 0
DON’T KNOW d
REFUSED r
E
HII
YES 1
NO 0
DON’T KNOW d
REFUSED r
IF R= MALE, FILL FATHER. IF R=FEMALE, FILL MOTHER.
The next questions are about your relationship with your biological parents.
F
FFCWS
Yes 1
No 0
DON’T KNOW d
REFUSED r
F
PACT
very involved, 1
somewhat involved, or 2
not at all involved? 3 GO TO F4
DON’T KNOW d GO TO F4
REFUSED r GO TO F4
F
PACT
excellent, 1
very good, 2
good, 3
fair or, 4
poor? 5
we did not have a relationship 6
DON’T KNOW d
REFUSED r
The next questions are about how you are doing.
F
PHQ-8
|
SELECT ONE RESPONSE PER ROW |
|||||
|
NOT AT ALL |
SEVERAL DAYS |
MORE THAN HALF THE DAYS |
NEARLY EVERY DAY |
DK |
REF |
a. Little interest or pleasure in doing things |
0 |
1 |
2 |
3 |
d |
r |
b. Feeling down, depressed, or hopeless |
0 |
1 |
2 |
3 |
d |
r |
c. Trouble falling or staying asleep, or sleeping too much |
0 |
1 |
2 |
3 |
d |
r |
d. Feeling tired or having little energy |
0 |
1 |
2 |
3 |
d |
r |
e. Poor appetite or overeating |
0 |
1 |
2 |
3 |
d |
r |
f. Feeling bad about yourself — or that you are a failure or have let yourself or your family down |
0 |
1 |
2 |
3 |
d |
r |
g. Trouble concentrating on things, such as reading the newspaper or watching television |
0 |
1 |
2 |
3 |
d |
r |
h. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual |
0 |
1 |
2 |
3 |
d |
r |
F
PSI
|
STRONGLY AGREE |
SOMEWHAT AGREE |
SOMEWHAT DISAGREE |
STRONGLY DISAGREE |
DK |
REF |
a. Being a parent is harder than I thought it would be. |
1 |
2 |
3 |
4 |
d |
r |
b. I feel trapped by my responsibilities as a parent. |
1 |
2 |
3 |
4 |
d |
r |
c. I find that taking care of my children is much more work than pleasure. |
1 |
2 |
3 |
4 |
d |
r |
F
PSI
An excellent parent, 1
A very good parent, 2
A good parent, or 3
Not a very good parent? 4
DON’T KNOW d
REFUSED r
F6. For each of the following questions, please tell me if you feel this way never, rarely, sometimes, very often, or extremely often. How often do you:
|
|
SELECT ONE RESPONSE PER ROW |
||||||
FFCWS
tailored for CSPED |
NEVER |
RARELY |
SOMETIMES |
VERY OFTEN |
EXTREMELY OFTEN |
DK |
REF |
|
FFCWS
tailored for CSPED a. Feel in control over the things that happen to you? |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
FFCWS
tailored for CSPED b. Feel that you can change many of the important things in your life? |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
FFCWS
tailored for CSPED c. Feel helpless in dealing with problems? |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
d. Feel that you are being pushed around? |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
PACT
e. Find it hard to make plans for the future? |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
I would like to ask you a few questions about your experience with the criminal justice system.
F
SVORI
YES 1
NO 0 GO TO G1
DON’T KNOW d
REFUSED r
F
SVORI
tailored for CSPED
INTERVIEWER: IF LESS THAN 1 WEEK, ENTER 1 WEEK.
INTERVIEWER: FIRST ENTER IF RESPONSE IS WEEKS, MONTHS AND/OR YEARS. YOU WILL ENTER THE NUMBER OF YEARS AND/OR MONTH ON NEXT TWO SCREENS.
| | | |
WEEKS 1
MONTHS 2
YEARS 3
NEVER INCARCERATED 0 GO TO F11
DON’T KNOW d
REFUSED r
F
SVORI
tailored for CSPED
INTERVIEWER: IF LESS THAN 1 WEEK, ENTER 1 WEEK.
INTERVIEWER: FIRST ENTER IF RESPONSE IS WEEKS, MONTHS AND/OR YEARS. YOU WILL ENTER THE NUMBER OF YEARS AND/OR MONTH ON NEXT TWO SCREENS.
| | | | MONTH
| | | | YEAR GO TO F110
DON’T KNOW d GO TO F101
REFUSED r GOTO F101
F
SVORI
tailored for CSPED
Less than one month ago 1
One to six months ago 2
Seven months to 1 year ago 3
1 year to less than 5 years ago, or 4
More than 5 years ago? 5
DON’T KNOW d
REFUSED r
F
SVORI
tailored for CSPED
YES 1
NO 0
DON’T KNOW d
REFUSED r
N
PACT
tailored for CSPED
G1. People apply for programs like [FILL PROGRAM] for different reasons. I’m going to read you a list of reasons people sometimes give for applying for [FILL PROGRAM]. Please tell me whether each reason was not at all important, a little important, somewhat important, very important, or extremely important in your decision to apply.
|
|
CODE ONE PER ROW |
||||||
|
NOT AT ALL |
A LITTLE |
SOMEWHAT |
VERY |
EXTEREMELY |
DK |
REF |
|
a. Your relationship with your child(ren) |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
b. Your job situation |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
c. Your relationship with your child(ren)’s [mother/father] |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
d. Your child support debt |
1 |
2 |
3 |
4 |
5 |
d |
r |
|
G
PACT
tailored for CSPED
Not at all important, 0
A little important, 1
Somewhat important, 2
Very important, or 2
Extremely important to you? 3
DON’T KNOW d
REFUSED r
To thank you for your time, we would like to send you a $10 gift card.
H1. What is your address?
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H2. Do you want us to send the your $10 gift card to that the address you gave me at the beginning of the interview?
DISPLAY ADDRESS FROM A4.
INTERVIEWER: VERIFY ADDRESS IF NEEDED.
YES 1 GO TO H3
NO 0
DON’T KNOW d
REFUSED r
H2a. What address would you like us to mail your $10 gift card to?
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H3. What is your email address?
DON’T HAVE ONE 0
DON’T KNOW d
REFUSED r
We have a couple of questions that will help us contact you in about a year. Do you have any of the following social networking accounts?
H
Youthbuild
YES 1
NO 0 GO TO H5
DON’T KNOW d GO TO H5
REFUSED r GO TO H5
H5. Do you have a Facebook account?
YES 1
NO 0 GO TO H6
DON’T KNOW d GO TO H6
REFUSED r GO TO H6
H5a. What name do you use on Facebook?
DON’T KNOW d
REFUSED r
H6. Do you have a MySpace account?
YES 1
NO 0 GO TO H7
DON’T KNOW d GO TO H7
REFUSED r GO TO H7
H6a. What name do you use on MySpace?
DON’T KNOW d
REFUSED r
H7. Do you have a Twitter account?
YES 1
NO 0 GO TO H8
DON’T KNOW d GO TO H8
REFUSED r GO TO H8
H7a. What name do you use on Twitter?
DON’T KNOW d
REFUSED r
H8. Do you have a social networking account other than Facebook, MySpace, or Twitter?
YES 1
NO 0 GO TO H9a
DON’T KNOW d GO TO H9a
REFUSED r GO TO H9a
H8a. What social networking provider do you use?
DON’T KNOW d
REFUSED r
We would like to contact you in about a year to see how you are doing. In case we have trouble reaching you, we would like to have the names of three people who would most likely know where you are or who you keep in close contact with, such as a grandmother or grandfather, other relative, or friend. We will not contact these people for any other reason.
H9a. What is the full name of the first person we should contact?
FIRST NAME
MIDDLE INITIAL/NAME
LAST NAME
DON’T KNOW d
REFUSED r
H9b. What is (his/her) address?
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H9c. What is (his/her) relationship to you?
WIFE/GIRLFRIEND/FIANCÉE 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
FRIEND 6
OTHER (SPECIFY) 99
DON’T KNOW d
REFUSED r
H9d. What is (his/her) home telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO LANDLINE, ONLY CELL PHONE 0
DON’T KNOW d
REFUSED r
H9e. Does (he/she) have a cell phone?
YES 1
NO 0 GO TO H9g
DON’T KNOW d GO TO H9g
REFUSED r GO TO H9g
H9f. Can I have that number?
| | | | - | | | | -| | | | | TELEPHONE
DON’T KNOW d
REFUSED r
H9g. What is (his/her) work telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
H9h. What is (his/her) email address?
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H9j
DON’T KNOW d GO TO H9j
REFUSED r GO TO H9j
H9i. Does (he/she) have another email address?
EMAIL ADDRESS
DON’T KNOW d
REFUSED r
H9j. Which of the following is the primary social network used by this person?
Facebook, 1
Twitter, 2
MySpace, 3
personal blog, or 4
other (SPECIFY) 99
NONE 0 GO TO H10a
DON’T KNOW d GO TO H10a
REFUSED r GO TO H10a
H9k. What name does this person use in that social network?
NAME
DON’T KNOW d
REFUSED r
SECOND CONTACT
H10a. What is the full name of the second person we should contact?
FIRST NAME
MIDDLE INITIAL/NAME
LAST NAME
DON’T KNOW d
REFUSED r
H10b. What is (his/her) address?
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H10c. What is (his/her) relationship to you?
WIFE/GIRLFRIEND/FIANCÉE 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
FRIEND 6
OTHER (SPECIFY) 99
DON’T KNOW d
REFUSED r
H10d. What is (his/her) home telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO LANDLINE, ONLY CELL PHONE 0
DON’T KNOW d
REFUSED r
H10e. Does (he/she) have a cell phone?
YES 1
NO 0 GO TO H10g
DON’T KNOW d GO TO H10g
REFUSED r GO TO H10g
H10f. Can I have that number?
| | | | - | | | | -| | | | | TELEPHONE
DON’T KNOW d
REFUSED r
H10g. What is (his/her) work telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
H10h. What is (his/her) email address?
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H10j
DON’T KNOW d GO TO H10j
REFUSED r GO TO H10j
H10i. Does (he/she) have another email address?
EMAIL ADDRESS
DON’T KNOW d
REFUSED r
H10j. Which of the following is the primary social network used by this person?
Facebook, 1
Twitter, 2
MySpace, 3
personal blog, or 4
other (SPECIFY) 99
NONE 0 GO TO H10
DON’T KNOW d GO TO H10
REFUSED r GO TO H10
H10k. What name does this person use in that social network?
NAME
DON’T KNOW d
REFUSED r
THIRD CONTACT
H11a. What is the full name of the third person we should contact?
FIRST NAME
MIDDLE INITIAL/NAME
LAST NAME
DON’T KNOW d
REFUSED r
H11b. What is (his/her) address?
STREET 1
STREET 2
APT. #
CITY
STATE
ZIP
DON’T KNOW d
REFUSED r
H11c. What is (his/her) relationship to you?
WIFE/GIRLFRIEND/FIANCÉE 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
FRIEND 6
OTHER (SPECIFY) 99
DON’T KNOW d
REFUSED r
H11d. What is (his/her) home telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO LANDLINE, ONLY CELL PHONE 0
DON’T KNOW d
REFUSED r
H11e. Does (he/she) have a cell phone?
YES 1
NO 0 GO TO H11g
DON’T KNOW d GO TO H11g
REFUSED r GO TO H11g
H11f. Can I have that number?
| | | | - | | | | -| | | | | TELEPHONE
DON’T KNOW d
REFUSED r
H11g. What is (his/her) work telephone number?
| | | | - | | | | -| | | | | TELEPHONE
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
H11h. What is (his/her) email address?
EMAIL ADDRESS
DOESN’T HAVE ONE 0 GO TO H11j
DON’T KNOW d GO TO H11j
REFUSED r GO TO H11j
H11i. Does (he/she) have another email address?
EMAIL ADDRESS
DON’T KNOW d
REFUSED r
H11j. Which of the following is the primary social network used by this person?
Facebook, 1
Twitter, 2
MySpace, 3
personal blog, or 4
other (SPECIFY) 99
NONE 0 GO TO END1
DON’T KNOW d GO TO END1
REFUSED r GO TO END1
H11k. What name does this person use in that social network?
NAME
DON’T KNOW d
REFUSED r
END OF CALL
END1. Those are all of the questions I have. You will receive $10 as a token of our appreciation. We will be in touch with you again in about a year to see how you are doing. As I mentioned earlier, a computer will randomly assign you to one of two study groups. Please hand the phone back to the staff person at [PROGRAM NAME], and he or she will let you know which group you have been assigned to. Thank you.
INTERVIEWER: INFORM PROGRAM STAFF THAT RESPONDENT HAS COMPLETED THE INTERVIEW AND HE OR SHE CAN CONTINUE WITH RANDOM ASSIGNMENT.
END2. Thank you very much for your time. Those are all of the questions I have. As I mentioned earlier, we will be contacting you again in about one year to update some of the information you give us today and ask some new questions. Can you please hand the phone back to the staff person at [PROGRAM NAME]?
INTERVIEWER: INFORM PROGRAM STAFF THAT RESPONDENT IS NOT ELIGIBLE TO PARTICIPATE IN THE CSPED STUDY BECAUSE SHE OR HE DOES NOT HAVE ANY BIOLOGICAL CHILDREN OR IS NOT 18 YEARS OF AGE.
Prepared
by Mathematica Policy Research
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | FATHERS BASELINE DATA COLLECTION |
| Subject | CATI |
| Author | VARIOUS |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |
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