XX-XXXX 36 Month Follow-up Survey

National FSS Evaluation – 5-6-2016

Overall question: When the respondent refuses to answer any of these questions, is there guidance for how the interviewer can explain the purpose of the question; or, ease the fear or reluctance to respond to the question?

[INTRODUCTORY SCRIPT]

SECTION A:

PARTICIPATION IN EMPLOYMENT, EDUCATION, AND SOCIAL SERVICES

CATI: ADD NECESSARY INSTRUCTIONS

A1. Job Search Assistance

In the last 12 months, that is since [CATI INSERT: INTERVIEW MONTH] [CATI INSERT: INTERVIEW YEAR -1], have you attended any workshops or received any assistance with finding a job or a better job? Assistance could include help in preparing a resume, finding job openings, calling employers, interviewing for a job, or completing a job application?

1 YES

2 NO

3 DON’T KNOW

4 REFUSED

A2. Post-Employment Assistance

In the last 12 months have you received any assistance with keeping a job, solving a problem at work, increasing your hours of employment, or getting a raise or promotion?

1 YES

2 NO

3 DON’T KNOW

4 REFUSED

ABE/GED/REGULAR HIGH SCHOOL

A4. In the last 12 months, have you ever taken part in any Adult Basic Education (ABE) classes, English as a second language (ESL), GED classes, or classes to prepare for a regular high school diploma?

IF NECESSARY, READ “Adult Basic Education (ABE) classes are for improving your basic reading and math skills. GED stands for General Educational Development, and these classes help prepare for the GED test.”

[INTERVIEWER NOTE: IF CLASSES WERE STARTED more than 12 months ago AND CONTINUED into this 12 month period , THEY ARE INCLUDED, BUT IF CLASSES WERE STARTED AND COMPLETED more than 12 months ago, THEY ARE NOT.]

1 YES

2 NO (GO TO A5)

7 DON’T KNOW (GO TO A5)

8 REFUSED (GO TO A5)

A4a. In the last 12 months, about how many weeks did you attend these classes?

___(#)

7 DON’T KNOW

8 REFUSED

COLLEGE COURSES

A5. In the last 12 months, have you ever taken any college courses for credit? These are courses that lead to a 2-year Associate’s degree or 4-year Bachelor’s degree or Graduate degree.

[INTERVIEWER NOTE: IF CLASSES WERE STARTED more than 12 months ago AND CONTINUED into this 12 month period, THEY ARE INCLUDED, BUT IF CLASSES WERE STARTED AND COMPLETED, more than 12 months ago , THEY ARE NOT.]

1 YES

2 NO (GO TO A6)

7 DON’T KNOW (GO TO A6)

8 REFUSED (GO TO A6)

A5a. What type of degree are you working towards?

INTERVIEWER: PLEASE READ LIST

            1          2-Year/Associate’s degree (GO TO A5b)

2          4-Year/Bachelor’s degree (GO TO A5b)

3          Graduate degree, or (GO TO A5b)

4          Some other type

7          DON’T KNOW (GO TO A5b)

8          REFUSED(GO TO A5b)

A5a_O. What type of degree are you working towards?

___________________________________________

97 DON’T KNOW

98 REFUSED

A5a. In the last 12 months, about how many weeks did you attend these classes?

___(#)

7 DON’T KNOW

8 REFUSED

VOCATIONAL TRAINING

A6. In the last 12 months, did you take any vocational training courses for a specific job, trade, or occupation [CATI: IF A3 = 1 (YES) INSERT “other than the college courses you just mentioned”]? Please don’t include on-the-job training or unpaid work experience.

[INTERVIEWER NOTE: IF CLASSES WERE STARTED more than 12 months ago AND CONTINUED into this 12 month period, THEY ARE INCLUDED, BUT IF CLASSES WERE STARTED AND COMPLETED, more than 12 months ago , THEY ARE NOT.]

1 YES

2 NO (GO TO A7)

7 DON’T KNOW (GO TO A7)

8 REFUSED (GO TO A7)

A6e. What kind of occupation or type of job was the vocational training for?

INTERVIEWER: DO NOT READ LIST. CODE ALL THAT APPLY.

1 HOME HEALTH AIDE

2 NURSES AIDE/ NURSES ASSISTANT (CNA)

3 NURSE (LPN, LVN, RN)

4 CHILD CARE/TEACHING

5 ADMINISTRATIVE ASSISTANT/CLERICAL

6 COMPUTER PROGRAMMER/TECH SUPPORT/NETWORK ADMIN

7 COMPUTER REPAIR/INSTALLATION

8 MEDICAL ASSISTANT/TECHNICIAN

9 MEDICAL BILLING/CLERICAL

10 SECURITY

11 COMMERCIAL DRIVER

12 OTHER SPECIFY

97 DON’T KNOW

98 REFUSED

CATI: IF A6e =12 ASK A6e_O, ELSE GO TO INSTRUCTION BEFORE A6f

A6e_O. What kind of occupation or type of job was the vocational training for?

___________________________________________

97 DON’T KNOW

98 REFUSED

A6f. In the last 12 months, about how many weeks did you attend these classes?

___(#)

7 DON’T KNOW

8 REFUSED

OTHER TRAINING

A7. CATI: IF A4=1, A45=1, A6=1,: You’ve told me that you took part in: [CATI: RECALL ACTIVITIES WHERE A4=1, A5=1, and/or A6=1]. Are there any other educational or training activities or employment programs that you took part in the last 12 months that I did not mention?

1 YES

2 NO (GO TO B1)

7 DON'T KNOW (GO TO B1)

8 REFUSED (GO TO B1)

A7a. What kind of activity was it?

INTERVIEWER: DO NOT READ LIST.

1 HOME HEALTH AIDE

2 NURSES AIDE/ NURSES ASSISTANT (CNA)

3 NURSE (LPN, LVN, RN)

4 CHILD CARE/TEACHING

5 ADMINISTRATIVE ASSISTANT/CLERICAL

6 COMPUTER PROGRAMMER/TECH SUPPORT/NETWORK ADMIN

7 COMPUTER REPAIR/INSTALLATION

8 MEDICAL ASSISTANT/TECHNICIAN

9 MEDICAL BILLING/CLERICAL

10 SECURITY

11 COMMERCIAL DRIVER

12 OTHER SPECIFY

97 DON’T KNOW

98 REFUSED

CATI: IF A7a =11 ASK A7a_O, ELSE GO TO A7b

A7a_O. What kind of activity was it?

___________________________________________

97 DON’T KNOW

98 REFUSED

A7b. In the last 12 months, about how many weeks did you attend these classes?

___(#)

7 DON’T KNOW

8 REFUSED

FINANCIAL COACHING

A8. In the last 12 months have you attended any workshops or received assistance in learning more about your personal or household finances and acquiring skills to manage them better? Assistance could include help with budgeting or money management, repairing or raising your credit score, reducing debt, opening a checking or savings account, or saving for retirement or education.

1 YES

2 NO (GO TO A9)

3 DON’T KNOW (GO TO A9)

4 REFUSED (GO TO A9)

AX. In the last 12 months did you obtain your credit report?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

A9. In the last 12 months, have you attended any workshops or received assistance in applying for a mortgage or buying a home?

1 YES (GO TO A9a)

2 NO (GOT TO A10)

3 DON’T KNOW (GOT TO A10)

4 REFUSED (GOT TO A10)

A10. In the last 12 months, have you opened an Individual Development Account (IDA)?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

Other Assistance

A12. Child Care Assistance

In the last 12 months, have you received assistance in finding a child care provider or paying for child care?

1 YES (GO TO A12a)

2 NO (GO TO A13)

3 DON’T KNOW (GO TO A13)

4 REFUSED (GO TO A13)

5 Not Applicable ((GO TO A13)

A12. Transportation Assistance

In the last 12 months, have you received assistance in buying a car or paying for transportation for employment, school, or other reasons?

1 YES (GO TO A12a)

2 NO (GO TO A13)

3 DON’T KNOW (GO TO A13)

4 REFUSED (GO TO A13)

A13. Assistance with Housing/Landlord Issues

In the last 12 months, have you received assistance in dealing with housing issues or problems with your landlord?

1 YES (GO TO A13a)

2 NO (GO TO A14)

3 DON’T KNOW (GO TO A14)

4 REFUSED (GO TO A14)

A14. Other Social Services

In the last 12 months, have you received assistance in dealing with personal or legal issues; obtaining food or clothing; paying for emergencies; or paying for special events like birthdays and holidays?

1 YES (GO TO A14a)

2 NO (GO TO B1)

3 DON’T KNOW (GO TO B1)

4 REFUSED (GO TO B1)

CATI: ADD NECESSARY INSTRUCTIONS

SECTION B: EDUCATIONAL ATTAINMENT

CATI: ADD NECESSARY INSTRUCTIONS

B1. What is the highest level of education that you have completed?

1 Did not complete high school or receive GED [GO TO SECTION C]

2 GED certificate [GO TO B1a]

3 High school diploma [GO TO B1a]

4 Some college or advanced training certificate [GO TO B1a]

5 Associate’s degree/2-year college [GO TO B1a]

6 Four-year college degree or higher [GO TO B1a]

7 DON’T KNOW [GO TO SECTION C]

8 REFUSED [GO TO SECTION C]

B2. Do you have any type of trade license or training certification?

1 YES

2 NO (GO TO C1)

7 DON’T KNOW (GO TO C1)

8 REFUSED (GO TO C1)

B3. What type of license or certification is it? (PROBE: What type of trade or work does it qualify you to do?)

INTERVIEWER: IF RESPONDENT HAS MULTIPLE LICENSES/CERTIFICATES ASK ONLY ABOUT MOST RECENT.

INTERVIEWER: CODE RESPONSE BASED ON LIST. DO NOT READ LIST.

1 HOME HEALTH AIDE

2 NURSES AIDE/ NURSES ASSISTANT (CNA)

3 NURSE (LPN, LVN, RN)

4 CHILD CARE/TEACHING

5 ADMINISTRATIVE ASSISTANT/CLERICAL

6 COMPUTER

7 MEDICAL ASSISTANT/TECHNICIAN

8 MEDICAL BILLING/CLERICAL

9 SECURITY

10 COMMERCIAL DRIVER

11 OTHER SPECIFY

97 DON’T KNOW

98 REFUSED

CATI: IF B3 =11 ASK B3_O, ELSE GO TO C1

B3_O. What type of license or certification is it?

___________________________________________

97 DON’T KNOW

98 REFUSED

SECTION C: EMPLOYMENT

CATI: ADD NECESSARY INSTRUCTIONS

C1. The next questions are about any paid work that you may be doing currently or have done at different times over the last 12 months. This includes working for a private employer, school or hospital, or government agency; or picking up temporary, seasonal, or odd jobs. Please also include any type of self-employment or running your own business, such as providing child care or in-home nursing care, making home repairs, doing taxes for people, housecleaning, cooking and catering, sewing, doing nails or hair; or doing other paid work. Please do not count volunteer work or unpaid internships or work experience jobs. Again, I would like to remind you that your answers will remain entirely confidential.

In the past 12 months, that is since [CATI INSERT: INTERVIEW MONTH] [CATI INSERT: INTERVIEW YEAR -1], have you worked for pay at all? Please don't count unpaid experience.

1 YES (GO TO C1b)

2 NO (GO TO C1a)

7 DON’T KNOW (GO TO C1a)

8 REFUSED (GO TO C1a)

C1a A lot of people have irregular, odd, or side jobs, or do extra work to make ends meet. Have you done any work like that for pay in the past 12 months?

1 YES

2 NO (GO TO C25)

7 DON’T KNOW (GO TO C25)

8 REFUSED (GO TO C25)

C1b. How many jobs have you held in during the past 12 months?

(INTERVIEWER: SELF-EMPLOYMENT OR TEMPORARY OR "TEMP" WORK IN THE SAME FIELD COUNTS AS ONE JOB.)

INTERVIEWER: IF RESPONDENT SAYS “0” CLARIFY, IF TRULY “0” GO BACK AND REVISE PREVIOUS ANSWERS.

________ [RANGE 1- 10]

NUMBER

97 DON’T KNOW

98 REFUSED

C1e. During the past 12 months about how many months were you working for pay?

(PROBE: Your best estimate is fine.)

INTERVIEWER: RECORD A WHOLE NUMBER, ROUNDED UP (EXAMPLE: IF LESS THAN A MONTH, ENTER 1; IF 2 ½ MONTHS, ENTER 3). COUNT ALL TYPES OF EMPLOYMENT.

INTERVIEWER: IF RESPONDENT SAYS “0” CLARIFY, IF TRULY “0” GO BACK AND REVISE PREVIOUS ANSWERS.

________ [RANGE 1 -12]

MONTHS

97 DON’T KNOW

98 REFUSED

C1f. Of the [CATI: INSERT A1f, IF A1f= 97 OR 98, LEAVE BLANK] months you’ve worked within the last year, how many were months when you were working full-time—that is, 35 or more hours a week? (PROBE: Your best estimate is fine.)

INTERVIEWER: COUNT ALL TYPES OF EMPLOYMENT AND COUNT MULTIPLE PART-TIME JOBS AS FULL-TIME IF TOTAL HOURS/WEEK ≥ 35.

RECORD A WHOLE NUMBER, ROUNDED UP (EXAMPLE: IF LESS THAN A MONTH, ENTER 1; IF 2 ½ MONTHS, ENTER 3).

________

MONTHS [RANGE = 0 TO MONTHS IN C1f]

97 DON’T KNOW

98 REFUSED

C2. Are you currently working for pay?

1 YES

2 YES, CURRENTLY ON LEAVE

3 NO (GO TO C5)

7 DON’T KNOW (GO TO C5)

8 REFUSED (GO TO C5)

C3. How many jobs do you currently have? (SELF-EMPLOYMENT OR TEMPORARY OR "TEMP" WORK IN THE SAME FIELD COUNTS AS ONE JOB.)

________ [RANGE 1-10]

NUMBER

97 DON’T KNOW

98 REFUSED

[CATI: IF C3 = 1, 97, 98, GO TO C5 (WORKING 1 JOB OR DID NOT ANSWER)]

C3a. Thinking about all your current jobs, how many hours per week do you work?

________ [RANGE 0 – 80]

NUMBER

97 DON’T KNOW

98 REFUSED

CATI: FOR TEXT FILLS IN REMAINDER OF THIS SECTION, USE FIRST CHOICE (PRESENT TENSE) IF R IS STILL EMPLOYED (C2 = 1 OR 2). USE SECOND CHOICE (PAST TENSE) IF R IS NOT CURRENTLY EMPLOYED (C2 = 3 OR 4) BUT WAS EMPLOYED AT SOME POINT WITHIN THE PAST YEAR (C1c=1 OR C1d=1).

C5. I'd like to ask you some questions about your [current/most recent] job. [IF C3>1: “Please focus on the job you work the most hours at”] Please tell me where you work[ed].

(PROBE: What [is/was] your employer's name?)

__________________________________________

EMPLOYER’S NAME

96 SELF-EMPLOYED

97 DON’T KNOW

98 REFUSED

CATI: IF “96” (SELF-EMPLOYED), CREATE TEXT BOX FOR INTERVIEWER TO INSERT JOB NAME FOR USE AS C4/C5 TEXT FILL IN SUBSEQUENT QUESTIONS

CATI: IF “96” (SELF-EMPLOYED), CREATE TEXT BOX FOR INTERVIEWER TO INSERT JOB NAME FOR USE AS C4/C5 TEXT FILL IN SUBSEQUENT QUESTIONS

C5b. [C5=96 ASK,] What kind of work [do/did] you do?

[C5 NOT EQUAL TO 96 ASK] What kind of work [do/did] you do on this job?

INTERVIEWER: ENTER VERBATIM RESPONSE. PROBE AS NEEDED.

_________________________________________

97 DON’T KNOW

98 REFUSED

C5c. What do they make or what service do they provide?

____________________________________________

INTERVIEWER: ENTER VERBATIM RESPONSE. PROBE AS NEEDED.

97 DON’T KNOW

98 REFUSED

CATI: IF C3=1 BUT NOT EQUAL TO 97 0R 98 ASK, ELSE GO TO INSTRUCTION BEFORE C6

C5d. Would you describe this job as work for a “temp” agency?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: IF C2 = 1 OR 2, INSERT END DATE OF “77 / 7777” TO DESIGNATE STILL WORKING

C6. What month and year did you start [CATI: IF C2 = 3 OR 4, INSERT “and end”] this job?

INTERVIEWER: PROBE FOR SEASON IF DON’T KNOW MONTH. IF R CAN ONLY PROVIDE SEASON, SPRING = 05, SUMMER = 08, FALL = 11, WINTER = 02. ENTER 77/7777 (STILL WORKING) FOR END DATE OF JOB.

C6a. START: ___ ___/___ ___ ___ ___

MONTH YEAR

97 DON’T KNOW MONTH 9997 DON’T KNOW YEAR

98 REFUSED MONTH 9998 REFUSED YEAR

CATI: INCLUDE DROP DOWN BOX FOR 2-DIGIT MONTH AND 4-DIGIT YEAR. INCLUDE

VALUES FOR DON’T KNOW AND REFUSED

MONTH RANGE: (1-12; 97; 98)

YEAR RANGE: (1950-2010; 9997; 9998)

C6b. END: ___ ___/___ ___ ___ ___

MONTH YEAR

CATI: INCLUDE DROP DOWN BOX FOR 2-DIGIT MONTH AND 4-DIGIT YEAR. INCLUDE

VALUES FOR DON’T KNOW AND REFUSED

MONTH RANGE: (1-12; 77; 97; 98)

YEAR RANGE: (1950-2016; 7777; 9997; 9998)

77 Still Working 7777 Still Working

97 DON’T KNOW MONTH 9997 DON’T KNOW YEAR

98 REFUSED MONTH 9998 REFUSED YEAR

C7. [Now/Just before you left], including overtime, how many hours per week [do/did] you usually work on this job at [CATI INSERT: C4/C5 EMPLOYER NAME]?

INTERVIEWER: IF LESS THAN 10 HOURS OR MORE THAN 60 HOURS, VERIFY ANSWER IS HOURS PER WEEK.

[RANGE: 0- 80]

HOURS/WEEK

997 DON’T KNOW

998 REFUSED

C8. How many days per week [do/did] you usually work?

[RANGE 1 – 7]

DAYS/WEEK

97 DON’T KNOW

98 REFUSED

C9. What [are/were] your earnings [now/just before you left] before taxes? Please include tips, commissions, and regular overtime pay.

INTERVIEWER: IF R’S JOB IS ON AN IRREGULAR SCHEDULE OR A COMMISSION BASIS, PROBE FOR HOW MUCH R MAKES IN A TYPICAL WEEK.

$ ___ ___ ___ ,___ ___ ___.___ ___ [RANGE 000000.01 – 999999.94]

AMOUNT

999999.97 DON’T KNOW

999999.98 REFUSED

CATI: IF C9 IS 999999.97 (DON’T KNOW) OR 999999.98 (REFUSED) GO TO INSTRUCTION BEFORE D12

C10. (INTERVIEWER: IF NECESSARY) [Is/Was] that:

INTERVIEWER: PLEASE READ LIST

1 Per hour,

2 Per week,

3 Every 2 weeks,

4 Twice a month,

5 Once a month,

6 Per year,

7 Per day, or

95 Some other way

97 DON’T KNOW

98 REFUSED

CATI: IF C10=95 , ASK C10_O, ELSE GO TO C11

C10_O. How often/frequently did you receive that amount?

________________________________________

97 DON’T KNOW

98 REFUSED

C11. [Is/Was] that before or after taxes?

1 BEFORE

2 AFTER

7 DON’T KNOW

8 REFUSED

CATI: IF C4 OR C5 = 96 (SELF EMPLOYED), GO TO C15

C12. [Does/Did] your employer offer any of the following benefits?

INTERVIEWER: SELECT “YES” IF R WILL EVENTUALLY BE OFFERED BENEFITS.

	YES	NO	DON’T KNOW	REFUSED
C12a. Any sick days with full pay?	1	2	7	8
C12b. Any vacation days with full pay?	1	2	7	8
C12d. Paid overtime? Dental benefits, including any offered at a cost to you?	1	2	7	8
C12e. A plan that gives you money for retirement?	1	2	7	8
C12f. A health plan or medical insurance, including any offered at a cost to you?	1	2	7	8

CATI: IF C12f = 1 (YES), THEN ASK C13. ELSE GO TO C15

C15. Which of the following best describes your usual weekly work schedule at your job during the last month you worked? Did you work a:

INTERVIEWER: PLEASE READ LIST

1 Regular daytime shift,

2 Regular evening shift,

3 Regular night shift,

4 Rotating shift (one that changes regularly from days to evenings to nights),

5 Split shift (one consisting of two distinct periods each day),

6 An irregular schedule (one that changes from day to day), or

95 Something else SPECIFY

97 DON’T KNOW

98 REFUSED

CATI: IF C15= 95 ASK C15_O, ELSE GO TO C17

C15_O. What is your weekly work schedule?

_________________________________

97 DON’T KNOW

98 REFUSED

CATI: IF C3 = 1 (WORKING 1 JOB) OR C2 = 3 OR 4 (NOT CURRENTLY WORKING OR LAID OFF), GO TO INSTRUCTIONS AT BEFORE C24a. IF C3 IS GREATER THAN OR EQUAL TO 2, DISPLAY C17

C17. I’d like to ask you questions about the other jobs at which you are currently working. Let’s start with the name of your other current employer.

CATI: RECORD THE NAME(S) OF UP TO TWO ADDITIONAL CURRENT JOBS IN C17a. USE ‘96’ TO INDICATE NO OTHER CURRENT JOBS. WHEN NO MORE JOBS, GO TO C18 FOR FIRST JOB IN C17a. LOOP THROUGH C18– C23 FOR EACH CURRENT JOB IN C17a SEPARATELY

CATI: FOR C17a AND C21, DON’T KNOW = ’97’ AND REFUSED = ‘98’

FOR D21, DON’T KNOW MONTH = ‘97’, DON’T KNOW YEAR = ‘9997’

REFUSED MONTH = ‘98’ AND REFUSED YEAR = ‘9998’

FOR C22 AND C23, DON’T KNOW = ‘7’ AND REFUSED = ‘8’

CATI: IF C20 IS 999999.97 (DON’T KNOW) OR 999999.98 (REFUSED), GO TO C23

	SECOND CURRENT JOB	THIRD CURRENT JOB
C17a. What are your other current jobs? CATI: RECORD ALL JOBS, THEN CONTINUE WITH C18	C17a_1.	C17a_2.
CATI: LOOP THROUGH C18-C23 FOR EACH JOB SEPARATELY.
C18. When did you start this job? INTERVIEWER: PROBE FOR SEASON IF DON’T KNOW MONTH. IF R CAN ONLY PROVIDE SEASON, SPRING = 05, SUMMER = 08, FALL = 11, WINTER = 02. ENTER 77/7777 (STILL WORKING) FOR END DATE OF JOB. CATI: INCLUDE DROP DOWN BOX FOR 2-DIGIT MONTH AND 4-DIGIT YEAR. INCLUDE VALUES FOR DON’T KNOW AND REFUSED. MONTH RANGE: (1-12; 97; 98) YEAR RANGE: (1950-2010; 9997; 9998)	C18a1_Start. START: ___ ___/___ ___ ___ ___ MONTH YEAR C18a1_End. END: ___ ___/___ ___ ___ ___ MONTH YEAR (STILL WORKING = 77/7777)	C18a2_Start. START: ___ ___/___ ___ ___ ___ MONTH YEAR C18a2_End. END: ___ ___/___ ___ ___ ___ MONTH YEAR (STILL WORKING = 77/7777)
C19. Including overtime, how many hours per week do you work on this job currently? INTERVIEWER: IF MORE THAN 60 HOURS, VERIFY ANSWER AS HOURS PER WEEK.	C19_1. ______ _____ HOURS/WEEK 0-80 RANGE 97 DON’T KNOW 98 REFUSED	C19_2. _____ ____ HOURS/WEEK 0-80 RANGE 97 DON’T KNOW 98 REFUSED
C20. What is your wage now, before taxes? Please include tips, commissions, and regular overtime pay. INTERVIEWER: IF R’S JOB IS ON AN IRREGULAR SCHEDULE OR A COMMISSION BASIS, PROBE FOR HOW MUCH R MAKES IN A TYPICAL WEEK. CATI: IF C20 IS 999999.97 (DON’T KNOW) OR 999999.98 (REFUSED), GO TO D23	C20_1. $___ ___ , ___ ___ ___.___ ___ AMOUNT 999999.96 MINIMUM WAGE 999999.97 DON’T KNOW 999999.98 REFUSED	C20_2. $___ ___ , ___ ___ ___.___ ___ AMOUNT 999999.96 MINIMUM WAGE 999999.97 DON’T KNOW 999999.98 REFUSED
C21. (IF NECESSARY) Is that: C21_O. How often did you receive that amount?	C21_1. Per hour…………………1 Per week……………….. 2 Every 2 weeks………… 3 Twice a month…………...4 Once a month……………5 Per year…………………. 6 Per day, or………………..7 Some other way? SPECIFY 95 DON’T KNOW……………97 REFUSED………………..98 D21_O1. ____________________________ ___________________	C21_2. Per hour…………………1 Per week……………….. 2 Every 2 weeks………… 3 Twice a month…………...4 Once a month……………5 Per year…………………. 6 Per day, or………………..7 Some other way? SPECIFY 95 DON’T KNOW……………97 REFUSED………………..98 D21_O2. _________________________
C22. Is that before or after taxes?	D22_1. BEFORE .1 AFTER .2 DON’T KNOW………….....7 REFUSED……………….…8	D22_2. BEFORE ..1 AFTER ..2 DON’T KNOW………….....7 REFUSED……………….…8
C23. Did your employer make available a health plan or medical insurance, including any offered at a cost to you?	D23_1. YES 1 NO 2 DON’T KNOW………….....7 REFUSED……………….…8	D23_2. YES 1 NO 2 DON’T KNOW………….....7 REFUSED……………….…8

Note: UPDATE CATI INSTRUCTIONS BELOW

CATI: IF C2=1 OR 2 AND C7 OR C3a LESS THAN 30 GO TO C24 (WORKING PART-TIME)

CATI: IF C2=3, 4, 7, 8 (NOT CURRENTLY WORKING), GO TO C25

CATI: IF C2=1 OR 2 (CURRENTLY WORKING) AND C7 OR C3a GREATER THAN OR EQUAL TO 30 GO TO C26 (WORKING FULL-TIME)

CATI: IF C2 = 3 (NOT CURRENTLY WORKING), THEN ASK C25

CATI: IF C2 = 1 OR 2 (CURRENTLY WORKING), GO TO D1

C25. Some people may not be able to get a job even if they want to work. Other people may have personal or other reasons for not working for pay. What is the main reason you are not working for pay?

INTERVIEWER: DO NOT READ LIST

1. ILLNESS, DISABILITY, SELF

2. ILLNESS, DISABILITY OTHER

3. Taking care of home or family MEMBERS

4. Unable to find (adequate) child care

5. going to school, in training

6. unable to find work

7. Pregnancy

8. criminal record makes finding work hard

9. Poor Credit Score Makes Finding Work Hard

10. TEMPORARILY LAID OFF/ TEMPORARY LEAVE

11. Inadequate transportation options

12. RETIRED OR TOO OLD

13. other SPECIFY

97. DON’T KNOW

98 refUSED

CATI: IF C25=12 ASK, ELSE GO TO C26

C25_O. What is the main reason you are not working for pay?

_______________________________

97 DON’T KNOW

98 REFUSED

C26. In the last four weeks, did you look for a full-time or part-time job?

(PROBE: Did you look for a fulltime job or a part time job?)

INTERVIEWER: DO NOT READ LIST

1 FULL TIME

2 PART TIME

3 EITHER/BOTH

4 NEITHER

7 DON’T KNOW

8 REFUSED

CATI: RECORD END DATE (SECCETDT) AND TIME (SECCETTM)

SECTION D:

MARRIAGE AND HOUSEHOLD COMPOSITION

CATI: RECORD START DATE (SECDSTDT) AND TIME (SECDSTTM)

D2. Are you currently:

INTERVIEWER: PLEASE READ LIST

1 Married, living with spouse

2 Living with a partner

3 Single, never married

4 Separated or living apart from your spouse

5 Divorced

6 Widow/Widower

7 DON’T KNOW

8 REFUSED

D5. Now I’m going to ask you about the people who lived in your household at least two nights a week last month. Including you [CATI: IF D2 = 1, INSERT “and your spouse”. IF D2 = 2, INSERT “and your partner”], and any other adults and children, how many people lived together in your household at least two nights a week during the month of [PRIOR MONTH]?

_________ [RANGE 1-20 PEOPLE]

97 DON’T KNOW

98 REFUSED

CATI: IF D5<2 AND D2= 1 or 2 ASK, ELSE CONTINUE TO D5a

D5_1. Just to confirm, you told me earlier that you were [CATI: Insert “married” if D2=1; Insert “living with a partner” if D2=2]. Are you including [CATI: IF D2 = 1, INSERT “your spouse”. IF D2 = 2, INSERT “your partner”] in the number of people living in your household?

1. YES, THEY DIDN’T LIVE HERE LAST MONTH

2. NO (GO BACK TO D5)

7. DON’T KNOW

8. REFUSED

D5a. Of these people you just mentioned, how many were children of your own who are age 18 or younger? Please include biological, adopted, step, foster children, or children for whom you are the guardian.

_____ # BIOLOGICAL/ADOPTED/STEP/FOSTER CHILDREN [RANGE 0-12]

97 DON’T KNOW

98 REFUSED

CATI: RECORD END DATE (SECDETDT) AND TIME (SECDETTM)

SECTION E:

INCOME, EXPENSES, AND MATERIAL HARDSHIP

CATI: RECORD START DATE (SECESTDT) AND TIME (SECESTTM)

CATI: FOR PRIOR MONTH, INSERT CALENDAR MONTH BEFORE INTERVIEW MONTH

Now, I am going to ask you some questions about the income that came into your household for everyone who lived together in [PRIOR MONTH]. Please include all income from all the people who lived together in your household at least two nights a week last month. Again, I want to assure you that none of your answers will be discussed with anyone.

During [PRIOR MONTH]:

E1. Did you work for pay?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

CATI: IF D5=1, GO TO E2.

E1a. Did any other adults or children who live in your household work for pay?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E2. In [PRIOR MONTH], did you [CATI: IF D5 GREATER THAN 1, INSERT “or anyone else in your household”] receive:

	YES	NO	DON’T KNOW	REFUSED
E2a. SNAP, also known as Food Stamps, including EBT cards from the government that can be used at the store to buy food?	1	2	7	8
E2b. Child Support?	1	2	7	8
E2c. TANF or [insert state program name] or any cash assistance, not including child support money or child care payments?	1	2	7	8
E2d. Unemployment Insurance Benefits or UI?	1	2	7	8
E2e. SSDI	1	2	7	8
E2f. SSI	1	2	7	8
E2g. The Special Supplemental Nutrition Program for Women, Infants, and Children or WIC?	1	2	7	8
E2h. Heating or Cooling Assistance?	1	2	7	8
E2i. Free or reduced-price school lunch?	1	2	7	8
E2.j Alimony?	1	2	7	8

E3. In [PRIOR MONTH] did you or anyone in your household receive money from any other source, such as rent from boarders, a pension, other government benefits, or any other income we have not already talked about?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E4 What was the total income for everyone living together in your household in [PRIOR MONTH]? (PROBE: Your best estimate is fine.)

$ ___ ___ ___ ,___ ___ ___. [RANGE = 0 – 999995]

AMOUNT

999997 DON’T KNOW

999998 REFUSED

CATI: IF E4>10,000 BUT < 999995 ASK, ELSE GO TO E5

CATI: IF E4 = 999997 or 999998, GO TO E4a

E4_confirm. Just to confirm, you said that the total income for everyone living together in your household in [PRIOR MONTH] was [INSERT E4].

1 YES (GOTO E5)

2 NO

7 DON’T KNOW

8 REFUSED (GO TO E4a)

CATI: IF E4 = 999997 OR E4_revised=999997 (DON’T KNOW), GO TO E4a. IF E4 = 0 OR 999998, GO TO F5

CATI: IF AMOUNT GIVEN IN E4 or E4_revised THAT IS NOT EQUAL TO 999997 OR 999998 , GO TO E5

E4a. Would you say it was more or less than $1,500?

INTERVIEWER: DO NOT READ LIST

1 MORE THAN $1,500 (GO TO E4b)

2 EXACTLY $1,500 (GO TO E5)

3 LESS THAN $1,500 (GO TO E4c)

7 DON’T KNOW (GO TO E5)

8 REFUSED (GO TO E5)

E4b. Would you say it was:

INTERVIEWER: READ LIST

1 More than $1,500 but less than $2,000,

2 At least $2000 but less than $2,500, or

3 $2,500 or more?

7 DON’T KNOW

8 REFUSED

CATI: ALL GO TO E5

E4c. Would you say it was:

INTERVIEWER: READ LIST

1 At least $1,200 but less than $1,500,

2 At least $800 but less than $1,200,

3 At least $500 but less than $800, or

4 Less than $500?

7 DON’T KNOW

8 REFUSED

TAXES

E5. Did or will you or someone else fill out a federal tax return for you for the 201X tax year?

(PROBE: This is the return you would have filed in April of this year.)

1 YES

2 NO (GO TO E5d)

7 DON’T KNOW (GO TO E5d)

8 REFUSED (GO TO E5d)

E5a. When you filed or file your 201X federal tax return did you or will you use a free or paid tax preparer service to prepare your taxes?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

BANKING / USE OF FINANCIAL SERVICES

E6. Do you currently have any kind of account at a bank or a credit union, including a checking or savings account?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E7. In the past 12 months, that is since [INSERT INTERVIEW MONTH] [INTERVIEW YEAR-1], how often, if at all, did you use the following financial services—would you say: several times a month, about once a month, every few months, a few times during the year, or never?

	Several Times A Month		About Once A Month	Every Few Months	Never	DON’T KNOW	REFUSED
E7a. Cash a check at a check casher that is not a bank?	1		2	3	4	7	8
E7b. Pay a bill at a check casher?	1		2	3	4	7	8
E7d. Get a cash advance on a credit card?	1		2	3	4	7	8
E7e. Bounce a check or overdraw your checking account?	1		2	3	4	7	8
E7f. Get a Payday, pawn, installment or auto title loan (including loans where you apply on the internet)?		1	2	3	4	7	8

SAVINGS

E8. Do you [or your CATI: IF D2 = 1 , INSERT “spouse” IF D2 = 2, INSERT “partner”] have any money or savings you keep in a safe place at home or elsewhere, such as money in a savings account? [IF TYPE=1 ASK Please do not include any escrow savings that you may have.]

(IF NECESSARY, READ: This would include money at home, in a savings bond, money market fund, credit union, pension fund, stocks or bonds, or certificates of deposit.)

1 YES

2 NO (GO TO E9)

7 DON'T KNOW (GO TO E9)

8 REFUSED (GO TO E9)

E8a. How much, altogether, do you [and your CATI: IF D2 = 1 , INSERT “spouse” IF D2 = 2, INSERT “partner”] have in savings? Your best estimate is fine. [IF TYPE=1 ASK Remember, please do not include any escrow savings that you may have.]

$ ___ ___ ___ ___ ___ SAVINGS AMOUNT [RANGE = 1-20,000]

99997 DON’T KNOW

99998 REFUSED

CATI: ASK IF E8a=99997 (DON’T KNOW), ELSE GO TO E8c

E8b. Would it be:

1 Less than $200,

2 $200 to $500,

3 $501 to $1000,

4 $1001 to $2000, or

5 More than $2000?

7 DON'T KNOW

8 REFUSED

DEBT

E10.  Next I’d like to ask you about loans and any debt (or money you might owe).

Right now, do you have any debt where you owe money for things like medical bills, credit card bills, student loans, your home, or store accounts and so on?

1 YES

2 NO (GO TO E16)

7 DON’T KNOW (GO TO E16)

8 REFUSED (GO TO E16)

E11.     When you think about all your outstanding loans and bills, what is the total amount you owe? If you have a mortgage, do not count that in the total amount. (PROBE: Your best estimate is fine.)

$ ___ ___ ___ ,___ ___ ___. DEBT AMOUNT [RANGE = 0 – 999995]

999997 DON’T KNOW

999998 REFUSED

E11a. [ASK IF E11=999997 ASK ELSE GO TO E12]

When you think about all your outstanding loans and bills, not including a mortgage if you have one, would you say that the total amount is ….

1 $1-$500

2 $501-$1000

3 $1001-$5000

4 $5001-15,000

5 More than $15,000

7 DON’T KNOW

8 REFUSED

E13. In the last 12 months have you ever been late on a payment for a loan? Please include credit card bills.

1. Yes

2. No

97. DON’T KNOW

98. REFUSED

FINANCIAL STRAIN

E16. How much do you agree or disagree with each of the following statements? Would you say you Strongly Agree, Agree Somewhat, Disagree Somewhat, or Strongly Disagree?

	Strongly Agree	Agree Somewhat	Disagree Somewhat	Strongly Disagree	DON’T KNOW	REFUSED
E16a. My financial situation is better than it was last year at this time.	1	2	3	4	7	8
E16b. I worry about having enough money in the future.	1	2	3	4	7	8
E16c. These days I can generally afford to buy the things (I/we) need.	1	2	3	4	7	8
E16d. There never seems to be enough money to buy something or go somewhere JUST FOR FUN.	1	2	3	4	7	8

MATERIAL HARDSHIP SCALE

[Source: Rent Reform BIF]

E17a. In the past 12 months was there ever a time when, because of cost, you or your household were not able to pay your portion of the rent? 1 Yes [Go to E17a.1] 2 No [Go to E17b] 3 No answer [Go to E17b]	E17a.1. In the past 12 months, in about how many months has this happened? 1 1 Month 2 2 or 3 months 3 4 to 6 months 4 7 or more months 5 No answer
E17b. In the past 12 months was there ever a time when, because of cost, you or your household were not able to pay your utility bills? 1 Yes [Go to E17b.1] 2 No [Go to E17c] 3 No answer [Go to E17c]	E17b.1. In the past 12 months, in about how many months has this happened? 1 1 Month 2 2 or 3 months 3 4 to 6 months 4 7 or more months 5 No answer
E17c. In the past 12 months was there ever a time when, because of cost, you or your household were not able to pay your telephone bill? 1 Yes [Go to E17c.1] 2 No [Go to E17d] 3 No answer [Go to E17d]	E17c.1. In the past 12 months, in about how many months has this happened? 1 1 Month 2 2 or 3 months 3 4 to 6 months 4 7 or more months 5 No answer
E17d. In the past 12 months was there ever a time when, because of cost, you or your household were not able to buy food? 1 Yes [Go to E17d.1] 2 No [Go to E17e] 3 No answer [Go to E17e]	E17d.1. In the past 12 months, in about how many months has this happened? 1 1 Month 2 2 or 3 months 3 4 to 6 months 4 7 or more months 5 No answer
E17e. In the past 12 months was there ever a time when, because of cost, you or your household were not able to buy prescription medicine? 1 Yes               2 No               3 No answer
E17f. In the past 12 months was there ever a time when, because of cost, you or your household were not able to see a doctor or get medical assistance? 1 Yes               2 No               3 No answer

FOOD INSUFFICIENCY

E18. Which of these statements best describes the food eaten by you and your family in [PRIOR MONTH]: Did you have …

1 Enough of the kinds of food you wanted, (GO TO E20)

2 Enough but not always the kinds of food you wanted to eat(GO TO E20)

3 Sometimes not enough to eat, or

4 Often not enough to eat?

7 DON’T KNOW

8 REFUSED

OVERALL FINANCIAL WELL-BEING

E20. In general, how do your family finances usually work out at the end of the month? Is there:

1 Some money left over,

2 Just enough to make ends meet, or

3 Not enough money to make ends meet?

7 DON’T KNOW

8 REFUSED

E21. Do you currently have any major credit cards like MasterCard and Visa that you can use to shop in many different places.

1 YES

2 NO

7 DON’T KNOW

8 Refused

E22. A credit score is a number that lenders use when deciding whether to give someone a loan. The most common type of credit score in the United States is called the “FICO score.” A FICO score can be between 300 and 850. A higher number is a better credit score.

Do you know your credit score?

1. Yes

2. No [GO TO E23]

3. I do not have a credit score [GO TO E23]

98. I do not know [GO TO E23]

99. Decline to answer [GO TO E23]

E22a. How would you rate your current credit score?

1 Very bad

2 Bad

3 About average

4 Good

5 Very good

6 I do not know

88 REFUSED

E22b. Is your credit score 650 or higher?

1. Yes

2. No

98. I do not know

99. Decline to answer

Income Stability

E23. Would you say that [your /your household’s] income stays about the same each month, varies a little month by month, or varies a lot month by month?

1 STAYS ABOUT THE SAME

2 VARIES A LITTLE

3 VARIES A LOT

4 DON’T KNOW

5 REFUSED

E24.

In the last 12 months about how many months did [you/your household] have no income or unusually low income?

1 Zero months

2 One or two months

3 Three or four months

4. Five or six months

5. 7 or 8 months

6. 9 months or more

7 DON’T KNOW

8 REFUSED

Emergency Expenses

E29. Suppose that you have an emergency expense that costs $400. Based on your

current financial situation, how would you pay for this expense?

INTERVIEWER: Code all responses

1. Put it on my credit card and pay it off in full at the next statement

2. Put it on my credit card and pay it off over time

3. With the money currently in my checking/savings account or with cash

4. Using money from a bank loan or line of credit

5. By borrowing from a friend or family member

6. Using a payday loan, deposit advance, or overdraft

7. By selling something

8. I wouldn’t be able to pay for the expense right now

9. Other (Please specify):[TXT]___________________________

97 DON’T KNOW

98 REFUSED

Efficacy and Hope

E30. The next questions are about how you handle problems in life and work.

[ONYC G21].

For each of the following statements, please indicate how much you agree or disagree that it describes you.

	Strongly disagree	disagree	agree	Strongly agree	Don’t know	Refused
At this time I am meeting the goals I set for myself.	1	2	3	4	7	8
I can think of many ways to reach my current goals.	1	2	3	4	7	8
Right now I see myself as pretty successful.	1	2	3	4	7	8
There are lots of ways around any problems I am facing now.	1	2	3	4	7	8
At the present time I am energetically pursuing my goals.	1	2	3	4	7	8
If I should find myself in a jam, I could think of many ways to get out of it.	1	2	3	4	7	8

Health

E31. In [PRIOR MONTH], were you covered by any health insurance plan including Medicaid or [insert local public health insurance], private insurance, an employer-paid plan, or a private HMO?

(PROBE: Did you have one of these kinds of insurance?)

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

E32. In general, how would you rate your overall health now? Is it:

1 Excellent,

2 Very good,

3 Good,

4 Fair, or

5 Poor

7 DON’T KNOW

8 REFUSED

CATI: RECORD END DATE (SECEETDT) AND TIME (SECEETTM)

SECTION F: HOUSING

CATI: RECORD START DATE (SECFSTDT) AND TIME (SECFSTTM)

F1. These questions are about your housing and your neighborhood. Do you currently:

INTERVIEWER: READ ALL OPTIONS EVEN IF R INTERRUPTS WITH ANSWER.

1 Own your own home or apartment, (GO TO F3)

2 Rent your home or apartment, (GO TO F1a)

3 Live with family or friends and pay part of the rent or mortgage payment, (GO TO F1a)

4 Live with family or friends and not pay rent, (GO TO F1a)

5 Live in a group shelter, or (GO TO F3)

6 Live in some other arrangement? (GO TO F3)

INTERVIEWER: DO NOT READ: CODE IF APPROPRIATE.

7 HOMELESS AND LIVING ON THE STREET (GO TO F3)

8 JAIL (GO TO F3)

9 ALONE AND RENT-FREE (GO TO F3)

97 DON’T KNOW (GO TO F3)

98 REFUSED (GO TO F3)

F1a. Do you live in:

1 Public housing—that is, housing owned by a federal, state or local government agency, such as [Insert PHA NAME]

2 Private housing for which part of your rent bill is paid by the government, such as Section 8 or vouchers, or

3 Do you live in private housing paid for by you with no help from the government (i.e., entire rent bill paid without any help from the government to pay the rent)?

7 DON’T KNOW

8 REFUSED

F2. Altogether, what does your family now pay in rent each month? If you receive housing assistance, please only include your portion of the rent.

$ ___ , ___ ___ ___ . ___ ___

MONTHLY RENT

0000 NOTHING OR UNDER $1

9997 DON’T KNOW

9998 REFUSED

F2a. Does that rent include any utilities such as gas, heat, or electricity?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

RESIDENTIAL MOVES and Housing/Neighborhood Quality

F3. Have you moved at all since [RAMY]?

1 YES

2 NO (GO TO F7)

7 DON’T KNOW (GO TO F7)

8 REFUSED (GO TO F7)

F4. How many times have you moved since [RAMY]?

NUMBER OF TIMES MOVED

97 DON’T KNOW (GO TO F6)

98 REFUSED (GO TO F6)

F5. (CATI: IF F4 = 1): What was the main reason you moved?

(CATI: IF F4 > 1 BUT ≠97 OR 98): What was the main reason you moved the last time?

INTERVIEWER: DO NOT READ LIST

1. RENT WENT UP AT OLD PLACE

2. WANTED A CHEAPER PLACE

3. no longer receiving section 8/lost voucher – could not afford

4. Income Increased and needed more expensive place to maintain voucher

5. EVICTION OR DISPUTE WITH LANDLORD

6. landlord no longer accept section 8

7. WANTED A BIGGER PLACE

8. WANTED A NICER PLACE

9. WANTED A SMALLER PLACE

10. WANTED A safer NEIGHBORHOOD

11. WANTED a place closer to work/Closer to school

12. wanted to move closer to family or friends

13. wanted a neighborhood with better schools

14. WANTED MY OWN PLACE (NOT SHARED WITH OTHERS)

15. Other SPECIFY

97. don'T Know

98. refused

CATI: IF F5=12 (OTHER) ASK F5_O; ELSE GO TO F6

F5_O. What was the main reason you moved?

____________________________________

97 DON’T KNOW

98 REFUSED

F6. Overall, how satisfied are you with your home?

1. Very satisfied

2. Somewhat satisfied

3. Neither satisfied nor dissatisfied

4. Somewhat dissatisfied

5. Very dissatisfied

6. Don’t know

7. Refused

F7. Overall, how satisfied are you with conditions in your neighborhood?

1 Very satisfied

2 Somewhat satisfied

3 Neither satisfied nor dissatisfied

4 Somewhat dissatisfied

5 Very dissatisfied

6 Don’t know

7 Refused

CATI: RECORD END DATE (SECGEDDT) AND TIME (SECGEDTM)

SECTION G: PROGRAM PARTICIPATION

CATI: RECORD START DATE (SECGSDDT) AND TIME (SECGSDTM)

CATI: IF (TYPE=1 (PROGRAM) AND (Q6=1 OR Q6a=1)) ASK G1, ELSE GO TO SECTION N CLOSING

G_INTRO

When we began this interview, you said you said you had signed-up for the Family Self-Sufficiency program (FSS). We would like to now ask you some questions about FSS and services you may have received from the FSS program or organization(s) you may have been referred to by the program since [RAMY].

G1. Are you currently signed-up for or receiving services from the FSS program?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

G1a. Have you left the FSS program?

1 YES

2 NO (GO TO G2)

7 DON’T KNOW (GO TO G2)

8 REFUSED (GO TO G2)

G1b. I am going to read you a list of possible reasons why you may have left the FSS program. Please tell me those that apply to you.

INTERVIEWER: PLEASE READ LIST. SELECT ALL THAT APPLY.

□ 1 I am no longer receiving a Section 8 or Housing Choice voucher

□ 2 I bought a home

□ 3 I moved out of the area

□ 4 I achieved my FSS goals and graduated from the program

□ 5 I was asked to leave the FSS program [x- BE MORE SPECIFIC?]

□ 6 I left the FSS program because I could not find the services I needed

□ x Some other reason (Specify:______________)

□ x DON’T KNOW

□ x REFUSED

CATI: IF G1b=7 ASK, ELSE GO TO G2

G1b_O Please briefly describe why you left the FSS program?

TEXT RESPONSE: __________________________________________________________

7 DON’T KNOW

8 REFUSED

INTRODUCTION/UNDERSTANDING OF PROGRAM AND ESCROW

G2. How many years can someone be enrolled in the FSS program? ,

[INTERVIEWER NOTE: RANGE IS 0-7, IF RESPONDENT PROVIDES A NUMBER GREATER THAN 7, CODE THE ACTUAL RESPONSE.

_________________ NUMBER OF YEARS [RANGE=0-7]

7 DON’T KNOW

8 REFUSED

G4. Have you heard of the FSS escrow account?

1 YES (GO TO G5)

2 NO

7 DON’T KNOW

8 REFUSED

G4a. The FSS escrow account is a long-term savings account that your PHA opens up for you when an increase in your household’s earned income causes your rent to go up. Your PHA takes the difference between your old rent and new rent and puts that amount into a savings account – or escrow account. You can get that money if you meet certain conditions. Have you ever heard about an FSS escrow account before this interview?

1 YES

2 NO (GO TO G6)

7 DON’T KNOW

8 REFUSED

G5. Have you earned any escrow?

1 YES

2 NO (GO TO G6)

7 DON’T KNOW (GO TO G6)

8 REFUSED (GO TO G6)

G5a. How much escrow have you earned?

$___________________ [RANGE: 0- 99999]

PROVIDE RESPONSE CATEGORIES FOR PEOPLE WHO DON’T KNOW EXACT AMOUNT

999997 DON’T KNOW

999998 REFUSED

G5X. How do you know how much escrow you have earned?

1 PHA annual notification

2 Case manager informs me

3 Both

7 DON’T KNOW (GO TO G6)

8 REFUSED (GO TO G6)

NOTE TO REVIEWERS: WE ARE STILL WORKING ON THE WORDING OF QUESTION G5B.

G5b.    What does your housing agency require for FSS participants to complete their FSS contract and receive the full amount deposited in their escrow account?

INTERVIEWER: Code Responses.

           

             1         The head of household must complete all the goals on the ITSP and graduate from the program 

            2          The head of household should be employed

            3.          All adults in the household should be employed

            4.         No one in household should be receiving cash assistance [PGM] for 12 months before graduation from FSS

            5.         No one in the household should be receiving food stamps/SNAP for 12 months before graduation from FSS

            6.         The household must give up their voucher and leave the Section 8 program  

G5c. In the future, how do you plan to use the money in the escrow account? I am going to read you a list of possible uses, please tell me all that apply to you…

[INTERVIEWER READ LIST – SELECT ALL THAT APPLY]

1 To help pay for education or training

2. To buy a house

3 To start a business

4. To pay for basic necessities my family needs

5 To treat myself or my family to something we usually cannot buy or do

6 To save for my child’s/children’s future education

x To build an emergency fund

x To pay off my bills / debt

7 Or something else?

77 DON’T KNOW

88 REFUSED

CATI: IF G5c=7 ASK, ELSE GO TO G6

G5c_O Please briefly describe how you plan to use the money in your escrow savings account.

TEXT RESPONSE: __________________________________________________________

7 DON’T KNOW

8 REFUSED

GOALS, CONTACTS, AND CASE MANAGEMENT

G6. After [RAMY] and the initial meeting when you set your FSS goals, did you ever meet with an FSS case manager?

CATI: INSERT HELP SCREEN WITH DEFINITION The initial meeting with the specialist or case manager is generally used to develop FSS goals and complete an Individual Training and Services Plan [ITSP] and discuss services or resources in the community to help you achieve your goals.

1 YES

2 NO (GO TO G7)

7 DON’T KNOW (GO TO G7)

8 REFUSED (GO TO G7)

Gx. Are you currently working on any of your FSS goals?

1. YES

2 NO (GO TO Gx)

7 DON’T KNOW (GO TO Gx)

8 REFUSED (GO TO Gx)

Gx. Which type of goal are you working toward? (check all that apply)

1. An employment or career goal

2. An education & training goal

3. A financial management goal

4. A family or personal well-being goal

5. Home Ownership

6. None of the above

7. Other

8. DK

9. RF

Gx. Which goal is the most important one to achieve for you achieve your self-sufficiency goals?

1. My employment or career goal

2. My education & training goal

3. My financial management goal

4. My family or personal well-being goal

5. None of the above

6. All of the above

7. Other

8. DK

9. RF

Going forward, what services are the most important for you to become self-sufficient? SELECT ALL THAT APPLY.

1. Job search

2. Job training

3. Childcare

4. Education and training

5. Money management

6. Credit repair

7. Homeownership counseling

8. Addressing personal any health issues? (may be hard to ask)

G6a. In the last 12 months, approximately how many times have you communicated with your FSS case manager about your goals, services, or other issues? Include times you met with the case manager in-person, talked by phone, or SENT an email.

# of times: __________________ (0-99) (Go to G6b)

7 DON’T KNOW (Go to G6a_1)

8 REFUSED (Go to G6b)

G6a_1. Your best guess is fine. Was it….

1. 0 times

2. 1 time

3. 2 times

4. 3 times

5. 4 times

6. 5 to 9 times

7. 10 or more times

G6x. In the last 12 months, how many times did you?

Meet with your case manager in-person?

1. 0 times

2. 1 time

3. 2 times

4. 3 times

5. 4 times

6. 5 to 9 times

7. 10 or more times

Talk to your case manager by phone?

1. 0 times

2. 1 time

3. 2 times

4. 3 times

5. 4 times

6. 5 to 9 times

7. 10 or more times

Send an email to your case manager?

1. 0 times

2. 1 time

3. 2 times

4. 3 times

5. 4 times

6. 5 to 9 times

7. 10 or more times

G6x. Overall, in your opinion, did you have too few, just the right number, or too many contacts with your case manager in the past 12 months?

1. Just the right number

2. Too few

3. Too many

4. DK

5. Refused

G6b. When you met with your FSS case manager in-person, by phone, or email, did you usually talk about….

[INTERVIEWER READ LIST AND SELECT ALL THAT APPLY]

1 Progress toward FSS goals

3. Barriers coming in the way of meeting FSS goals

4 Information on referrals and services related to FSS goals

5 Housing and landlord issues

6. Your escrow account or escrow account balance

7 Some other topics related to FSS goals

8 Some other topic unrelated to FSS goals

9 DON’T KNOW

10 REFUSED

Gx. (WA_24m) How important is /was your contact with case manager in helping you to make progress towards your FSS goals? Would you say your contact with such staff was…

1 very important,

2 somewhat important,

3 not very important, or

4 not important at all

6 NO CONTACT WITH STAFF SINCE I ENROLLED IN FSS

7 DON’T KNOW

8 REFUSED

G6x. Did the FSS case manager ever talk to you about how you could accumulate or grow your escrow savings?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

G7. Next we are going to talk about different things that your FSS case manager or an organization you were referred to by the FSS program may have helped you with.

CATI: ASK IF C1=01 OR C1a=01 OR C2=01, ELSE GO TO G7k

G7k. Did the FSS program help you or someone in your household find any health care services you needed?

1 YES (GO TO G7k_1)

2 NO (GO TO INSTRUCTIONS BEFORE G8)

7 DON’T KNOW (GO TO INSTRUCTIONS BEFORE G8)

8 REFUSED (GO TO INSTRUCTIONS BEFORE G8)

G7m Did the FSS program help you with personal issues, issues with your children, or family issues that make having a job difficult?

1 YES (GO TO G7l_1)

2 NO (GO TO G7k)

7 DON’T KNOW (GO TO G7k)

8 REFUSED (GO TO G7k)

Referrals

Did the FSS program improve your awareness of services or service providers in your community?

1 YES

2 NO

7 DON’T KNOW

8 REFUSED

How often did the referrals given to you by your case manager help you meet your needs?

1. Always

2. Often

3. Sometimes

4. Never

5. Not applicable; my Case Manager did not give referrals.

7 DON’T KNOW

8 REFUSED

Support from case manager

Please rate the extent to which you agree will the following statements:

	Strongly Agree	Agree Somewhat	Disagree Somewhat	Strongly Disagree	DK	RF
My case manager meets with me often enough to meet my needs	1	2	3	4	7	8
My case manager is knowledgeable about services in the community	1	2	3	4	7	8

BARRIERS TO PARTICIPATION

Gy. Were/are there any obstacles that get/got in the way of your participation in the FSS program?

Interviewer: do not read list. Code responses.

1. Taking care of small children or lack of appropriate child care

2. Personal problems [x-CLARIFY – NOT CLEAR]

3. Lack of transportation access and expense

4. Illness, disability, self

5. Illness. Disability, other

6. Fear of losing Section 8 assistance or other benefits

7. The costs of education and training, such as tuition or books

8. Moved to another PHA and dropped out of FSS

9. Cannot get in touch with my case manager

10. I was not able to get the services I needed from the program

11. Other

12. No obstacles

13. Don’t Know

14. Refused

OVERALL ASSESSMENT OF FSS PROGRAM

G15. Overall, how satisfied [are/were] you with the FSS program? Would you say that you are …

1 Very Satisfied

2 Satisfied

3 Dissatisfied

4 Very dissatisfied

7 DON’T KNOW/NO OPINION

8 REFUSED

CATI: RECORD END DATE (SECGETDT) AND TIME (SECGSETTM)

[CONTACT SECTION DROPPED FROM THIS DRAFT]

59

36-Month Survey, DRAFT 1.0 - question numbers, skips, response categories, lead-in text, CATI instructions, etc., will be fixed in the final instrument.