National Food Study Pilot

Appendix B-1

Household Screener

National Food Study Pilot

Agency: Economic Research Service

Contractor: Westat, Inc.

OMB Control Number: xxxx-xxxx

Expiration Date: xx/xx/xxxx

National Food Study Pilot

Household Screener

Hello. My name is [FILL NAME]. I work for Westat and we’re conducting the National Food Study Pilot for the U.S. Department of Agriculture. We recently sent a letter to this address.

[SHOW ID CARD]

The National Food Study will help the USDA improve its programs by answering questions about where households get food and how much they pay for food.

[OFFER THE DISCLAIMER/SURVEY INFORMATION SHEET]

I am here to conduct a 12 minute questionnaire to see if your household is eligible to participate in the study. If you are eligible and you complete the study you will receive $176 or more. All of your responses to this information collection are voluntary. The information that you provide will be kept completely confidential. We will use your information only for statistical purposes and your responses will not have any effect on services you currently receive or may apply for in the future.

Q1. Are you a member of this household and at least 18 years of age?

(1) YES GO TO Q2

(0) NO ASK TO SPEAK WITH AN ADULT HOUSEHOLD MEMBER, START AT INTRO AGAIN.

Q2. May I begin the twelve minute questionnaire?

(1) YES GO TO Q3

(0) NO [INTERVIEWER: ATTEMPT TO CONVERT RESPONDENT. IF NOT SUCCESSFUL, TERMINATE INTERVIEW AND CODE CASE A REFUSAL IN IMS¹]

Q3. I have this address as [READ ADDRESS ON CONTACT SHEET]. Is that your exact address?

(1) YES, EXACTLY AS LISTED GO TO Q6

(2) MOSTLY CORRECT, BUT NEEDS MINOR CORRECTING ADDRESS IN CAPI THEN GO TO Q6

(3) INCORRECT ADDRESS TERMINATE INTERVIEW

Q4. USED IN 2012 BUT SAVED FOR POTENTIAL LATER USE.²

Q5. USED IN 2012 BUT SAVED FOR POTENTIAL LATER USE.

[IF Q3 IN (1, 2), GO TO Q6. IF Q3=3, TERMINATE INTERVIEW]

Q6. Do you or at least one member of your household live or stay at this address year round?

(1) YES GO TO Q7

(0) NO

(97) DON’T KNOW

(98) REFUSED

[IF Q6 =1, GO TO Q7.]

Q6a. How many months of the year do members of this household stay at this address?

(1) 6 MONTHS OR MORE GO TO Q7

(0) LESS THAN 6 MONTHS TERMINATE AND GO TO INELIGIBLE SECTION. RECORD CASE STATUS AS SCREENER COMPLETE INELIGIBLE FOR MAIN STUDY.

[IF Q6a =1, GO TO Q7. IF Q6a=0, TERMINATE AND GO TO INELGIBLE SECTION. . RECORD CASE STATUS AS SCREENER COMPLETE INELIGIBLE FOR MAIN STUDY.]

Q7. Including yourself, how many people live in your household? Don’t forget to include babies, small children, and non-relatives who live here. Also include persons who usually live here but are temporarily away for reasons such as: vacation, traveling for work, in the military, or in the hospital. Do not include people living away at school or incarcerated.

_______________ NUMBER Variable name: HHSIZE

(97) DON’T KNOW READ: This information is critical for determining your household’s eligibility to participate in the main study. IF R STILL GIVES DON’T KNOW, TERMINATE. RECORD CASE STATUS AS SCREENER REFUSAL IN IMS.

(98) REFUSED READ: This information is critical for determining your household’s eligibility to participate in the main study. IF R STILL GIVES DON’T KNOW, TERMINATE. RECORD CASE STATUS AS SCREENER REFUSAL IN IMS.

[IF Q7 IN (97, 98), [INTERVIEWER: ATTEMPT TO CONVERT RESPONDENT. IF NOT SUCCESSFUL, TERMINATE INTERVEIW AND CODE CASE A REFUSAL IN IMS]

Q8b. Is anyone in your household currently pregnant?

(1) YES

(0) NO

Q8c. How many of the [FILL IN HH SIZE] people is under the age of 5?

__________NUMBER

Q9. From now on when we refer to your household we mean the [FILL HH SIZE] people that live together at this address.

Next are questions about your household’s income in the last 12 months, that is since (month) 1st of [2015/2016]. When we say “income” we mean earnings from work, unemployment, welfare, child support, retirement income, disability income, investment income, and any type of income even if you do not get it regularly. Please look at my computer screen [TURN COMPUTR SCREEN TOWARDS RESPONDENT] and tell me which types of income were received by people in your household in the last 12 months. SELECT ALL THAT APPLY.

IF NECESSARY: SNAP BENEFITS ARE NOT COUNTED AS INCOME.

1 EARNINGS FROM WORK 2 UNEMPLOYMENT COMPENSATION 3 WORKERS COMPENSATION 4 DISABILITY OR SSI 5 SOCIAL SECURITY 6 PENSIONS AND RETIREMENT INCOME 7 CHILD SUPPORT

8 ALIMONY 9 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) 10 PUBLIC ASSISTANCE (NOT INCLUDING TANF) 11 INVESTMENT INCOME 12 OTHER 97 DON’T KNOW 98 REFUSED

Q10. Thinking about your household’s income from [IF Q9>=1 AND Q9<=11: LIST INCOME SOURCES IN Q9; IF Q9 IN (97,98): all sources], in the last 12 months, which group corresponds to your household total income in the 12 months, before taxes? [IF MORE THAN ONE PERSON IN HOUSEHOLD: Please include income from all people in your household.]

[IF HHSIZE=1]

(1) LESS THAN $15,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $15,000 TO LESS THAN $21,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $21,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE=2]

(1) LESS THAN $20,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $20,000 TO LESS THAN $29,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $29,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE=3]

(1) LESS THAN $26,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $26,000 TO LESS THAN $37,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $37,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE=4]

(1) LESS THAN $31,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $31,000 TO LESS THAN $44,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $44,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE=5]

(1) LESS THAN $36,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $36,000 TO LESS THAN $52,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $52,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE=6]

(1) LESS THAN $42,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $42,000 TO LESS THAN $60,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $60,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE=7]

(1) LESS THAN $48,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $48,000 TO LESS THAN $67,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $67,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF HHSIZE>=8]

(1) LESS THAN $53,000CAPI RECODE INCOME CATEGORY AS ‘A’AND GO TO Q11

(2) $53,000 TO LESS THAN $75,000 CAPI RECODE INCOME CATEGORY AS ‘B’ AND GO TO Q11

(3) $75,000 OR MORE CAPI RECODE INCOME CATEGORY AS ‘C’ AND GO TO Q11

(97) DON’T KNOW GO TO Q10a

(98) REFUSED GO TO Q10a

[IF Q10 IN (1, 2, 3), GO TO Q11. IF Q10 IN (97, 98), GO TO Q10a.]

Q10a. Was it [IF HHSIZE=1, SHOW: $15,000; ELSE IF HHSIZE=2, SHOW: $20,000; ELSE IF HHSIZE=3, SHOW: $26,000; ELSE IF HHSIZE=4, SHOW: $31,000; ELSE IF HHSIZE=5, SHOW: $36,000; ELSE IF HHSIZE=6, SHOW $42,000; ELSE IF HHSIZE=7, SHOW $48,000; ELSE IF HHSIZE>=8, SHOW $53,000] or more last year?

(1) YES GO TO Q10b

(0) NO  CAPI RECORD “A” AS INCOME CATEGORY AND GO TO Q11

(97) DON’T KNOW GO TO Q10b

(98) REFUSED GO TO Q10b

[IF Q10a IN (1, 97, 98), GO TO Q10b. IF Q10a=0, GO TO Q11.]

10b. Was it [ IF HHSIZE=1, SHOW: $21,000; ELSE IF HHSIZE=2, SHOW: $29,000; ELSE IF HHSIZE=3, SHOW: $37,000; ELSE IF HHSIZE=4, SHOW: $44,000; ELSE IF HHSIZE=5, SHOW: $52,000; ELSE IF HHSIZE=6, SHOW $60,000; ELSE IF HHSIZE=7, SHOW $67,000; ELSE IF HHSIZE>=8, SHOW $75,000] or more last year?

(1) YES CAPI RECORD “C” AS INCOME CATEGORY

(0) NO CAPI RECORD “B” AS INCOME CATEGORY

(97) DON’T KNOW CAPI RECORD “DK” AS INCOME CATEGORY

(98) REFUSED CAPI RECORD “REF” AS INCOME CATEGORY

Q11. Do you or any member of your household currently receive [FILL STATE SNAP NAME]? This program puts money on an EBT card that you can use to buy food.

(1) YES

(0) NO

(97) DON’T KNOW

(98) REFUSED

State	State SNAP Name
California	CalFresh
Connecticut, Kentucky, Pennsylvania, Texas, Virginia	SNAP
Florida, Kansas, Ohio	Food Assistance Program

Q12. The WIC program - the Women, Infants, and Children program. -- provides healthy foods and other services to low-income pregnant and breastfeeding women, infants, and children up to age 5. Is anyone in your household now receiving benefits from WIC?

(1) YES

(0) NO

(97) DON’T KNOW

(98) REFUSED

Q13. USED IN 2012 BUT SAVED FOR POTENTIAL LATER USE.

Q14. USED IN 2012 BUT SAVED FOR POTENTIAL LATER USE.

Q15. Do you have a working cell phone?

(1) YES GO TO Q16

(0) NOGO TO Q17

(97) DON’T KNOW GO TO Q17

(98) REFUSED GO TO Q17

[IF Q15=1, GO TO Q16. IF Q15 IN (0, 97, 98), GO TO Q17.]

Q16. Some cell phones are called 'smartphones' because of certain features they have. Is your cell phone a smartphone or not, or are you not sure?

(1) Yes, is a smartphone

(0) No, is not a smartphone

(97) NOT SURE/DON’T KNOW

(98) REFUSED

Q17. [IF Q16=1, READ:]Who else in this household has a smartphone?

[IF Q16 IN (0, 97, 98), READ:] Who in this household has a smartphone?

[IF Q15 IN (0, 97, 98), READ:] Some cell phones are called 'smartphones' because of certain features they have. Who in this household has a smartphone?

INTERVIEWERS: CHECK ALL THAT APPLY

1. R’S SPOUSE/PARTNER

2. R’S CHILDREN

3. R’S PARENTS

4. OTHER RELATIVES IN HH

5. OTHER NON-RELATIVES IN HH

6. NO ONE ELSEGO TO Q20

[IF Q16=1 OR Q17 IN (1, 2, 3, 4, 5), THEN ASK Q18 AND Q19; ELSE GO TO Q20.]

Q18. Do the smartphones/does the smartphone in your household have a data plan?

1. YESGO TO Q19

(0) NOGO TO Q20

(97) DON’T KNOW GO TO Q20

(98) REFUSED GO TO Q20

[IF Q18=1, GO TO Q19. IF Q18 IN (0, 97, 98), GO TO Q20.]

Q19. What is the maximum amount of data allowed to use as part of the cell phone plan?

1. Below 1GB per month

2. Above 1GB per month but below 2GB per month

3. Above 2GB per month but below 4GB per month

4. Unlimited data plan

(97) DON’T KNOW

(98) REFUSED

Q20. Do you or anyone in your household own a desktop or laptop computer?

1. YES

0. NO

(97) DON’T KNOW

(98) REFUSED

Q21. Do you or anyone in your household own a tablet computer (e.g., IPad, Kindle, Microsoft Surface, Samsung Galaxy Tab, Nook, etc.)?

(1) YES

(0) NO

(97) DON’T KNOW

(98) REFUSED

Q22. (IF Q18=1, READ: Other than the data plan on your cell phone,) do you have high-speed internet service at home (such as cable internet, DSL, FIOS, or satellite internet service)?

0. YES

0. NO

(97) DON’T KNOW

(98) REFUSED

Q23. (INTERVIEWER CHECK: ) RESPONDENT RACE/ETHNICITY: CHECK ALL THAT APPLY

[1 ] WHITE

[2] BLACK OR AFRICAN AMERICAN

[3] HISPANIC

[4] AMERICAN INDIAN

[5]ASIAN

[6]OTHER

[IF Q11=1 GO TO INTERVIEWER CHECK 1; ELSE GO TO INSTRUCTION BEFORE INTERVIEWER CHECK 2]

INTERVIEWER CHECK 1 (OR CAPI CHECK?): IS SAMPLING DOMAIN “SNAP HOUSEHOLDS” OPEN?

Variable name: CHECK1

1. YES GO TO ELIGIBLE SECTION

0. NO GO TO INELIGIBLE SECTION

[IF CHECK1=1, GO TO ELIGIBLE SECTION. IF CHECK1=0, GO TO INELIGIBLE SECTION.]

[IF Q12=1 THEN GO TO INTERVIEWER CHECK 2; ELSE GO TO INSTRUCTION BEFORE INTERVIEWER CHECK 3]

INTERVIEWER CHECK 2 (OR CAPI CHECK?): IS SAMPLING DOMAIN “NON-SNAP WIC HOUSEHOLDS” OPEN?

Variable name: CHECK2

1. YES GO TO ELIGIBLE SECTION

(0) NO GO TO INELIGIBLE SECTION

[IF CHECK2=1, GO TO ELIGIBLE SECTION. IF CHECK2=0, GO TO INELIGIBLE SECTION.]

[IF INCOME CATEGORY IS A, B, OR C, THEN GO TO INTERVIEWER CHECK 3; ELSE INTERVIEWER CHECK 4]

Variable name: CHECK3

INTERVIEWER CHECK 3: IS INCOME SAMPLING DOMAIN OPEN?

(1)YES  GO TO ELIGIBLE SECTION

0. NO GO TO INELIGIBLE SECTION

[IF CHECK3=1, GO TO ELIGIBLE SECTION. IF CHECK3=0, GO TO INELIGIBLE SECTION.]

[IF INCOME CATEGORY IS DK OR REF, GO TO INTERVIEWER CHECK 4]

INTERVIEWER CHECK 4: IS SAMPLING DOMAIN “INCOME CATEGORY C” OPEN?

Variable name: CHECK4

(1)YES  GO TO ELIGIBLE SECTION

0. NO GO TO INELIGIBLE SECTION

[IF CHECK4=1, GO TO ELIGIBLE SECTION. IF CHECK4=0, GO TO INELIGIBLE SECTION.]

[INELIGIBLE SECTION]

IE1. Thank you for your time. I’m sorry your household is not eligible for the study.

(IF Q6A=0, READ IF NECESSARY: This study only includes people at their permanent residence. Based on your responses, you are not eligible for the study at this time)

READ IF NECESSARY: In order to produce a representative sample we only take households with certain characteristics. Based on your responses you are not eligible at this time.

May I have your name and telephone number in case my supervisor wants to confirm that I spoke with you?

FIRST NAME: IE1FName

LAST NAME: IE1LName

TELEPHONE: (______) -______ - ________

IE1PHONE_1 IE1PHONE_2 IE1PHONE_3

(0) NO TELEPHONE

(97) DON’T KNOW

(98) REFUSED

IE2. (INTERVIEWER CHECK: ) WHAT LANGUAGE WAS USED FOR THIS INTERVIEW?

1 ENGLISH

2 SPANISH

3 KOREAN

4 VIETNAMESE

5 CHINESE

6 TRANSLATED BY OTHER HH MEMBER

THANK AGAIN AND TERMINATE. RECORD CASE STATUS AS SCREENER COMPLETE- INELIGIBLE FOR MAIN STUDY.

[ELIGIBLE SECTION]

E1. Are you the person who does most of the shopping for food in your household?

0. YES

0. NO

(97) DON’T KNOW

(98)REFUSED

E2. Are you the person who does most of the planning or preparing of meals in your household?

IF RESPONDENT ANSWERS “SOMETIMES” OR “50/50,” ENTER YES.

(1) YES

(0) NO

(97) DON’T KNOW

(98) REFUSED

Variable name: CHECK5

INTERVIEWER CHECK #5: IS RESPONDENT THE FOOD SHOPPER (E1=YES) OR MEAL PLANNER (E2=YES)?

(1) YES GO TO CONTACT INFORMATION

(0) NO GO TO E3

[IF CHECK5 =1, GO TO CONTACT INFORMATION. IF CHECK5 =0, GO TO E3.]

E3. Your household is eligible to take part in the study, but I need to speak with the person who does most of the shopping for food in your household. What is the name of the person who does most of the shopping for food?

FIRST NAME _____________________

E4. May I speak with [FILL E3 NAME]?

0. YES  GO TO NEW RESPONDENT INTRO

(0) NO GO TO E5

(97) DON’T KNOW GO TO E5

(98) REFUSEDGO TO E5

[IF E4 =1, GO TO NEW RESPONDENT INTRO; ELSE IF E4 IN (0, 97,98), GO TO E5.]

5. What is the best telephone number to reach [FILL Q.E3 NAME]?

(______) - ______ - _______________

Area Code

E5_1 E5_2 E5_3

(0) NO TELEPHONE

(97) DON’T KNOW

(98) REFUSED

As I mentioned, your household is eligible for the study, but I need to speak with the Food Shopper or Meal Planner. I’d like to schedule a time to come back.

IF PHONE NUMBER PROVIDED: I will call [FILL Q.E3 NAME] at the phone number you provided to schedule a time to come back. When is a good time to call?

IF PHONE NUMBER NOTPROVIDED: When is a good time to come back and speak with [FILL Q.E3 NAME]?

WHEN YOU RETURN TO TALK TO THE NEW RESPONDENT START AT THE NEW RESPONDENT INTRO.

[NEW RESPONDENT INFORMATION] Hello. My name is [FILL NAME]. I work for Westat and we’re conducting the National Food Purchase Study Pilot for the U.S. Department of Agriculture. We recently sent a post card to this address. SHOW ID CARD

The National Food Purchase Study Pilot will help the USDA improve its programs by answering questions about where households get food and how much they pay for food. The addresses we visit are scientifically selected to represent all households in the country. Taking part is completely voluntary and any information that you provide will be kept completely confidential. We will use your information only for statistical purposes and your responses will not have any effect on services you currently receive or may apply for in the future.

GO TO C1

C1. Your household is eligible for this study! In this study, you will be asked to complete one 30-minute interview now or as soon as we can schedule the time, keep track of foods you get during the week, and complete one final 30-minute interview at the end. Your household will receive an incentive of $176 or more at the end of the week.

I’d like to get your contact information before we continue.

What is your name?

C1FNAME FIRST NAME ___________________________

C1LNAME LAST NAME ____________________________

C2. What is the best telephone number to reach you?

(______) - ______ - _______________

Area Code

C2_1 C2_2 C2_3

(0) NO TELEPHONE

(97) DON’T KNOW

(98) REFUSED

[IF Q16=1 OR Q17 IN (1, 2, 3, 4, 5), THEN ASK C2a. ELSE GO TO C3]

C2a. Is this your cell phone number?

(1) YES

(0) NO

C3. Is there another number where you can be reached?

(______) - ______ - _______________

Area Code

C2_1 C2_2 C2_3

(0) NO TELEPHONE GO TO C4

(97) DON’T KNOW GO TO C4

(98) REFUSED GO TO C4

[IF C3 IN (0, 97, 98), GO TO C4.]

C3a. Is this a cell phone number?

(1) YES

(0) NO

C4a. What language would you be most comfortable using for our interviews?

1 ENGLISH

2 SPANISH

3 KOREAN

4 VIETNAMESE

5 OTHER (SPECIFY

C5. Do you have time now to discuss the study and learn about what you’ll be doing for the week? This will take a little over an hour.

1 YES  CONTINUE TO INITIAL INTERVIEW AND TRAINING. RECORD CASE STATUS AS SCREENER COMPLETE ELIGIBLE FOR MAIN STUDY.

2 NO, NO TIME NOW  SCHEDULE A TIME FOR THE INITIAL INTERVIEW AND TRAINING. RECORD CASE STATUS AS SCREENER COMPLETE ELIGIBLE FOR MAIN STUDY.

3 NO, REFUSED TO PARTICIPATE.  GO TO NONRESPONSE TO MAIN STUDY SECTION. RECORD CASE STATUS AS SCREENER COMPLETE ELIGIBLE FOR MAIN STUDY.

[IF C5=1, CONTINUE TO INITIAL INTERVIEW AND TRAINING. RECORD CASE STATUS AS SCREENER COMPLETE ELIGIBLE FOR MAIN STUDY.]

[IF C5=2, SCHEDULE A TIME FOR THE INITIAL INTERVIEW AND TRAINING. RECORD CASE STATUS AS SCREENER COMPLETE ELIGIBLE FOR MAIN STUDY.]

[IF C5=3, GO TO NONRESPONSE TO MAIN STUDY SECTION. RECORD CASE STATUS AS SCREENER COMPLETE ELIGIBLE FOR MAIN STUDY.]

1 IMS stands for Westat’s Interview Management System.

2 Respondents will not see the question number as this is an interviewer administered instrument. The 2012 instrument was the starting point for development and questions were not renumbered to save time.