Households: M - Household Survey
Third Access, Participation, Eligibility and Certification Study Series (APEC III)
rev062112 Attachment M.2-Household_Survey_Spanish
Households: M - Household Survey
OMB: 0584-0530
M.2
HOUSEHOLD SURVEY SPANISH
OMB
Approval No.: 0584-0530
Approval
Expires:
NATIONAL SCHOOL LUNCH AND SCHOOL BREAKFAST PROGRAM ACCESS, PARTICIPATION, ELIGIBILITY, AND CERTIFICATION STUDY (APEC-II)
HOUSEHOLD QUESTIONNAIRE
SPANISH VERSION
April 23, 2012
-
CASE ID NUMBER: | | | | | | | | |
DATE: | | | / | | | / | 2 | 0 | 1 | |
MONTH DAY YEAR
INTERVIEWER ID NUMBER: | | | | | |
TIME INTERVIEW BEGAN: | | |:| | | AM 1
HOUR MINUTE PM 2
De
acuerdo con el Acto de Reducción
de Papeleo
de 1995 (Paperwork Reduction Act of 1995), ninguna
persona es requerida a responder a una recolección de
información si no despliega un válido número de
control de OMB. El válido número de control de OMB
para esta recolección de información es 0584-0530.
El tiempo requerido para completar esta recolección de
información es calculada en un promedio de 45 minutos por
respuesta, incluyendo el tiempo para revisar instrucciones, buscar
en recursos de datos existentes, recopilar los datos necesitados y
completar y revisar la recolección de información.
SECTION A: INTRODUCTION |
A1. INTRODUCTION WHEN CALLING TO MAKE AN APPOINTMENT: Hola, mi nombre es INTERVIEWER’S FULL NAME y estoy llamando de parte del Estudio de Comidas Escolares del Departamento de Agricultura de los Estados Unidos. Recientemente le enviamos a (usted/PARENT FROM APPLICATION FORM) una carta describiendo el estudio. Quisiera fijar una cita con (usted/PARENT FROM APPLICATION FORM/el padre o la madre de TARGET CHILD) para venir a su hogar y entrevistarle sobre sus experiencias con los programas de comidas escolares. ¿Puedo hablar con (él/ella)?
INTERVIEWER: ATTEMPT APPOINTMENT. MENTION $25.00 GIFT CARD TO PARENT.
IF APPOINTMENT MADE—RECORD ON CONTACT
SHEET AND POLITELY THANK RESPONDENT AND
TERMINATE CALL (RECORD ON CONTACT SHEET) 1
WANTS TO KNOW MORE ABOUT THE STUDY (GO TO A2) 2
DID NOT GET LETTER—VERIFY
ADDRESS AND OFFER TO BRING
OR SEND LETTER (RECORD OUTCOME ON CONTACT SHEET) 3
HOW DID YOU GET MY NAME OR NUMBER (GO TO A3) 4
DO INTERVIEW NOW (TELEPHONE ONLY) (GO TO B1) 5
TARGET CHILD DECEASED (GO TO B7) 6
PARENT FROM APPLICATION
FORM DECEASED (GO TO B7) 7
NOT INTERESTED—RECORD ON
CONTACT SHEET AND TERMINATE
CALL (RECORD ON CONTACT SHEET) 8
A2. El Departamento de Agricultura de los Estados Unidos está interesado en aprender sobre la participación de padres y madres en el programa de comidas escolares. Para hacer esto hemos seleccionado a una muestra de estudiantes cuyos padres solicitaron al programa de comidas escolares, y quisiéramos hablar con los padres de esos estudiantes para averiguar acerca de sus experiencias con el programa de comidas y de la participación de sus hijos e hijas. TARGET CHILD fue seleccionado(a) al azar. La entrevista generalmente toma unos 45 minutos, y le daremos una tarjeta de regalo de $25.00 cuando se haya completado. ¿Cuándo sería un buen tiempo para fijar una cita para la entrevista en su hogar?
IF APPOINTMENT MADE—RECORD
ON CONTACT SHEET AND POLITELY
THANK RESPONDENT AND
TERMINATE CALL 1
NOT INTERESTED—RECORD
SITUATION ON CONTACT SHEET
AND POLITELY TERMINATE CALL 2
A3. Recibimos su nombre de listas de padres que solicitaron para el programa de comidas escolares para este año escolar. Seleccionamos a TARGET CHILD al azar y quisiéramos entrevistar a sus padres sobre sus experiencias con el programa de comidas. La entrevista generalmente toma unos 45 minutos, y le daremos una tarjeta de regalo de $25.00 cuando se haya completado. ¿Cuándo sería un buen tiempo para fijar una cita para la entrevista en su hogar?
IF APPOINTMENT MADE—RECORD
ON CONTACT SHEET AND POLITELY
THANK RESPONDENT AND
TERMINATE CALL 1
NOT INTERESTED—RECORD
SITUATION ON CONTACT SHEET
AND POLITELY TERMINATE CALL 2
A4. INTRODUCTION WHEN AT RESPONDENT’S HOME: Hola. ¿Puedo hablar con PARENT FROM APPLICATION FORM? Mi nombre es INTERVIEWER’S FULL NAME y estoy aquí de parte del Estudio de Comidas Escolares del Departamento de Agricultura de los Estados Unidos. El estudio ayudará al Departamento de Agricultura o USDA entender las experiencias de la gente con los programas y la participación de sus hijos e hijas en programas de comidas escolares.
WHEN PARENT ON APPLICATION FORM PRESENT: Estamos entrevistando a los padres de niños y niñas que asistieron a la escuela en el distrito escolar DISTRICT. Usted fue seleccionado(a) al azar para participar en esta encuesta porque usted solicitó para el almuerzo o para el desayuno escolar para TARGET CHILD. Usted recibirá una tarjeta de regalo de $25.00 por completar la encuesta.
La participación en este estudio es voluntaria y no afectará a ningún beneficio que usted pueda estar recibiendo. Toda la información es privada y no será usada en cualquier manera que pueda identificar a usted o a su hijo o hija. Quisiera empezar la entrevista ahora.
YES (GO TO B1) 1
NOT A GOOD TIME, SCHEDULE REVISIT 2
REFUSED OR NOT INTERESTED—
RECORD SITUATION ON CONTACT
AND TERMINATE INTERVIEW 3
NOT SURE ABOUT DOING
THE SURVEY OR HAS
QUESTIONS (GO TO A5) 4
NAMED PERSON NOT AVAILABLE
OR NOT CORRECT—RECORD
SITUATION ON CONTACT SHEET
AND TERMINATE INTERVIEW 5
NO LONGER HAS CUSTODY
OF FOSTER CHILD—ATTEMPT
INTERVIEW 6
STUDENT RESIDES IN GROUP HOME—
ATTEMPT INTERVIEW 7
SAMPLED CHILD NOW LIVES WITH
ANOTHER PARENT OR GUARDIAN—
ATTEMPT INTERVIEW 8
TARGET CHILD DECEASED (GO TO B7) n
A5. INFORMATION SCREEN FOR NSLP AND SBP APEC-II STUDY
WHAT IS THE PURPOSE OF THE STUDY? / ¿CUÁL ES EL PROPÓSITO DEL ESTUDIO?
El Departamento de Agricultura de los Estados Unidos está interesado en aprender sobre la participación de niños en programas de comidas escolares y las percepciones de la calidad de programas de comidas.
MY CHILD DOES NOT EAT SCHOOL MEALS / MI HIJO(A) NO COME COMIDAS ESCOLARES
Aunque su hijo o hija nunca ha tomado un desayuno escolar o comido un almuerzo escolar, necesitamos información sobre por qué usted no participa. Esto nos ayudará a entender cómo los programas de desayuno y almuerzo escolar están funcionando en su distrito escolar.
HOW DID YOU GET MY NAME? WHY SHOULD I PARTICIPATE? / ¿CÓMO OBTUVO MI NOMBRE? ¿POR QUÉ DEBO PARTICIPAR?
Familias con niños matriculados en el distrito escolar de su hijo o hija fueron seleccionadas al azar de una lista proporcionada por la escuela de su hijo o hija de quién solicitó beneficios de comidas. La información que usted proporcione ayudará a proveer un retrato preciso de las experiencias de hogares con el programa de comidas escolares.
AM I REQUIRED TO PARTICIPATE? / ¿ESTOY OBLIGADO(A) A PARTICIPAR?
Su participación en la encuesta es completamente voluntaria y no afectará a su elegibilidad o a la elegibilidad de su hijo o hija para comidas escolares o para cualquier otro programa. Usted puede negarse a contestar cualquier pregunta durante la entrevista. Sin embargo, sus experiencias y opiniones son muy importantes para el estudio y para el éxito del programa. Le daré una tarjeta de regalo con un valor de $25.00 cuando la entrevista ha sido completada.
I HAVE OTHER CHILDREN WHO ATTEND SCHOOL IN THE DISTRICT, BUT YOU DID NOT NAME THEM / TENGO OTROS NIÑOS QUE ASISTEN A LA ESCUELA EN EL DISTRITO, PERO USTED NO DIJO SUS NOMBRES
Solamente hemos identificado a un niño o niña matriculado por hogar que estamos contactando en el distrito para hacer las preguntas. Para los propósitos de esta encuesta, todas las preguntas que le hacemos son en referencia a TARGET CHILD.
I DO NOT HAVE THE TIME FOR THE SURVEY / NO TENGO TIEMPO PARA LA ENCUESTA
Entiendo el valor que tiene su tiempo. Esta encuesta solamente tomará unos 45 minutos, podemos tratar de hacerla ahora o si este momento no le es conveniente puedo hacer arreglos para volver a una hora que es mejor para usted.
I AM NOT SATISFIED WITH THE SCHOOL MEAL PROGRAM /NO ESTOY SATISFECHA(O) CON EL PROGRAMA DE COMIDAS ESCOLARES
Esa es una buena razón para hacer la encuesta. Sus comentarios serán especialmente importantes porque el Departamento de Agricultura de los Estados Unidos está interesado en las diferentes perspectivas de personas que usan el programa de comidas escolares o lo han usado en el pasado.
IS THE SURVEY PRIVATE? / ¿LA ENCUESTA ES PRIVADA?
Sí. Toda la información que recolectamos en la encuesta es completamente privada en la plena medida permitida por ley y solamente será usada para propósitos de estudio. Sus respuestas serán combinadas con las respuestas de otros participantes en al encuesta y nunca serán vinculadas con su nombre o con el nombre de su hijo o hija en cualquier reporte.
HOW LONG WILL THE SURVEY TAKE? / ¿CUÁNTO TIEMPO TOMARÁ LA ENCUESTA?
La duración de la entrevista es diferente para personas diferentes, pero generalmente toma unos 40 a 45 minutos.
WHY CAN’T YOU DO THE INTERVIEW BY TELEPHONE OR WHY DO YOU HAVE TO COME TO MY HOME? / ¿POR QUÉ NO PUEDE HACER LA ENTREVISTA POR TELÉFONO? O ¿POR QUÉ NECESITA VENIR A MI HOGAR?
Algunas de las preguntas de la encuesta quizás requerirán que usted busque alguna información, lo que tomaría demasiado tiempo por teléfono. El entrevistador o la entrevistadora también necesitará ver algunos documentos como parte de la encuesta.
WHAT IS THE INTERVIEW ABOUT? / ¿SOBRE QUÉ ES LA ENTREVISTA?
La persona que le entrevistará a usted posiblemente le preguntará sobre participación en los programas de desayuno y almuerzo escolar, percepciones de las comidas escolares y del tamaño de su hogar y sus ingresos. Recuerde, toda la información es completamente privada. La información que usted provea no afectará a los reembolsos por comida que su escuela recibe ni a la elegibilidad de su hijo o hija para recibir beneficios de comidas escolares.
WHY ARE YOU ASKING ABOUT INCOME? / ¿POR QUÉ ESTÁ PREGUNTANDO SOBRE INGRESOS?
La información sobre ingresos ayudará a documentar la precisión de los distritos escolares en la administración de programas de comidas escolares. Le estaremos pidiendo su permiso para examinar registros de ingresos y elegibilidad. Su permiso es importante para el éxito de este estudio. Recuerde, toda la información es completamente privada. La información que usted provea no afectará a los reembolsos por comida que su escuela recibe ni a la elegibilidad de su hijo o hija para recibir beneficios de comidas escolares.
WHO WILL COME TO MY HOME? / ¿QUIÉN VENDRÁ A MI HOGAR?
Un entrevistador o una entrevistadora que trabaja para (Mathematica)(DIR) vendrá a su hogar en la fecha y a la hora que usted haya acordado. El entrevistador o la entrevistadora tendrá una placa de identificación que dice que él o ella trabaja para (Mathematica)(DIR).
WHEN WILL I RECEIVE MY PAYMENT? / ¿CÓMO RECIBIRÉ MI PAGO?
El entrevistador o la entrevistadora DE (Mathematica)(DIR) le dará su tarjeta de regalo después de completar la entrevista.
SECTION B: ENROLLMENT STATUS |
B1. CODE WITHOUT ASKING IF KNOWN OR ASK: ¿Es TARGET CHILD niña o niño?
MALE 1
FEMALE 2
DOES NOT KNOW d
REFUSED r
B2. ¿Actualmente TARGET CHILD asiste a TARGET SCHOOL?
YES (GO TO B5) 1
NO 0
DOES NOT KNOW (GO TO D0) d
REFUSED (GO TO D0) r
B3. ¿A qué escuela asiste ahora?
SCHOOL NAME AND ADDRESS
CHILD DROPPED OUT OF SCHOOL 1
CHILD DECEASED (GO TO B7) 2
DOES NOT KNOW d
REFUSED r
B4. ¿Cuándo dejó (ella/él) de asistir a TARGET SCHOOL?
| | | / | | | / | | |
MONTH DAY YEAR
DOES NOT KNOW d
REFUSED r
B5. ¿Cuándo comenzó (ella/él) a asistir a TARGET SCHOOL este año escolar?
PROBE: Cuando digo ""este año escolar"" quiero decir el año escolar actual de
2012-2013.
PROBE: ¿Fue al principio, en el medio o al final del mes? IF BEGINNING ENTER 5, IF MIDDLE ENTER 15, IF END ENTER 25.
| | | / | | | / | | | (GO TO D0)
MONTH DAY YEAR
FIRST DAY OF SCHOOL (GO TO D0) f
NEVER ATTENDED THIS YEAR n
DOES NOT KNOW (GO TO D0) d
REFUSED (GO TO D0) r
B6. INTERVIEWER: IF B5 EQUALS “NEVER ATTENDED THIS YEAR” THEN TERMINATE INTERVIEW AND REPORT DISPOSITION TO YOUR SUPERVISOR. FOR ALL OTHER SITUATIONS, PROCEED TO D1 AND CONDUCT INTERVIEW.
B7. Lamento mucho su perdida. Muchas gracias por su tiempo. No vamos a hacer la entrevista. INTERVIEWER TERMINATE CALL.
NO SECTION C IN THIS DOCUMENT
SECTION D: PARTICIPATION IN SCHOOL LUNCH AND BREAKFAST PROGRAMS |
D0. INTERVIEWER: CHECK B2. HAS TARGET CHILD LEFT TARGET SCHOOL? DOES B2 EQUAL “0”?
YES (GO TO D71) 1
NO 0
D1. Las siguientes preguntas son sobre las comidas que TARGET CHILD come en la escuela.
Le voy a preguntar si su hija(o) tomó un desayuno escolar o comió un almuerzo escolar (ayer/el viernes), y luego le preguntaré sobre cada día durante la semana pasada. Al decir desayuno o almuerzo escolar, me refiero a las comidas que la escuela de su hija(o) provee a estudiantes bajo el Programa de Desayuno Escolar y Almuerzo Escolar. Las comidas escolares son comidas que están en el menú (gratis/por un solo precio), opuesto a comidas individuales tales como ensaladas, carnes y postres, que tienen precios separados y se compran por separado.
¿Asistió (ella/él) a la escuela (ayer/el viernes pasado)?
YES 1
NO (GO TO D9a) 0
DOES NOT KNOW (GO TO D9a) d
REFUSED (GO TO D9a) r
D2. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D5) 0
DOES NOT KNOW (GO TO D5) d
REFUSED (GO TO D5) r
D3. ¿Tomó TARGET CHILD desayuno en la escuela (ayer/el viernes)? Incluya
desayuno servido en el ómnibus escolar?.
YES 1
NO (GO TO D5) 0
DOES NOT KNOW (GO TO D5) d
REFUSED (GO TO D5) r
D4. ¿Fue ese el desayuno escolar, o su hija(o) obtuvo el desayuno de otra forma?
PROBE: Por desayuno escolar nos referimos a la comida recibida del Programa de Desayuno Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL BREAKFAST (GO TO D5) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D5. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL LUNCH PROGRAM (SLP)?
YES 1
NO (GO TO D9a) 0
DOES NOT KNOW (GO TO D9a) d
REFUSED (GO TO D9a) r
NO D6 IN THIS DOCUMENT
D7. ¿Comió (ella/él) almuerzo en la escuela (ayer/el último viernes)?
YES 1
NO (GO TO D9a) 0
DOES NOT KNOW (GO TO D9a) d
REFUSED (GO TO D9a) r
D8. ¿Fue ese el almuerzo escolar, o su hija(o) obtuvo el almuerzo de otra forma?
PROBE: Por almuerzo escolar nos referimos a la comida recibida del Programa de Almuerzo Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL LUNCH 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D9a. CODE WITHOUT ASKING IF KNOWN:
¿Cuándo fue la última semana completa de clases?
LAST WEEK 1
FROM | | | | | | TO | | | | | |
DAY MONTH DAY MONTH
DOES NOT KNOW d
REFUSED r
D9b. Ahora piense por favor en la última semana completa de clases - eso sería
(de lunes a viernes de la semana pasada/de lunes - DATE a viernes - DATE). Le preguntaré si TARGET CHILD tomó o comió (desayuno/almuerzo/desayuno o almuerzo) en la escuela todos los días, y qué es lo que comió. (Aquí tiene un menú con las comidas ofrecidas en la escuela para ayudarle a recordar lo que (ella/él) puede haber comido.)
¿Asistió (ella/él) a la escuela (el último lunes/el lunes DATE)?
YES 1
NO (GO TO D17) 0
DOES NOT KNOW (GO TO D17) d
REFUSED (GO TO D17) r
D10. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D13) 0
DOES NOT KNOW (GO TO D13) d
REFUSED (GO TO D13) r
D11. ¿Tomó TARGET CHILD desayuno en la escuela (el último lunes/el lunes DATE)?
YES 1
NO (GO TO D13) 0
DOES NOT KNOW (GO TO D13) d
REFUSED (GO TO D13) r
D12. ¿Fue ese el desayuno escolar, o su hija(o) obtuvo el desayuno de otra forma?
PROBE: Por desayuno escolar nos referimos a la comida recibida del Programa de Desayuno Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL BREAKFAST (GO TO D13) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D13. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL LUNCH PROGRAM (SLP)?
YES 1
NO (GO TO D17) 0
DOES NOT KNOW (GO TO D17) d
REFUSED (GO TO D17) r
NO D14 IN THIS DOCUMENT
D15. ¿Comió (ella/él) almuerzo en la escuela (el último lunes/el lunes DATE)?
YES 1
NO (GO TO D17) 0
DOES NOT KNOW (GO TO D17) d
REFUSED (GO TO D17) r
D16. ¿Fue ese el almuerzo escolar, o su hija(o) obtuvo el almuerzo de otra forma?
PROBE: Por almuerzo escolar nos referimos a la comida recibida del Programa de Almuerzo Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL LUNCH (GO TO D18) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D17. ¿Asistió (ella/él) a la escuela (el último martes/el martes DATE)?
YES 1
NO (GO TO D25) 0
DOES NOT KNOW (GO TO D25) d
REFUSED (GO TO D25) r
D18. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D21) 0
DOES NOT KNOW (GO TO D21) d
REFUSED (GO TO D21) r
D19. ¿Tomó (ella/él) el desayuno en la escuela (el último martes/el martes DATE)?
YES 1
NO (GO TO D21) 0
DOES NOT KNOW (GO TO D21) d
REFUSED (GO TO D21) r
D20. ¿Fue ese el desayuno escolar, o su hija(o) obtuvo el desayuno de otra forma?
PROBE: Por desayuno escolar nos referimos a la comida recibida del Programa de Desayuno Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL BREAKFAST (GO TO D21) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D21. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL LUNCH PROGRAM (SLP)?
YES 1
NO (GO TO D25) 0
DOES NOT KNOW (GO TO D25) d
REFUSED (GO TO D25) r
NO D22 IN THIS DOCUMENT
D23. ¿Comió (ella/él) almuerzo en la escuela (el último martes/el martes DATE)?
YES 1
NO (GO TO D25) 0
DOES NOT KNOW (GO TO D25) d
REFUSED (GO TO D25) r
D24a. ¿Fue ese el almuerzo escolar, o su hija(o) obtuvo el almuerzo de otra forma?
PROBE: Por almuerzo escolar nos referimos a la comida recibida del Programa de Almuerzo Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL LUNCH (GO TO D26) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D25. ¿Asistió (ella/él) a la escuela (el último miércoles/el miércoles DATE)?
YES 1
NO (GO TO D33) 0
DOES NOT KNOW (GO TO D33) d
REFUSED (GO TO D33) r
D26. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D29) 0
DOES NOT KNOW (GO TO D29) d
REFUSED (GO TO D29) r
D27. ¿Tomó (ella/él) el desayuno en la escuela (el último miércoles/el miércoles DATE)?
YES 1
NO (GO TO D29) 0
DOES NOT KNOW (GO TO D29) d
REFUSED (GO TO D29) r
D28a. ¿Fue ese el desayuno escolar, o su hija(o) obtuvo el desayuno de otra forma?
PROBE: Por desayuno escolar nos referimos a la comida recibida del Programa de Desayuno Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL BREAKFAST (GO TO D29) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D29. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL LUNCH PROGRAM (SLP)?
YES 1
NO (GO TO D33) 0
DOES NOT KNOW (GO TO D33) d
REFUSED (GO TO D33) r
NO D30 IN THIS DOCUMENT
D31. ¿Comió (ella/él) almuerzo en la escuela (el último miércoles/el miércoles DATE)?
YES 1
NO (GO TO D33) 0
DOES NOT KNOW (GO TO D33) d
REFUSED (GO TO D33) r
D32a. ¿Fue ese el almuerzo escolar, o su hija(o) obtuvo el almuerzo de otra forma?
PROBE: Por almuerzo escolar nos referimos a la comida recibida del Programa de Almuerzo Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL LUNCH (GO TO D34) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D33. ¿Asistió (ella/él) a la escuela (el último jueves/el jueves DATE)?
YES 1
NO (GO TO D41) 0
DOES NOT KNOW (GO TO D41) d
REFUSED (GO TO D41) r
D34. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D37) 0
DOES NOT KNOW (GO TO D37) d
REFUSED (GO TO D37) r
D35. ¿Tomó (ella/él) el desayuno en la escuela (el último jueves/el jueves DATE)?
YES 1
NO (GO TO D37) 0
DOES NOT KNOW (GO TO D37) d
REFUSED (GO TO D37) r
D36a. ¿Fue ese el desayuno escolar, o su hija(o) obtuvo el desayuno de otra forma?
PROBE: Por desayuno escolar nos referimos a la comida recibida del Programa de Desayuno Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL BREAKFAST (GO TO D37) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D37. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL LUNCH PROGRAM (SLP)?
YES 1
NO (GO TO D41) 0
DOES NOT KNOW (GO TO D41) d
REFUSED (GO TO D41) r
NO D38 IN THIS DOCUMENT
D39. ¿Comió (ella/él) almuerzo en la escuela (el último jueves/el jueves DATE)?
YES 1
NO (GO TO D41) 0
DOES NOT KNOW (GO TO D41) d
REFUSED (GO TO D41) r
D40a. ¿Fue ese el almuerzo escolar, o su hija(o) obtuvo el almuerzo de otra forma?
PROBE: Por almuerzo escolar nos referimos a la comida recibida del Programa de Almuerzo Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL LUNCH (GO TO D41) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D41. INTERVIEWER: IS THE INTERVIEW BEING ADMINISTERED ON A MONDAY OR ON THE WEEKEND? DID WE ALREADY ASK ABOUT FRIDAY AT QUESTIONS D1 THROUGH D8?
YES (GO TO D50) 1
NO 0
D42. ¿Asistió (ella/él) a la escuela (el último viernes/el viernes DATE)?
YES 1
NO (GO TO D50) 0
DOES NOT KNOW (GO TO D50) d
REFUSED (GO TO D50) r
D43. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D46) 0
DOES NOT KNOW (GO TO D46) d
REFUSED (GO TO D46) r
D44. ¿Tomó (ella/él) el desayuno en la escuela (el último viernes/el viernes DATE)?
YES 1
NO (GO TO D46) 0
DOES NOT KNOW (GO TO D46) d
REFUSED (GO TO D46) r
D45a. ¿Fue ese el desayuno escolar, o su hija(o) obtuvo el desayuno de otra forma?
PROBE: Por desayuno escolar nos referimos a la comida recibida del Programa de Desayuno Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado.
HAD SCHOOL BREAKFAST (GO TO D46) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D46. INTERVIEWER: CHECK CONTACT SHEET. DOES TARGET CHILD’S SCHOOL HAVE A SCHOOL LUNCH PROGRAM (SLP)?
YES 1
NO (GO TO D50) 0
DOES NOT KNOW (GO TO D50) d
REFUSED (GO TO D50) r
NO D47 IN THIS DOCUMENT
D48. ¿Comió (ella/él) almuerzo en la escuela (el último viernes/el viernes DATE)?
YES 1
NO (GO TO D50) 0
DOES NOT KNOW (GO TO D50) d
REFUSED (GO TO D50) r
D49a. ¿Fue ese el almuerzo escolar, o su hija(o) obtuvo el almuerzo de otra forma?
PROBE: Por almuerzo escolar nos referimos a la comida recibida del Programa de Almuerzo Escolar que consiste de una serie de artículos alimenticios del menú que eran gratis, o si fueron comprados, fue por un precio único, opuesto a comidas individuales que tienen precios separados y se compran por separado..
HAD SCHOOL LUNCH (GO TO D50) 1
HAD SOMETHING ELSE 0
DOES NOT KNOW d
REFUSED r
D50. INTERVIEWER: CHECK CONTACT SHEET. DOES THE TARGET CHILD’S SCHOOL HAVE A SCHOOL BREAKFAST PROGRAM (SBP)?
YES 1
NO (GO TO D60) 0
DOES NOT KNOW (GO TO D60) d
REFUSED (GO TO D60) r
D51. INTERVIEWER: DID THE TARGET CHILD PARTICIPATE IN THE SBP ON ANY DAY IN THE TARGET WEEK? ARE ANY QUESTIONS D4, D12, D20, D28, D36, AND D45 EQUAL TO “1”?
YES (GO TO D55) 1
NO 0
D52. Usted acaba de mencionar que TARGET CHILD no obtuvo el desayuno escolar en ninguno de los días que (ella/él) asistió a la escuela (la semana pasada/durante la última semana que (ella/él) asistió a la escuela).
¿Por qué (ella/él) no obtuvo el desayuno escolar (la semana pasada/durante esa semana)?
AFTER RESPONSE, SAY: ¿Hubieron otras razones por las cuales no tomó el desayuno escolar (la semana pasada/esa semana)?
PROBE: El desayuno escolar completo.
CIRCLE ALL
THAT APPLY
EATS BREAKFAST AT HOME 1
BRINGS BREAKFAST FROM HOME 2
DOES NOT LIKE THE FOOD AT SCHOOL 3
NOT ENOUGH TIME TO EAT AT SCHOOL 4
CHILD DOES NOT EAT BREAKFAST 5
ON A DIET 6
DOES NOT LIKE WAITING IN LINE 7
CHILD THINKS ONLY NEEDY CHILDREN
EAT SCHOOL BREAKFASTS 8
CHILD DOES NOT EAT SCHOOL BREAKFAST
BECAUSE FRIENDS DO NOT EAT IT 9
NOT IN SCHOOL THAT WEEK/
OUT SICK ALL WEEK 10
LATE FOR SCHOOL EVERY DAY
THAT WEEK 11
HAD EARLY MORNING CLASSES
THAT WEEK 12
CHILD OR PARENT TOO EMBARRASSED
TO PARTICIPATE 13
OTHER (SPECIFY) 14
DOES NOT KNOW d
REFUSED r
D53. INTERVIEWER: IS THERE MORE THAN ONE ANSWER TO D52?
YES 1
NO (GO TO D59) 0
D54. ¿Cuál es la razón más importante por la que (ella/él) no obtuvo el desayuno escolar (la semana pasada/esa semana)?
EATS BREAKFAST AT HOME 1
BRINGS BREAKFAST FROM HOME 2
DOES NOT LIKE THE FOOD AT SCHOOL 3
NOT ENOUGH TIME TO EAT AT SCHOOL 4
CHILD DOES NOT EAT BREAKFAST 5
ON A DIET 6
DOES NOT LIKE WAITING IN LINE 7
CHILD THINKS ONLY NEEDY CHILDREN
EAT SCHOOL BREAKFASTS 8
CHILD DOES NOT EAT SCHOOL BREAKFAST
BECAUSE FRIENDS DO NOT EAT IT 9
NOT IN SCHOOL THAT WEEK/
OUT SICK ALL WEEK 10
LATE FOR SCHOOL EVERY DAY
THAT WEEK 11
HAD EARLY MORNING CLASSES
THAT WEEK 12
CHILD OR PARENT TOO EMBARRASSED
TO PARTICIPATE 13
OTHER (SPECIFY) 14
DOES NOT KNOW d
REFUSED r
GO TO D59 |
D55. INTERVIEWER: DID THE TARGET CHILD GET THE SCHOOL BREAKFAST ON EVERY DAY (SHE/HE) ATTENDED SCHOOL IN THE TARGET WEEK? WHEN D9b EQUALS “1” DOES D12 EQUAL “1” AND WHEN D17 EQUALS “1” DOES D20 EQUAL “‘1” AND WHEN D25 EQUALS “1” DOES D28 EQUAL “1” AND WHEN D33 EQUALS “1” DOES D36 EQUAL “1” AND WHEN D42 EQUALS “1” DOES D45 EQUAL “1”?
YES (GO TO D60) 1
NO 0
D56. Usted mencionó que TARGET CHILD no obtuvo el desayuno escolar todos los
días que (ella/él) asistió a la escuela (la semana pasada/durante su última semana en la escuela). ¿Por qué (ella/él) no obtuvo el desayuno escolar todos los días que (ella/él) asistió a la escuela esa semana?
AFTER RESPONSE, SAY: ¿Hubieron algunas otras razones?
CIRCLE ALL
THAT APPLY
ATE BREAKFAST AT HOME 1
BROUGHT BREAKFAST FROM HOME 2
DOES NOT ALWAYS LIKE THE
FOOD SERVED 3
WAS NOT IN SCHOOL ON THAT
OR THOSE DAYS/OUT SICK 4
WAS LATE FOR SCHOOL 5
HAD EARLY MORNING CLASSES
OR PROGRAMS 6
EARLY DISMISSAL OR STUDENT LEFT
SCHOOL EARLY 7
SCHOOL CLOSED ALL DAY 8
OTHER (SPECIFY) 9
DOES NOT KNOW d
REFUSED r
D57. INTERVIEWER: IS THERE MORE THAN ONE ANSWER TO D56?
YES 1
NO (GO TO D59) 0
D58. ¿Cuál es la razón más importante por la que (ella/él) no obtuvo el desayuno escolar en esos días?
ATE BREAKFAST AT HOME 1
BROUGHT BREAKFAST FROM HOME 2
DOES NOT ALWAYS LIKE THE
FOOD SERVED 3
WAS NOT IN SCHOOL ON THAT
OR THOSE DAYS/OUT SICK 4
WAS LATE FOR SCHOOL 5
HAD EARLY MORNING CLASSES
OR PROGRAMS 6
EARLY DISMISSAL OR STUDENT LEFT
SCHOOL EARLY 7
SCHOOL CLOSED ALL DAY 8
OTHER (SPECIFY) 9
DOES NOT KNOW d
REFUSED r
NO D59 IN THIS DOCUMENT
D60. INTERVIEWER: CHECK CONTACT SHEET. DOES THE TARGET CHILD’S SCHOOL HAVE A NATIONAL SCHOOL LUNCH PROGRAM (NSLP)?
YES 1
NO (GO TO D70) 0
DOES NOT KNOW (GO TO D70) d
REFUSED (GO TO D70) r
D61. INTERVIEWER: DID THE TARGET CHILD PARTICIPATE IN THE NSLP ON ANY DAYS IN THE TARGET WEEK? ARE ANY QUESTIONS D8, D16, D24, D32, D40, AND D49 EQUAL TO “1”?
YES (GO TO D65) 1
NO 0
D62. Usted mencionó que TARGET CHILD no obtuvo el almuerzo escolar en ninguno de los días que (ella/él) asistió a la escuela. ¿Por qué (ella/él) no obtuvo el almuerzo
escolar (la semana pasada/durante esa semana)?
AFTER RESPONSE, SAY: ¿Hubieron otras razones por las cuales no comió el almuerzo escolar (la semana pasada/esa semana)?
PROBE: El almuerzo escolar completo.
CIRCLE ALL
THAT APPLY
PREFERS TO BRING LUNCH FROM HOME 1
EATS LUNCH AT HOME 2
DOES NOT LIKE THE FOOD AT SCHOOL 3
NOT ENOUGH TIME TO EAT AT SCHOOL 4
CHILD DOES NOT EAT LUNCH 5
ON A DIET 6
DOES NOT LIKE WAITING IN LINE 7
CHILD THINKS ONLY NEEDY CHILDREN
EAT SCHOOL LUNCHES 8
CHILD DOES NOT EAT SCHOOL LUNCH
BECAUSE FRIENDS DO NOT EAT IT 9
NOT IN SCHOOL THAT WEEK/
SICK ALL WEEK 10
LATE FOR SCHOOL EVERY DAY
THAT WEEK 11
HAD CLASSES DURING LUNCH PERIOD
THAT WEEK 12
CHILD OR PARENT TOO EMBARRASSED
TO PARTICIPATE 13
OTHER (SPECIFY) 14
DOES NOT KNOW d
REFUSED r
D63. INTERVIEWER: IS THERE MORE THAN ONE ANSWER IN D62?
YES 1
NO (GO TO D69) 0
D64. ¿Cuál es la razón más importante por la que no obtuvo el almuerzo escolar (la semana pasada/esa semana)?
PREFERS TO BRING LUNCH FROM HOME 1
EATS LUNCH AT HOME 2
DOES NOT LIKE THE FOOD AT SCHOOL 3
NOT ENOUGH TIME TO EAT AT SCHOOL 4
CHILD DOES NOT EAT LUNCH 5
ON A DIET 6
DOES NOT LIKE WAITING IN LINE 7
CHILD THINKS ONLY NEEDY CHILDREN
EAT SCHOOL LUNCHES 8
CHILD DOES NOT EAT SCHOOL LUNCH
BECAUSE FRIENDS DO NOT EAT IT 9
NOT IN SCHOOL THAT WEEK/
OUT SICK ALL WEEK 10
LATE FOR SCHOOL EVERY DAY
THAT WEEK 11
HAD CLASSES DURING LUNCH PERIOD
THAT WEEK 12
CHILD OR PARENT TOO EMBARRASSED
TO PARTICIPATE 13
OTHER (SPECIFY) 14
DOES NOT KNOW d
REFUSED r
GO TO D69 |
D65. INTERVIEWER: DID THE TARGET CHILD GET THE SCHOOL LUNCH ON EVERY DAY (SHE/HE) ATTENDED SCHOOL IN TARGET WEEK? WHEN D9b EQUALS “1” DOES D16 EQUAL “1” AND WHEN D17 EQUALS “1” DOES D24 EQUAL “1” AND WHEN D25 EQUALS “1” DOES D32 EQUAL “1” AND WHEN D33 EQUALS “1” DOES D40 EQUAL “1” AND WHEN D42 EQUALS “1” DOES D49 EQUAL “1”?
YES (GO TO D70) 1
NO 0
D66. Usted mencionó que TARGET CHILD no obtuvo el almuerzo escolar todos los
días que (ella/él) asistió a la escuela (la semana pasada/durante su última semana en la escuela). ¿Por qué (ella/él) no obtuvo el almuerzo escolar todos los días que (ella/él) asistió a la escuela (la semana pasada/esa semana)?
AFTER RESPONSE, SAY: ¿Hubieron algunas otras razones?
CIRCLE ALL
THAT APPLY
ATE LUNCH AT HOME 1
BROUGHT LUNCH FROM HOME 2
DOES NOT ALWAYS LIKE THE
FOOD SERVED 3
WAS NOT IN SCHOOL ON THAT
OR THOSE DAYS/OUT SICK 4
WAS LATE FOR SCHOOL 5
HAD EARLY MORNING CLASSES
OR PROGRAMS 6
EARLY DISMISSAL OR STUDENT LEFT
SCHOOL EARLY 7
SCHOOL CLOSED ALL DAY 8
OTHER (SPECIFY) 9
DOES NOT KNOW d
REFUSED r
D67. INTERVIEWER: IS THERE MORE THAN ONE ANSWER TO D66?
YES 1
NO (GO TO D69) 0
D68. ¿Cuál es la razón más importante por la que no obtuvo el almuerzo escolar en esos días?
ATE LUNCH AT HOME 1
BROUGHT LUNCH FROM HOME 2
DOES NOT ALWAYS LIKE THE FOOD SERVED 3
WAS NOT IN SCHOOL ON THAT
OR THOSE DAYS/OUT SICK 4
WAS LATE FOR SCHOOL 5
HAD EARLY MORNING CLASSES OR PROGRAMS 6
EARLY DISMISSAL OR STUDENT LEFT
SCHOOL EARLY 7
SCHOOL CLOSED ALL DAY 8
OTHER (SPECIFY) 9
DOES NOT KNOW d
REFUSED r
NO D69 IN THIS DOCUMENT
D70. INTERVIEWER: DID THE TARGET CHILD HELP THE RESPONDENT WITH THE
QUESTIONS ON MEALS EATEN AT SCHOOL?
YES (GO TO E1) 1
NO (GO TO E1) 0
D71. Voy a preguntarle con qué frecuencia su hijo(a) por lo general toma el desayuno o almuerzo escolar cada semana, cuando TARGET CHILD iba a TARGET SCHOOL. Por desayuno o almuerzo escolar, me refiero a las comidas que la escuela de su hijo(a) proporciona a los estudiantes como parte del Programa de Desayuno y Almuerzo Escolar. Las comidas escolares son las comidas que incluyen un conjunto de alimentos en el menú que eran gratis o, si pagó, fue comprado por un precio único, a diferencia de los distintos alimentos (como ensaladas, carnes o postres) que tienen un precio y se compran por separado.
Cuando TARGET CHILD asistía a TARGET SCHOOL, ¿cuántas veces en una semana de promedio (ella/él) tomó el desayuno escolar? When TARGET CHILD was going to TARGET SCHOOL, how many days in an average week did (he/she) eat a school breakfast?
| | NUMBER OF SCHOOL BREAKFASTS
NONE, DID NOT EAT BREAKFAST/
SCHOOL BREAKFAST 0
D72. Y cuando TARGET CHILD asistía a TARGET SCHOOL, ¿cuántas veces en una semana de promedio (ella/él) comió el almuerzo escolar?
| | NUMBER OF SCHOOL LUNCHES
NONE, DID NOT EAT LUNCH/
SCHOOL LUNCH 0
SECTION E: PERCEPTIONS OF SCHOOL MEALS |
INTERVIEWER: THE FOLLOWING QUESTIONS ARE ABOUT THE EXPERIENCES WITH SCHOOL MEALS AT TARGET SCHOOL, PROMPT AS NEEDED
E1. Las próximas preguntas son acerca de la satisfacción de TARGET CHILD con las comidas escolares en TARGET SCHOOL. ¿Qué tan satisfecha(o) está/estaba TARGET CHILD con el sabor de las comidas? Por lo general está (ella/él)/estabamuy satisfecha(o), algo satisfecha(o), algo insatisfecha(o) o muy insatisfecha(o)?
PROBE: ¿ Qué tan satisfecha(o) cree usted que (ella/él) está/estaba con el sabor de la comida?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
SOMEWHAT DISSATISFIED 3
VERY DISSATISFIED 4
CHILD NEVER EATS SCHOOL
MEALS (GO TO G1) n
DOES NOT KNOW d
REFUSED r
E2. ¿Qué tan satisfecha(o) está/estaba (ella/él) con la cantidad o con el tamaño de las porciones de comida que recibe/recibió en las comidas escolares? ¿Diría usted muy satisfecha(o), algo satisfecha(o), algo insatisfecha(o) o muy insatisfecha(o)?
PROBE: ¿Qué tan satisfecha(o) cree usted que está/estaba (ella/él) con la cantidad servida?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
SOMEWHAT DISSATISFIED 3
VERY DISSATISFIED 4
DOES NOT KNOW d
REFUSED r
E3. Por lo general, ¿qué tan satisfecha(o) está/estaba TARGET CHILD con la comida que (ella/él) recibe en la escuela?
PROBE: ¿Muy satisfecha(o), algo satisfecha(o), algo insatisfecha(o) o muy insatisfecha(o)?
PROBE: Por lo general, ¿qué tan satisfecha(o) cree usted que (ella/él) está/estaba?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
SOMEWHAT DISSATISFIED 3
VERY DISSATISFIED 4
DOES NOT KNOW d
REFUSED r
E4. Las próximas preguntas son acerca de su satisfacción con las comidas escolares.
¿Qué tan satisfecha(o) está usted con lo saludable que es la comida que TARGET CHILD es/fue servido en la escuela?
PROBE: ¿Muy satisfecha(o), algo satisfecha(o), algo insatisfecha(o) o muy insatisfecha(o)?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
SOMEWHAT DISSATISFIED 3
VERY DISSATISFIED 4
DOES NOT KNOW d
REFUSED r
E5. Por lo general, ¿qué tan satisfecha(o) está/estaba usted con el programa de comidas de la escuela de TARGET CHILD?
PROBE: ¿Muy satisfecha(o), algo satisfecha(o), algo insatisfecha(o) o muy insatisfecha(o)?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
SOMEWHAT DISSATISFIED 3
VERY DISSATISFIED 4
DOES NOT KNOW d
REFUSED r
NO SECTION F IN THIS DOCUMENT
SECTION G: HOUSEHOLD COMPOSITION |
G1. Ahora quisiera preguntarle sobre las personas que viven con usted. ¿Cuántas personas viven con usted, sin incluirse a usted misma(o)? Por favor incluya a bebés, niños pequeños, personas que no tienen relación de familia con usted y personas que temporalmente no están, por ejemplo en estudios o en un hospital.
INTERVIEWER: IF TRANSIENT HOUSEHOLDER(S), INCLUDE ALL WHO SLEEP THERE HALF THE MONTH OR MORE.
| | | PEOPLE IN HOUSEHOLD
NONE OR LIVES ALONE (GO TO G15) 0
DOES NOT KNOW d
REFUSED r
G1a. CODE IF OBVIOUS OR ASK: ¿TARGET CHILD vive con usted?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
INTERVIEWER: NUMBER OF PERSONS LISTED AT G2 MUST EQUAL NUMBER IN G1. |
G2. (Además de TARGET CHILD), Por favor dígame el (primer) nombre de cada otra persona que vive con usted.
PROBE: ¿Quién más vive con usted?
RECORD TARGET CHILD’S FIRST NAME THEN RECORD NAMES OF ALL OTHER HOUSEHOLD MEMBERS ACROSS THE GRID FIRST, THEN ASK G3 THROUGH G14 FOR EACH PERSON. |
_________________________ TARGET CHILD
TARGET CHILD NOT CURRENTLY LIVING IN HOUSEHOLD (GO TO NAME #2) 0
|
_________________________ NAME #2
|
_________________________ NAME #3
|
G3. ¿Cuál es la relación de NAME con usted?
CODE COHABITEE'S CHILD AND OTHER CHILDREN WHO ARE NOT NATURAL, ADOPTED, STEP, OR FOSTER, BUT FOR WHOM THE RESPONDENT TAKES RESPONSIBILITY, AS "OTHER CUSTODIAL CHILD." |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
|
|
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
|
COUSIN 13 GRANDCHILD 14 |
GRANDCHILD 14 |
GRANDCHILD 14 |
|
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
G4. CODE SEX. IF NECESSARY, ASK: ¿Es NAME mujer u hombre (niña o niño)? |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
NO G5 or G6 IN THIS DOCUMENT |
|||
G7. INTERVIEWER: IS NAME A CHILD? DOES G3 EQUAL “01,” “02,” “03,” “04,” “11”, “12,” “13”, OR “14”? |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
G8. ¿Cuál es su fecha de nacimiento? |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
G9. ¿Cuántos años tiene?
FILL IN BLANK BOXES WITH ZEROES. |
A. YEARS. |___|___| B. MONTHS |___|___|
|
A. YEARS. |___|___| B. MONTHS |___|___| |
A. YEARS. |___|___| B. MONTHS |___|___| |
_________________________ NAME #4
|
_________________________ NAME #5
|
_________________________ NAME #6
|
_________________________ NAME #7
|
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
A. YEARS. |___|___| B. MONTHS |___|___|
|
A. YEARS. |___|___| B. MONTHS |___|___|
|
A. YEARS. |___|___| B. MONTHS |___|___| |
A. YEARS. |___|___| B. MONTHS |___|___| |
G2. (Además de TARGET CHILD), Por favor dígame el (primer) nombre de cada otra persona que vive con usted.
PROBE: ¿Quién más vive con usted?
RECORD TARGET CHILD’S FIRST NAME THEN RECORD NAMES OF ALL OTHER HOUSEHOLD MEMBERS ACROSS THE GRID FIRST, THEN ASK G3 THROUGH G14 FOR EACH PERSON. |
_________________________ NAME #8
|
_________________________ NAME #9
|
_________________________ NAME #10
|
G3. ¿Cuál es la relación de NAME con usted?
CODE COHABITEE'S CHILD AND OTHER CHILDREN WHO ARE NOT NATURAL, ADOPTED, STEP, OR FOSTER, BUT FOR WHOM THE RESPONDENT TAKES RESPONSIBILITY, AS "OTHER CUSTODIAL CHILD." |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
|
|
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
|
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
|
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
G4. CODE SEX. IF NECESSARY, ASK: ¿Es NAME mujer u hombre (niña o niño)? |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
NO G5 or G6 IN THIS DOCUMENT |
|||
G7. INTERVIEWER: IS NAME A CHILD? DOES G3 EQUAL “01,” “02,” “03,” “04,” “11”, “12,” “13”, OR “14”? |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
G8. ¿Cuál es su fecha de nacimiento? |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
G9. ¿Cuántos años tiene?
FILL IN BLANK BOXES WITH ZEROES. |
A. YEARS. |___|___| B. MONTHS |___|___|
|
A. YEARS. |___|___| B. MONTHS |___|___| |
A. YEARS. |___|___| B. MONTHS |___|___| |
_________________________ NAME #11
|
_________________________ NAME #12
|
_________________________ NAME #13
|
_________________________ NAME #14
|
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
FEMALE 1
MALE 2 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
YES 1
NO (GO TO G9) 0 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r GO TO G10 |
A. YEARS. |___|___| B. MONTHS |___|___|
|
A. YEARS. |___|___| B. MONTHS |___|___|
|
A. YEARS. |___|___| B. MONTHS |___|___| |
A. YEARS. |___|___| B. MONTHS |___|___| |
G10. INTERVIEWER: CHECK G8 AND G9: IS NAME FIVE TO 18 YEARS OLD? |
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
G11. ¿Asiste NAME actualmente a la escuela?
INTERVIEWER: IF TARGET CHILD, CODE WITHOUT ASKING. |
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
G12. ¿En qué grado está (ella/él)?
NOTE: IF CHILD IS BETWEEN GRADES, CODE GRADE SHE OR HE WILL BE ENTERING. |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
G13. ¿Vivió NAME con usted en MONTH? |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
G14. INTERVIEWER: CHECK G2. IS THERE ANOTHER PERSON TO ASK ABOUT? |
YES (GO TO G2, NAME 2) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 3) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 4) 1
NO (GO TO G15) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES (GO TO G2, NAME 5) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 6) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 7) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 8) 1
NO (GO TO G15) 0
|
G10. INTERVIEWER: CHECK G8 AND G9: IS NAME FIVE TO 18 YEARS OLD? |
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
G11. ¿Asiste NAME actualmente a la escuela?
INTERVIEWER: IF TARGET CHILD, CODE WITHOUT ASKING. |
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
G12. ¿En qué grado está (ella/él)?
NOTE: IF CHILD IS BETWEEN GRADES, CODE GRADE SHE OR HE WILL BE ENTERING. |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
G13. ¿Vivió NAME con usted en MONTH? |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
G14. INTERVIEWER: CHECK G2. IS THERE ANOTHER PERSON TO ASK ABOUT? |
YES (GO TO G2, NAME 9) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 10) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 11) 1
NO (GO TO G15) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
YES 1
NO (GO TO G13) 0
DOES NOT KNOW (GO TO G13) d
REFUSED (GO TO G13) r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES (GO TO G2, NAME 12) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 13) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NAME 14) 1
NO (GO TO G15) 0
|
YES (GO TO G2, NEXT NAME) 1
NO (GO TO G15) 0
|
G15. ¿Alguien (más) que actualmente no está en este hogar vivía con usted en MONTH?
YES 1
NO (GO TO G29) 0
DOES NOT KNOW (GO TO G29) d
REFUSED (GO TO G29) r
G16. ¿Cuántas otras personas vivían con usted en MONTH? Por favor no cuente a cualquiera de los miembros del hogar de los que ya me dijo.
| | | ADDITIONAL HOUSEHOLD MEMBERS
G17. Por favor dígame el (primer) nombre de la(s) otra(s) persona(s) que vivía(n) con usted en el mes de MONTH, y que ya no vive(n) con usted.
PROBE: ¿Quién más vivía con usted entonces?
RECORD NAMES OF ALL OTHER HOUSEHOLD MEMBERS ACROSS GRID FIRST, THEN ASK G18 THROUGH G28 FOR EACH PERSON. |
____________________________
NAME #1
|
____________________________
NAME #2 |
____________________________
NAME #3 |
G18. ¿Cuál es la relación de NAME con usted?
CODE COHABITEE'S CHILD AND OTHER CHILDREN WHO ARE NOT NATURAL, ADOPTED, STEP, OR FOSTER BUT FOR WHOM THE RESPONDENT TAKES RESPONSIBILITY, AS "OTHER CUSTODIAL CHILD." |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
NATURAL CHILD 1 STEPCHILD OR ADOPTED CHILD 2 OTHER CUSTODIAL CHILD 3 FOSTER CHILD 4 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
SPOUSE OR DOMESTIC PARTNER 5 BOYFRIEND, GIRLFRIEND, OR PARTNER 6 PARENT 7 STEPPARENT 8 GRANDPARENT OR GREAT-GRANDPARENT 9 AUNT, UNCLE, GREAT-AUNT, OR GREAT-UNCLE 10 |
|
|
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
SIBLING (BROTHER OR SISTER) 11 NEPHEW OR NIECE 12 |
|
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
COUSIN 13 GRANDCHILD 14 |
|
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
OTHER RELATIVE OR IN-LAW 15 NON-RELATIVE (INCLUDING ROOMER OR BOARDER) 16 OTHER (SPECIFY) 17
DOES NOT KNOW d REFUSED r |
G19. CODE SEX. IF NECESSARY, ASK: ¿Es NAME mujer u hombre (niña o niño)? |
FEMALE 1 MALE 2 |
FEMALE 1 MALE 2 |
FEMALE 1 MALE 2 |
NO G20 or G21 IN THIS DOCUMENT |
|||
G22. INTERVIEWER: IS NAME A CHILD? DOES G18 EQUAL “01”, “02”, “03,” “04,” “11”, “12,” “13”, OR “14? |
YES 1
NO (GO TO G24) 0 |
YES 1
NO (GO TO G24) 0 |
YES 1
NO (GO TO G24) 0 |
G23. ¿Cuál es su fecha de nacimiento? |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r |
|___|___|/|___|___|/|___|___| MONTH DAY YEAR DOES NOT KNOW d REFUSED r |
|
GO TO G25 |
GO TO G25 |
GO TO G25 |
G24. ¿Cuántos años tiene (ella/él)?
FILL IN BLANK BOXES WITH ZEROES. |
A. YEARS. |___|___|
B. MONTHS |___|___|
|
A. YEARS. |___|___|
B. MONTHS |___|___|
|
A. YEARS. |___|___|
B. MONTHS |___|___|
|
G25. INTERVIEWER: CHECK G23 AND G24: IS NAME FIVE TO 18 YEARS OLD? |
YES 1
NO (GO TO G28) 0
|
YES 1
NO (GO TO G28) 0 |
YES 1
NO (GO TO G28) 0 |
G26. ¿Asistió NAME a la escuela durante el mes de MONTH? |
YES 1
NO (GO TO G28) 0
DOES NOT KNOW (GO TO G28) d
REFUSED (GO TO G28) r
|
YES 1
NO (GO TO G28) 0
DOES NOT KNOW (GO TO G28) d
REFUSED (GO TO G28) r |
YES 1
NO (GO TO G28) 0
DOES NOT KNOW (GO TO G28) d
REFUSED (GO TO G28) r |
G27. ¿En qué grado estaba (ella/él)?
NOTE: IF CHILD IS BETWEEN GRADES, CODE GRADE HE OR SHE WILL BE ENTERING. |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r
|
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
|___|___| GRADE OR
PRESCHOOL p
KINDERGARTEN k
UNGRADED u
DOES NOT KNOW d
REFUSED r |
G28. INTERVIEWER: CHECK G17. IS THERE ANOTHER PERSON TO ASK ABOUT? |
YES (GO TO G17, NAME 2) 1
NO (GO TO G29) 0
|
YES (GO TO G17, NAME 3) 1
NO (GO TO G29) 0 |
YES (GO TO G17, NAME 4 ON SUPPLEMENTAL FORM) 1
NO (GO TO G29) 0 |
G29. INTERVIEWER: IS THE TARGET CHILD A FOSTER CHILD? DOES G3 EQUAL “4” FOR PERSON NUMBER 1?
YES (GO TO G34) 1
NO (GO TO G30) 0
G30. ¿En TARGET MONTH usted (o su [esposo(a)/pareja]) pagó por algún gasto doméstico o proporcionó algún apoyo económico a [fill EACH CHILD 18 OR UNDER]?
YES (GO TO G32) 1
NO 0
DOES NOT KNOW d
REFUSED r
G31. ¿ En TARGET MONTH [NAME OF EACH HH MEMBER OVER 18] pagó por algún gasto doméstico o proporcionó algún apoyo económico a [fill EACH REMAINING CHILD 18 OR UNDER]?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
G32. ¿ En TARGET MONTH usted (o su [esposo(a)/pareja]) pagó por algún gasto doméstico o proporcionó algún apoyo económico a [NAME OF EACH HH MEMBER OVER 18]?
YES (GO TO H1b) 1
NO 0
DOES NOT KNOW d
REFUSED r
G33. ¿ En TARGET MONTH [NAME OF EACH HH MEMBER OVER 18] pagó por algún gasto doméstico o proporcionó algún apoyo económico a usted?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
ALL GO TO H1b
G34. ¿Quién tiene la responsabilidad legal por [TARGET CHILD]?
FILL ALL NAMES# FROM G2 AND G17 1
SOMEONE OUTSIDE THE HOUSEHOLD 2
AN AGENCY 3
OTHER (SPECIFY) 4
_________________________________________
DOES NOT KNOW d
REFUSED r
SECTION H: INCOME AND EARNINGS SOURCES |
H0a. INTERVIEWER: IS THE TARGET CHILD A FOSTER CHILD? DOES G3 EQUAL “4” FOR PERSON NUMBER 1?
YES 1
NO (GO TO H1b) 0
H0b. Next, I would like to ask you about the types of income TARGET CHILD may have had in TARGET MONTH. (I realize these questions may seem personal, but they are important to understanding the school food program application process and the needs of families whose children are enrolled in the DISTRICT NAME distrito escolar.) I would like to assure you that all of your responses are strictly private.
How much was TARGET CHILD’s personal income in TARGET MONTH?
PROBE: By “personal income,” we mean money received for a child’s personal use.
$ | |,| | | |
DOES NOT KNOW d
REFUSED r
-
GO TO K4
H1b. Next, I would like to ask you about sources of income you and your household may have had in TARGET MONTH. (I realize these questions may seem personal, but they are important to understanding the school food program application process and the needs of families whose children are enrolled in the DISTRICT NAME distrito escolar.) I would like to assure you that all of your responses are strictly private.
H1c. INTERVIEWER: RECORD TARGET CHILD’S NAME IN FIRST COLUMN IN H1d IF 16 YEARS OR YOUNGER, THEN CHECK G8 AND G9 AND G23 AND G24 AND RECORD NAME(S) OF ANY OTHER HOUSEHOLD MEMBERS AGE 16 YEARS OR YOUNGER IN SUBSEQUENT COLUMNS WHERE G30 OR G31 HAVE A “YES” ABOUT THAT HH MEMBER.
H1d. RECORD NAME(S) |
____________________________ TARGET CHILD
|
____________________________ CHILD 2
|
____________________________ CHILD 3
|
H1e. Durante el mes de MONTH, ¿tuvo (TARGET CHILD/NAME) algún ingreso proveniente de manutención de niños o ‘child support”, de Seguro Social, de personas fuera del hogar o de alguna otra fuente? |
YES 1
NO (GO TO H1h) 0
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
YES 1
NO (GO TO H1h) 0
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
YES 1
NO (GO TO H1h) 0
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
H1f. ¿Cuál fue la fuente de ese ingreso?
AFTER RESPONSE, SAY: ¿Hubieron otras fuentes de ingreso?
CIRCLE ALL THAT APPLY |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
H1g1. ¿Cuánto fue recibido por mantenimiento de niños o “child support” en MONTH? |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
H1g2. ¿Cuánto fue recibido de Seguro Social en MONTH? |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
H1g3. ¿Cuánto fue recibido de personas fuera del hogar en MONTH? |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
H1g4. ¿Cuánto fue recibido de OTHER IN H1d en MONTH? |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
H1h. INTERVIEWER: IS THERE ANOTHER PERSON 16 OR YOUNGER TO ASK ABOUT? |
YES (GO TO H1e, CHILD 2) 1
NO (GO TO H2) 0
|
YES (GO TO H1e, CHILD 3) 1
NO (GO TO H2) 0
|
YES (GO TO H1e, CHILD 4) 1
NO (GO TO H2) 0
|
____________________________ CHILD 4
|
____________________________ CHILD 5
|
____________________________ CHILD 6
|
____________________________ CHILD 7
|
|
|
|
|
YES 1
NO (GO TO H1h) 0
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
YES 1
NO (GO TO H1h) 0
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
YES 1
NO (GO TO H1h) 0
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
YES 1
NO (GO TO H2) 0
DOES NOT KNOW (GO TO H2) d
REFUSED (GO TO H2) r |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H1h) d
REFUSED (GO TO H1h) r |
CHILD SUPPORT 1
SOCIAL SECURITY OR DISABILITY SURVIVORS’ BENEFITS 2
PERSONS OUTSIDE THE HOUSEHOLD 3
OTHER (SPECIFY) 4
DOES NOT KNOW (GO TO H2) d
REFUSED (GO TO H2) r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | |,| | | |
DOES NOT KNOW d
REFUSED r |
YES (GO TO H1e, CHILD 5) 1
NO (GO TO H2) 0
|
YES (GO TO H1e, CHILD 6) 1
NO (GO TO H2) 0
|
YES (GO TO H1e, CHILD 7) 1
NO (GO TO H2) 0
|
GO TO H2
|
H2. INTERVIEWER: LIST THE RESPONDENT’S FIRST NAME IN COLUMN ONE OF THE GRID ON THE NEXT PAGE AND THEIR SPOUSE/DOMESTIC PARTNER IN COLUMN TWO, THEN LIST IN SUBSEQUENT COLUMNS THE FIRST NAMES OF ALL HOUSEHOLD MEMBERS AGE 17 OR OLDER WHO LIVED WITH (HIM/HER) DURING THE TARGET MONTH, INCLUDING THE TARGET CHILD IF AGE 17 OR OLDER. INCLUDE ALL ADULTS LISTED AT G2 THAT HAVE A “YES” RESPONSE TO G13 AND ALL ADULTS LISTED IN G17, WHERE G32 OR G33 HAVE A “YES” ABOUT THAT HH MEMBER. THEN CONTINUE TO H2a.
H2a. INTERVIEWER: RECORD THE MONTH AND YEAR FOR WHICH THE INCOME QUESTIONS ARE ASKED.
| | | / | | |
MONTH YEAR
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
H3. Durante MONTH trabajó (usted/NAME) en un empleo por pago? Por favor incluya trabajo pagado o salario recibido de su propio negocio o servicio militar. PROBE: Por favor no incluya ganancias o pérdidas de su propio rancho, granja o negocio. |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H4. Mis siguientes preguntas son sobre otros tipos de ingresos que (usted/NAME) puede haber recibido durante MONTH.
¿Durante MONTH recibió (usted/NAME) ingresos de compensación por desempleo? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H5. ¿Durante MONTH recibió (usted/NAME) ingresos de compensación de trabajadores??
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H5a. ¿Durante MONTH recibió (usted/NAME) ingresos de beneficios de huelga?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H6. ¿Durante MONTH recibió (usted/NAME) ingresos de jubilación del Seguro Social o retiro ferroviario?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H7. ¿Ingresos de pensiones privadas, anualidades o beneficios de sobrevivientes?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H7a. ¿Durante MONTH recibió (usted/NAME) beneficios militares en efectivo, tal como subsidios (allowances) por vivienda, comida o ropa? Por favor no incluya pago de combate.
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H8. ¿Ingresos de beneficios de veteranos?
PROBE: ¿Durante MONTH?
|
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H9. ¿Durante MONTH recibió (usted/NAME) beneficios de incapacidad del gobierno de Seguridad de Ingreso Suplementario o SSI?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H9a. ¿Ingresos de pagos privados por incapacidad?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
|
____________________________ RESPONDENT | | |
|
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
H10. ¿Pagos de pensión alimenticia (Alimony)?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H11. ¿Pagos de manutención de niños o “Child support”?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H12. ¿Ingresos de interés y dividendos?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H13. Durante MONTH recibió (usted/NAME) ingresos de alquiler?
PROBE: Ingresos que (usted/NAME) recibió de otros en forma de alquiler o renta. PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H14. ¿Ganancias o pérdidas de su propio negocio, sociedad o práctica profesional?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H15. ¿Ingresos o pérdidas de su propio rancho o granja?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H16. ¿Recibió (usted/NAME) ayuda económica (financial aid) para estudiantes de ‘college’ o universidad? Por favor excluya dinero usado para matrícula, libros y cuotas, pero incluya dinero usado por alojamiento y comida. PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H17. Durante MONTH recibió (usted/NAME) ingresos de dinero que fue retirado de ahorros?
PROBE: ¿Durante MONTH? PROBE: Ahorros personales. |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H18. ¿Ingresos de contribuciones regulares de personas fuera de su hogar, por ejemplo regalos en efectivo de amistades o familiares? PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
H19. ¿Algún otro ingreso en efectivo, tal como regalías en neto (net royalties), ingresos de fideicomiso (trusts), ganancias de premios o bonificación (bonuses)?
PROBE: ¿Durante MONTH? |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
YES 1 NO 0 DOES NOT KNOW d REFUSED r |
|
____________________________ RESPONDENT | | |
|
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
H20. ¿Asistencia general? Por favor no incluya a beneficios de TANF o de SNAP de los que hablaremos después.
PROBE: ¿Durante MONTH? |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
H21. ¿Recibió (usted/NAME) un subsidio no-militar para vivienda?
PROBE: ¿Durante MONTH? |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
H22. ¿Beneficios por la enfermedad pulmonar de mineros (Black lung)?
PROBE: ¿Durante MONTH? |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
H23. ¿Recibió (usted/NAME) algún otro tipo de asistencia pública durante MONTH? Por favor no incluya a beneficios de TANF o de SNAP de los que hablaremos después. |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
H23a. ¿Qué tipo de asistencia pública recibió (usted/NAME)?
RECORD VERBATIM |
___________________________
___________________________
___________________________
___________________________
|
___________________________
___________________________
___________________________
___________________________
|
___________________________
___________________________
___________________________
___________________________
|
H24. INTERVIEWER: CHECK H3. IS THERE ANOTHER PERSON TO ASK ABOUT?
|
YES (GO TO H3, NAME 2) 1
NO (GO TO I1) 0
|
YES (GO TO H3, NAME 3) 1
NO (GO TO I1) 0 |
YES (GO TO H3, NAME 4) 1
NO (GO TO I1) 0 |
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
____________________________ PERSON NUMBER | | |
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
|
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO 0
DOES NOT KNOW d
REFUSED r |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
YES 1
NO (GO TO H24) 0
DOES NOT KNOW (GO TO H24) d
REFUSED (GO TO H24) r |
___________________________
___________________________
___________________________
___________________________
|
___________________________
___________________________
___________________________
___________________________
|
___________________________
___________________________
___________________________
___________________________
|
___________________________
___________________________
___________________________
___________________________
|
YES (GO TO H3, NAME 5) 1
NO (GO TO I1) 0
|
YES (GO TO H3, NAME 6) 1
NO (GO TO I1) 0 |
YES (GO TO H3, NAME 7) 1
NO (GO TO I1) 0 |
YES (GO TO H3, SUPPLEMENT FORM) 1
NO (GO TO I1) 0 |
SECTION I: INCOME AND EARNINGS AMOUNTS |
I1. Ahora quisiera preguntarle sobre las diferentes sumas de ingresos que (usted/usted y los otros adultos en su hogar) (recibió/recibieron) de las fuentes de las que acabamos de hablar. Para cada tipo de ingreso del cual usted nos informó, quisiera ver documentación que usted quizás tiene, sólo para asegurarnos que tenemos las sumas correctas. Podemos tomar ahora una corta pausa para que usted pueda recolectar la documentación. Los tipos de documentación que quisiera ver son talones de cheques o al declaración de impuestos del año pasado para ganancias de empleos, recibos por trabajos pagados en efectivo, declaraciones de ausencia y ganancias, archivos de negocio o cartas de adjudicación (award letters). WAIT FOR RESPONDENT TO COLLECT DOCUMENTS THEN PROCEED TO I2a.
INCOME
FROM WORKING AT A JOB FOR PAY |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I2a. INTERVIEWER: WAS THERE EARNINGS FROM WORKING AT A JOB FOR PAY? DOES H3 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
I2b. ¿Cuántas fueron las ganancias de (usted/PERSON) de empleos por pago durante MONTH, antes de impuestos y otras deducciones? Eso sería el pago total de (usted/PERSON), no la suma que trajo a casa. Por favor incluya propinas, comisiones y pago regular por sobretiempo. PROBE: Por favor no incluya ganancias o pérdidas de su propio negocio o rancho o granja o de sociedad o práctica profesional en MONTH. |
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
I2c. INTERVIEWER: IF TOTAL FOR MONTH NOT GIVEN, ENTER PAY PERIOD, OR PROBE: ¿La suma fue recibida por hora, por día, por semana, dos veces por mes o cada dos semanas? |
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
I2d. ¿Cuántos(as) PERIODS in I2c trabajó (usted/PERSON) en MONTH?
PROBE: Su mejor estimado está bien. |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
I2e. ¿Tuvo (usted/PERSON) algún otro empleo por pago en MONTH? |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
I2f. ¿Cuánto ganó (usted/PERSON) de esos otros empleos en MONTH? |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
I2g. ¿Por favor puedo ver los talones de pago de (usted/PERSON) que muestran la suma que usted acaba de decirme? |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
I2h. INTERVIEWER: ENTER TYPE OF DOCUMENT(S).
CODE ALL THAT APPLY |
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
YES 1
NO (GO TO NEXT PERSON OR I3a) 0 |
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I2e) d
REFUSED (GO TO I2e) r
|
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
MONTH (GO TO I2e) 1 WEEK 2 DAY 3 HOUR 4 BI-MONTHLY (TWICE A MONTH) 5 EVERY TWO WEEKS 6 QUARTER (GO TO I2e) 7 YEAR (GO TO I2e) 8 DOES NOT KNOW (GO TO I2e) d REFUSED (GO TO I2e) r |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
|___|___|___| UNITS WORKED DOES NOT KNOW d REFUSED r |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
YES 1 NO (GO TO I2g) 0 DOES NOT KNOW (GO TO I2g) d REFUSED (GO TO I2g) r |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
$ |___|___|,|___|___|___| DOES NOT KNOW d REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I3a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I3a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I3a) r |
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
CHECK STUB 1 INCOME TAX RETURN 2 RECEIPT FOR CASH JOB 3 LEAVE AND EARNINGS STATEMENT 4 BUSINESS RECORDS 5 AWARD LETTER 6 EXPENSE RECEIPT 7 OTHER (SPECIFY) 8
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I2i. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I2j. INTERVIEWER: ENTER THE PAY PERIOD OF PAYMENT. |
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
I2k. INTERVIEWER: ENTER UNITS WORKED FROM I2j. |
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
I2l. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
I2m. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I2n. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I2b, I2c, I2d AND I2f. THEN COMPUTE THE TOTAL MONTHLY AMOUNT USING I2i, I2j, AND I2k. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I3a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I3a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
MONTH (GO TO I2l) 1
WEEK 2
DAY 3
HOUR 4
BI-MONTHLY (TWICE A MONTH) 5
EVERY TWO WEEKS 6
QUARTER (GO TO I2l) 7
YEAR (GO TO I2l) 8
OTHER (SPECIFY) 9
|
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
|___|___|___| UNITS WORKED
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I3a) 0
|
UNEMPLOYMENT
COMPENSATION |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I3a. INTERVIEWER: WAS THERE UNEMPLOYMENT COMPENSATION? DOES H4 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
I3b. ¿Cuánta compensación por desempleo recibió (usted/PERSON) durante MONTH? |
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r |
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r |
I3c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
13d. ¿Cuántas PERIODS IN I3c de compensación por desempleo recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I3e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de compensación por desempleo recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
I3f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I3g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I3h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
I3i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I4a) 0
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r |
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW (GO TO I3e) d
REFUSED (GO TO 13e) r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I3e) 3
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I4a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I4a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I4a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I3j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I3k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I3l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I3b, I3c, AND I3d. THEN COMPUTE THE MONTHLY AMOUNT USING I3g, I3h, AND I3i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I4a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I4a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I4a) 0
|
WORKER’S
COMPENSATION |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I4a. INTERVIEWER: WAS WORKER’S COMPENSATION RECEIVED? DOES H5 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
I4b. ¿Cuánto recibió (usted/NAME) de compensación de trabajadores en MONTH?
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
I4c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
14d. ¿Cuántas PERIODS IN I4c de compensación de trabajadores recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I4e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de compensación de trabajadores recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
I4f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
I4g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I4e) 3
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
STATEMENT 1
CHECK STUB 2
OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I4h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
I4i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
I4j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I4k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I4l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I4b, I4c, AND I4d. THEN COMPUTE THE MONTHLY AMOUNT USING I4g, I4h, AND I4i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I5a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I5a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
STRIKE
BENEFITS |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
a. INTERVIEWER: WAS THERE STRIKE BENEFIT INCOME? DOES H5a EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
b. ¿Cuánto recibió (usted/NAME) en beneficios de huelga en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
d. ¿Cuántas PERIODS IN C de beneficios de huelga recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
e. ¿ Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de beneficios de huelga recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I5a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I5a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I5a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I5a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING b, c, AND d. THEN COMPUTE THE MONTHLY AMOUNT USING g, h, AND i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I5a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I5a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I5a) 0
|
SOCIAL
SECURITY INCOME |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I5a. INTERVIEWER: WAS THERE SOCIAL SECURITY INCOME? DOES H6 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
I5b. ¿Cuánto recibió (usted/NAME) del Seguro Social o retiro ferroviario en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I5c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
15d. ¿Cuántas PERIODS IN I5c de beneficios de Seguro Social o retiro ferroviario recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I5e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de beneficios de Seguro Social o retiro ferroviario recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
I5f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I5g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
I5h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I5i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I6a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I5e) 3
DOES NOT KNOW d
REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I6a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I6a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I6a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I5j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
I5k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I5l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I5b, I5c, AND I5d. THEN COMPUTE THE MONTHLY AMOUNT USING I5g, I5h, AND I5i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I6a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I6a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I6a) 0
|
PRIVATE
PENSIONS |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I6a. INTERVIEWER: WERE THERE PRIVATE PENSIONS? DOES H7 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
I6b. ¿Cuánto recibió (usted/PERSON) en pensiones privadas durante MONTH? |
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
I6c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
I6d. ¿Cuántas PERIODS IN I6c de pagos de pensión privada recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I6e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de pagos de pensión privada recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
I6f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I6g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
I6h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I6i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I7a) 0
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
$ |___|___|,|___|___|___|
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I6e) 3 DOES NOT KNOW d REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I7a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I7a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I7a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I6j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
I6k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I6l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I6b, I6c, AND I6d. THEN COMPUTE THE MONTHLY AMOUNT USING I6g, I6h, AND I6i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I7a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I7a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I7a) 0
|
MILITARY
BENEFITS |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
a. INTERVIEWER: WERE THERE MILITARY CASH BENEFITS? DOES H7a EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
b. ¿Cuánto recibió (usted/NAME) en beneficios militares en efectivo en MONTH? Por favor no incluya pago de combate. |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
d. ¿Cuántas PERIODS IN C de beneficios militares en efectivo recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de beneficios militares en efectivo recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H8a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING b, c, AND d. THEN COMPUTE THE MONTHLY AMOUNT USING g, h, AND i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I8a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I8a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
VETERAN’S
BENEFITS |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I7a. INTERVIEWER: WERE THERE VETERAN’S BENEFITS? DOES H8 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
I7b. ¿Cuánto en beneficios de Veteranos recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I7c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
I7d. ¿Cuántas PERIODS IN I7c de beneficios de Veteranos recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I7e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de beneficios de Veteranos recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
I7f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I7g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
I7h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I7i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I8a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO I7e) 3
DOES NOT KNOW d
REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I8a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I8a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I8a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I7j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
I7k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I7l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I7b, I7c, AND I7d. THEN COMPUTE THE MONTHLY AMOUNT USING I7g, I7h, AND I7i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I8a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I8a. IS THERE ANOTHER PERSON? |
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I8a) 0
|
SSI
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I8a. INTERVIEWER: WAS THERE GOVERNMENT DISABILITY BENEFITS FROM SSI? DOES H9 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
I8b. ¿Cuánto en ingresos de Seguridad de Ingreso Suplementario o SSI recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I8c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
I8d. ¿Cuántas PERIODS IN I8c de SSI recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I8e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de SSI recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
I8f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I8g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I8h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I8i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
I8j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I9a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I8e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I9a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I9a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I9a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I8k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I8l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I8b, I8c, AND I8d. THEN COMPUTE THE MONTHLY AMOUNT USING I8g, I8h, AND I8i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I9a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I9a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I9a) 0
|
PRIVATE
DISABILITY |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
a. INTERVIEWER: WAS THERE PRIVATE DISABILITY INCOME? DOES H9a EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
b. Cuánto recibió (usted/NAME) en pagos privados por incapacidad en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
d. ¿Cuántas PERIODS IN C de pagos privados por incapacidad recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de pagos privados por incapacidad recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR H10a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1
EVERY TWO WEEKS 2
MONTH (GO TO e) 3
DOES NOT KNOW d
REFUSED r
|
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING b, c, AND d. THEN COMPUTE THE MONTHLY AMOUNT USING g, h, AND i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I10a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I10a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10 a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
ALIMONY
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I9a. INTERVIEWER: WAS THERE ALIMONY? DOES H10 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
I9b. ¿Cuánto en pagos de pensión alimenticia o ‘alimony’ recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I9c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
I9d. ¿Cuántas PERIODS IN I9c of pagos de pensión alimenticia o ‘alimony’ recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I9e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de pagos de pensión alimenticia o ‘alimony’ recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
I9f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I9g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I9h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I9i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
I9j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I10a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I9e) 3 OTHER (SPECIFY) (GO TO I9e) 4 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I10a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I10a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I10a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I9k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I9l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I9b, I9c, AND I9d. THEN COMPUTE THE MONTHLY AMOUNT USING I9g, I9h, AND I9i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I10a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I10a. IS THERE ANOTHER PERSON? IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I10a) 0
|
CHILD
SUPPORT |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I10a. INTERVIEWER: WAS THERE CHILD SUPPORT? DOES H11 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
I10b. ¿Cuánto en pagos de manutención de niños o ‘child support’ recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I10c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
I10d. ¿Cuántas PERIODS IN I10c de pagos de manutención de niños o ‘child support’ recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I10e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de pagos de manutención de niños o ‘child support’ recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
I10f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I10g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I10h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I10i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I11a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I10e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I11a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I11a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I11a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I10j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT. |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
I10k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I10l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I10b, I10c, AND I10d. THEN COMPUTE THE MONTHLY AMOUNT USING I10g, I10h, AND I10i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I11a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I11a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I11a) 0
|
INTEREST
INCOME |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I11a. INTERVIEWER: WAS THERE INTEREST INCOME? DOES H12 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
I11b. ¿Cuánto ingreso de interés y dividendos recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I11c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas, por mes, por trimestre o por año? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
111d. ¿Cuántas PERIODS IN I11c de ingreso de interés y dividendos recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I11e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de ingreso de interés y dividendos recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
I11f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I11g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I11h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I11i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I12a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I11e) 3 EVERY THREE MONTHS (QUARTERLY) (GO TO I11e) YEAR (GO TO I11e) 5 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I12a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I12a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I12a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I11j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I11k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I11l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I11b, I11c, AND I11d. THEN COMPUTE THE MONTHLY AMOUNT USING I11g, I11h, AND I11i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I12a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I12a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I12a) 0
|
RENTAL
INCOME |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I12a. INTERVIEWER: WAS THERE RENTAL INCOME? DOES H13 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
I12b. ¿Cuánto ingreso de alquiler recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
I12c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
112d. ¿Cuántas PERIODS IN I12c de ingreso de alquiler recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I12e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de ingreso de alquiler recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
I12f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I12g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT. |
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I12h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I12i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
I12j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I13a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I12e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I13a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I13a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I13a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I12k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I12l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I12b, I12c, AND I12d. THEN COMPUTE THE MONTHLY AMOUNT USING I12g, I12h, AND I12i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I13a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I13a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I13a) 0
|
NON-FARM
BUSINESS PROFIT OR LOSS |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I13a. INTERVIEWER: WAS THERE BUSINESS PROFIT OR LOSS? DOES H14 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
I13b. ¿Durante MONTH cuánto en ganancias o pérdidas tuvo (usted/PERSON) de su propio negocio no –granjero, sociedad o práctica profesional?
PROBE: ¿Eso fue ganancia o pérdida?
INTERVIEWER: INDICATE IF AMOUNT IS PROFIT OR LOSS. |
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
I13c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
113d. ¿Cuántas PERIODS IN I13c de (ganancia/pérdida) realizó (usted/PERSON) de su propio negocio en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I13e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de (ganancia/pérdida) de su propio negocio en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
I13f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I13g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I13h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I14a) 0
|
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
PROFIT 1
LOSS 2
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I13e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I14a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I14a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I14a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I13i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
I13j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I13k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I13l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I13b, I13c, AND I13d. THEN COMPUTE THE MONTHLY AMOUNT USING I13g, I13h, AND I13i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I14a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I14a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I14a) 0
|
FARM
BUSINESS PROFIT OR LOSS |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I14a. INTERVIEWER: WAS THERE FARM INCOME? DOES H15 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
I14b. ¿Durante MONTH cuánto en ganancias o pérdidas tuvo (usted/NAME) de su propio rancho o granja? |
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
I14c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
114d. ¿Cuántas PERIODS IN I14c de (ganancia/pérdida) recibió (usted/PERSON) de su rancho o granja en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I14e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de (ganancia/pérdida) de su rancho o granja recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
I14f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I14g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I14h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I15a) 0
|
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
$ | |,| | | |,| | | |
EARNING 1
LOSS 2
MONTH 3
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I14e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I15a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I15a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I15a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I14i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
I14j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I14k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I14l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I14b, I14c, AND I14d. THEN COMPUTE THE MONTHLY AMOUNT USING I14g, I14h, AND I14i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I15a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I15a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| NUMBER OF TIMES RECEIVED
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I15a) 0
|
COLLEGE
FINANCIAL AID
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I15a. INTERVIEWER: WAS THERE COLLEGE FINANCIAL AID? DOES H16 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
I15b. ¿Cuánta ayuda económica (financial aid) para estudiantes de ‘college’ o universidad recibió (usted/NAME) en MONTH? Por favor excluya dinero usado para matrícula, libros y cuotas, pero incluya dinero usado por alojamiento y comida. |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I15c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
115d. ¿Cuántas PERIODS IN I15c de ayuda económica (financial aid) para estudiantes de ‘college’ o universidad recibió (usted/NAME) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I15e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de ayuda económica (financial aid) para estudiantes de ‘college’ o universidad recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
I15f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I15g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I15h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I15i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I16a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I15e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I16a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I16a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I16a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I15j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I15k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I15l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I15b, I15c, AND I15d. THEN COMPUTE THE MONTHLY AMOUNT USING I15g, I15h, AND I15i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I16a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I16a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I16a) 0
|
SAVINGS
WITHDRAWAL
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I16a. INTERVIEWER: WAS THERE SAVINGS WITHDRAWAL? DOES H17 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
I16b. ¿Cuánto dinero retiró (usted/NAME) de sus ahorros en MONTH?
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I16c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
116d. ¿Cuántas PERIODS IN I16c retiró (usted/PERSON) dinero de sus ahorros en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I16e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de dinero que retiró de sus ahorros en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
I16f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I16g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I16h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I16i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I17a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I16e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I17a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I17a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I17a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n
|
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I16j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I16k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I16l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I16b, I16c, AND I16d. THEN COMPUTE THE MONTHLY AMOUNT USING I16g, I16h, AND I16i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I17a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I17a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I17a) 0
|
CONTRIBUTIONS
FROM OUTSIDE PERSONS
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I17a. INTERVIEWER: WERE THERE CONTRIBUTIONS FROM OUTSIDE PERSONS? DOES H18 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
I17b. ¿Cuánto ingreso de contribuciones regulares de personas fuera de su hogar, por ejemplo regalos en efectivo de amistades o familiares recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I17c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
117d. ¿Cuántas PERIODS IN I17c de contribuciones regulares de ingresos recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I17e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de contribuciones regulares de ingresos recibida MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
I17f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I17g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I17h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I18a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I17e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I18a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I18a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I18a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I17i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
I17j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I17k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I17l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I17b, I17c, AND I17d. THEN COMPUTE THE MONTHLY AMOUNT USING I17g, I17h, AND I17i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I18a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I18a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I18a) 0
|
OTHER
CASH INCOME
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I18a. INTERVIEWER: WAS THERE OTHER CASH INCOME? DOES H19 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
I18b. ¿Cuánto más ingreso en efectivo, tal como regalías en neto (net royalties), ingresos de fideicomiso (trusts), ganancias de premios o bonificación (bonuses) recibió (usted/NAME) en MONTH? |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I18c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
118d. ¿Cuántas PERIODS IN I18c otros ingresos en efectivo recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I18e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de otros ingresos en efectivo recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
I18f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I18g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I18h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I18i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I19a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I18e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I19a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I19a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I19a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I18j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I18k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I18l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I18b, I18c, AND I18d. THEN COMPUTE THE MONTHLY AMOUNT USING I18g, I18h, AND I18i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I19a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I19a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I19a) 0
|
GENERAL
ASSISTANCE
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I19a. INTERVIEWER: WAS THERE GENERAL ASSISTANCE? DOES H20 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
I19b. ¿Cuánto dinero de asistencia general recibió (usted/NAME) en MONTH?
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I19c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
119d. ¿Cuántas PERIODS IN I19c de asistencia general recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I19e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de asistencia general recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
I19f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I19g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I19h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I19i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I20a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I19e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I20a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I20a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I20a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I19j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I19k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I19l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I19b, I19c, AND I19d. THEN COMPUTE THE MONTHLY AMOUNT USING I19g, I19h, AND I19i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I20a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I20a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I20a) 0
|
NON-MILITARY
HOUSEHOLD SUBSIDIES |
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I20a. INTERVIEWER: WAS THERE NON-MILITARY HOUSEHOLD SUBSIDIES? DOES H21 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
I20b. ¿Cuánto recibió (usted/NAME) en subsidios no-militares para vivienda en MONTH?
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I20c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
120d. ¿Cuántas PERIODS IN I20c de subsidios no-militares para vivienda recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I20e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de subsidios no-militares para vivienda recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
I20f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I20g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I20h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I20i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I21a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I20e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I21a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I21a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I21a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I20j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I20k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I20l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I20b, I20c, AND I20d. THEN COMPUTE THE MONTHLY AMOUNT USING I20g, I20h, AND I20i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I21a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I21a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I21a) 0
|
BLACK
LUNG DISEASE
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I21a. INTERVIEWER: WAS THERE BLACK LUNG BENEFITS? DOES H22 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
I21b. ¿Cuánto en beneficios de enfermedad pulmonar de mineros (black lung) recibió (usted/NAME) en MONTH?
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I21c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
121d. ¿Cuántas PERIODS IN I21c de beneficios de enfermedad pulmonar de mineros (black lung) recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I21e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de beneficios de enfermedad pulmonar de mineros (black lung) recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
I21f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I21g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I21h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
I21i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
YES 1
NO (GO TO NEXT PERSON OR I22a) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I21e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I22a) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I22a) d REFUSED TO SHOW (GO TO NEXT PERSON OR I22a) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I21j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I21k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I21l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I21b, I21c, AND I21d. THEN COMPUTE THE MONTHLY AMOUNT USING I21g, I21h, AND I21i. IF THERE IS NO DIFFERENCE, CONTINUE TO NEXT PERSON OR I22a. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I22a. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I22a) 0
|
OTHER
PUBLIC ASSISTANCE
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I22a. INTERVIEWER: WAS THERE OTHER PUBLIC ASSISTANCE? DOES H23 EQUAL “YES”? |
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
I22b. ¿Cuánto recibió (usted/NAME) de algún otro tipo de asistencia pública durante MONTH? Por favor no incluya a beneficios de TANF o de SNAP de los que hablaremos después. |
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
I22c. INTERVIEWER: ENTER PERIOD COVERED OR ASK: ¿Eso fue por semana, cada dos semanas o por mes? |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
122d. ¿Cuántas PERIODS IN I22c de otros tipos de asistencia pública recibió (usted/PERSON) en MONTH? |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
I22e. ¿Puedo ver la declaración que (usted/PERSON) recibió que muestra la suma de otros tipos de asistencia pública recibida en MONTH?
PROBE: El talón del cheque. |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
I22f. INTERVIEWER: ENTER TYPE OF DOCUMENT. |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
I22g. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
I22h. INTERVIEWER: ENTER THE PERIOD OF PAYMENT. |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
YES 1
NO (GO TO NEXT PERSON OR I23) 0
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
$ | | |,| | | |
DOES NOT KNOW d
REFUSED r
|
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
WEEK 1 EVERY TWO WEEKS 2 MONTH (GO TO I22e) 3 DOES NOT KNOW d REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
|___|___| NUMBER OF TIMES RECEIVED
DOES NOT KNOW d
REFUSED r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
YES 1 DON’T HAVE/ CAN’T FIND (GO TO NEXT PERSON OR I23) 0 DOES NOT KNOW (GO TO NEXT PERSON OR I23) d REFUSED TO SHOW (GO TO NEXT PERSON OR I23) r |
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
STATEMENT 1 CHECK STUB 2 OTHER (SPECIFY) 3
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|,|___|___|___|
NOT ON DOCUMENT n
|
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
WEEK 1 TWO WEEKS 2 MONTH 3 OTHER (SPECIFY) 4
NOT ON DOCUMENT n |
|
________________________________ RESPONDENT | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
I22i. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH. |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
I22j. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT: |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
I22k. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT. |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n |
I22l. INTERVIEWER: COMPUTE THE TOTAL MONTHLY AMOUNT RECEIVED USING I22b, I22c, AND I22d. THEN COMPUTE THE MONTHLY AMOUNT USING I22g, I22h, AND I22i. IF THERE IS NO DIFFERENCE, CONTINUE NEXT PERSON OR TO I23. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO NEXT PERSON OR I23. IS THERE ANOTHER PERSON?
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
I23. INTERVIEWER: IS THERE ANOTHER PERSON TO ASK ABOUT? |
YES (GO TO I2, NAME 2) 1
NO (GO TO J1) 0 |
YES (GO TO I2, NAME 3) 1
NO (GO TO J1) 0 |
YES (GO TO I2, NAME 4) 1
NO (GO TO J1) 0 |
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
________________________________ PERSON NUMBER | | |
|
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| NUMBER OF TIMES RECEIVED
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
|___|___| |___|___| |___|___| MONTH DAY YEAR
NOT ON DOCUMENT n |
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
$ |___|___|___|,|___|___|___|
NOT ON DOCUMENT n
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
YES (GO TO NEXT PERSON) 1
NO (GO TO I23) 0
|
YES (GO TO I2, NAME 2) 1
NO (GO TO J1) 0 |
YES (GO TO I2, NAME 3) 1
NO (GO TO J1) 0 |
YES (GO TO I2, NAME 2) 1
NO (GO TO J1) 0 |
YES (GO TO I2, NAME 3) 1
NO (GO TO J1) 0 |
SECTION J: PUBLIC ASSISTANCE RECEIPT |
J1. Las siguientes preguntas son sobre la participación en otros programas gubernamentales.
¿Durante MONTH usted o alguna otra persona en su hogar recibió (STATE TANF/TANF), Asistencia Temporal para Familias Necesitadas, lo que también es conocido como asistencia social en efectivo (cash welfare)?
YES 1
NO (GO TO J23) 0
DOES NOT KNOW (GO TO J23) d
REFUSED (GO TO J23) r
J2. ¿Quién en su hogar recibió beneficios de (STATE TANF/TANF) en MONTH?
RELATIONSHIP
TO THE CIRCLE ALL
PERSON RESPONDENT THAT APPLY
RESPONDENT 1
PERSON 2: | | | 2
PERSON 3: | | | 3
PERSON 4: | | | 4
PERSON 5: | | | 5
PERSON 6: | | | 6
PERSON 7: | | | 7
PERSON 8: | | | 8
PERSON 9: | | | 9
PERSON 10: | | | 10
PERSON 11: | | | 11
PERSON 12: | | | 12
PERSON 13: | | | 13
PERSON 14: | | | 14
DOES NOT KNOW WHO ELSE (AT LEAST ONE RECIPIENT RECORDED) 15
DOES NOT KNOW d
REFUSED r
J3. INTERVIEWER: DID THE RESPONDENT, SPOUSE, OR CHILDREN/WARDS GET TANF DURING TARGET MONTH? CHECK J2 FOR RELATIONSHIPS CODES 4 AND 5, AND CODES 1, 2, 3, 11, 12, 13 OR 14 WHEN G30 OR G31 HAVE A “YES” FOR THAT HH MEMBER.
YES 1
NO (GO TO J13) 0
J4. ¿Cuánto recibieron [usted y su(s) (hijo/hija/hijos) /usted y su esposo(a) y su(s) (hijo/hija/hijos)] en beneficios de (STATE TANF/TANF) durante MONTH?
$ | |,| | | | TANF
DOES NOT KNOW d
REFUSED r
J5. ¿Puedo ver la declaración que usted recibió mostrando la suma de los beneficios de (STATE TANF/TANF) que recibió en MONTH?
PROBE: La carta de adjudicación (award letter) o notificación de la suma de beneficios de (STATE TANF/TANF) que usted recibe.
YES—ALL 1
YES—PARTIAL 2
NO/DOES NOT
HAVE/CAN’T GET
DOCUMENTATION (GO TO J13) 0
DOES NOT KNOW (GO TO J13) d
REFUSED TO SHOW
DOCUMENTATION (GO TO J13) r
J6. INTERVIEWER: ENTER TYPE OF DOCUMENT.
STATEMENT/NOTIFICATION 1
CHECK STUB 2
OTHER (SPECIFY) 3
J7. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
$| | |,| | | |
AMOUNT NOT ON DOCUMENT n
J8. INTERVIEWER: ENTER THE PERIOD OF PAYMENT.
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
PERIOD NOT ON DOCUMENT n
J9. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH.
| | | | NUMBER OF TIMES RECEIVED
NUMBER OF TIMES NOT ON DOCUMENT n
J10. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT.
| | | | | | | | | PERIOD ENDING DATE
MONTH DAY YEAR
END DATE NOT ON DOCUMENT n
J11. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT.
$| | | |,| | | |
AMOUNT NOT ON DOCUMENT n
J12. INTERVIEWER: COMPUTE THE MONTHLY AMOUNT USING J7, J8, AND J9. COMPARE IT TO THE AMOUNT RECORDED IN J4. IF THERE IS NO MORE THAN $100 DIFFERENCE, OR IF MONTHLY AMOUNT CANNOT BE COMPUTED DUE TO UNAVAILABLE PERIOD, NUMBERS, AMOUNTS, CONTINUE TO J13. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO J13. IF UNRESOLVABLE, CIRCLE CODE AND GO TO J13. CODE RESULT, BELOW.
NO DIFFERENCE OR DIFFERENCE
LESS THAN $100 1
RESOLVED DIFFERENCE(S) TO $100
OR LESS 2
UNRESOLVABLE 3
J13. INTERVIEWER: CHECK J2 FOR OTHER HH MEMBERS WHERE G32 OR G33 HAVE A “YES”. DID OTHER HOUSEHOLD MEMBER(S) RECEIVE TANF DURING TARGET MONTH?
YES 1
NO (GO TO J23) 0
J14. ¿Cuánto en beneficios de (STATE TANF/TANF) recibieron otros miembros de su hogar en MONTH? (Por favor no incluya los beneficios de (STATE TANF/TANF) recibidos por usted y su esposo(a).)
$ | | |,| | | | (TANF)
DOES NOT KNOW d
REFUSED r
J15. ¿Puedo ver la declaración que usted recibió mostrando la suma de los beneficios de (STATE TANF/TANF) que otros miembros de su hogar recibieron en MONTH?
PROBE: La carta de adjudicación (award letter) o notificación de la suma de
beneficios de (STATE TANF/TANF) recibidos.
YES—ALL 1
YES—PARTIAL 2
NO/DOES NOT
HAVE/CAN’T GET
DOCUMENTATION (GO TO J23) 0
DOES NOT KNOW (GO TO J23) d
REFUSED TO SHOW
DOCUMENTATION (GO TO J23) r
J16. INTERVIEWER: ENTER TYPE OF DOCUMENT.
STATEMENT/NOTIFICATION 1
CHECK STUB 2
OTHER (SPECIFY) 3
J17. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
$| | |,| | | |
AMOUNT NOT ON DOCUMENT n
J18. INTERVIEWER: ENTER THE PERIOD OF PAYMENT.
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
PERIOD NOT ON DOCUMENT n
J19. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH.
| | | NUMBER OF TIMES RECEIVED
NUMBER OF TIMES NOT ON DOCUMENT n
J20. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT.
| | | | | | | | |
MONTH DAY YEAR
END DATE NOT ON DOCUMENT n
J21. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT.
$| | | |,| | | |
AMOUNT NOT ON DOCUMENT n
J22. INTERVIEWER: COMPUTE THE MONTHLY AMOUNT USING J17, J18, AND J19. COMPARE IT TO THE AMOUNT RECORDED IN J14. IF THERE IS NO MORE THAN $100 DIFFERENCE, OR IF MONTHLY AMOUNT CANNOT BE COMPUTED DUE TO UNAVAILABLE PERIOD, NUMBERS, AMOUNTS, CONTINUE TO J23. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO J23. IF UNRESOLVABLE, CIRCLE CODE AND GO TO J23. CODE RESULT, BELOW.
NO DIFFERENCE OR DIFFERENCE
LESS THAN $100 1
RESOLVED DIFFERENCE(S) TO $100
OR LESS 2
UNRESOLVABLE 3
J23. ¿Usted o alguna otra persona en su hogar recibió beneficios de SNAP durante MONTH? Por favor incluya beneficios de transmisión electrónica.
YES 1
NO (GO TO J46) 0
DOES NOT KNOW (GO TO J46) d
REFUSED (GO TO J46) r
J24. ¿Quién en su hogar recibió beneficios de SNAP en MONTH?
RELATIONSHIP
TO THE CIRCLE ALL
PERSON RESPONDENT THAT APPLY
RESPONDENT 1
PERSON 2: | | | 2
PERSON 3: | | | 3
PERSON 4: | | | 4
PERSON 5: | | | 5
PERSON 6: | | | 6
PERSON 7: | | | 7
PERSON 8: | | | 8
PERSON 9: | | | 9
PERSON 10: | | | 10
PERSON 11: | | | 11
PERSON 12: | | | 12
PERSON 13: | | | 13
PERSON 14: | | | 14
DOES NOT KNOW WHO ELSE (AT LEAST ONE RECIPIENT RECORDED) 15
DOES NOT KNOW d
REFUSED r
J25. INTERVIEWER: DID SAMPLE MEMBER, SPOUSE, OR CHILDREN RECEIVE SNAP BENEFITS DURING TARGET MONTH? CHECK J24 FOR RELATIONSHIPS CODES 4 AND 5, AND CODES 1, 2, 3, 11, 12, 13 OR 14 WHEN G30 OR G31 HAVE A “YES” FOR THAT HH MEMBER.
YES 1
NO (GO TO J35) 0
J26. ¿Cuánto (recibió usted/recibieron usted y su esposo(a)) en beneficios de SNAP en MONTH?
$ | |,| | | | FOOD STAMPS
DOES NOT KNOW d
REFUSED r
J27. ¿Puedo ver la declaración que usted recibió mostrando la suma de los beneficios de SNAP (usted recibió/usted y su esposo(a) recibieron) en MONTH?
PROBE: La carta de adjudicación (award letter) o notificación de la suma de beneficios de SNAP que usted recibe.
YES—ALL 1
YES—PARTIAL 2
NO/DOES NOT
HAVE/CAN’T GET
DOCUMENTATION (GO TO J35) 0
DOES NOT KNOW (GO TO J35) d
REFUSED TO SHOW
DOCUMENTATION (GO TO J35) r
J28. INTERVIEWER: ENTER TYPE OF DOCUMENT.
STATEMENT/NOTIFICATION 1
CHECK STUB 2
OTHER (SPECIFY) 3
J29. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
$| | |,| | | |
AMOUNT NOT ON DOCUMENT n
J30. INTERVIEWER: ENTER THE PERIOD OF PAYMENT.
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
PERIOD NOT ON DOCUMENT n
J31. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH.
| | | NUMBER OF TIMES RECEIVED
NUMBER OF TIMES NOT ON DOCUMENT n
J32. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT.
| | | | | | | | |
MONTH DAY YEAR
END DATE NOT ON DOCUMENT n
J33. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT.
$| | | |,| | | |
AMOUNT NOT ON DOCUMENT n
J34. INTERVIEWER: COMPUTE THE MONTHLY AMOUNT USING J29, J30, AND J31. COMPARE IT TO THE AMOUNT RECORDED IN J26. IF THERE IS NO MORE THAN $100 DIFFERENCE, OR IF MONTHLY AMOUNT CANNOT BE COMPUTED DUE TO UNAVAILABLE PERIOD, NUMBERS, AMOUNTS, CONTINUE TO J35. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO J35. IF UNRESOLVABLE, CIRCLE CODE AND GO TO J35. CODE RESULT, BELOW.
NO DIFFERENCE OR DIFFERENCE
LESS THAN $100 1
RESOLVED DIFFERENCE(S) TO $100
OR LESS 2
UNRESOLVABLE 3
J35. INTERVIEWER: CHECK J24 FOR OTHER HH MEMBERS WHERE G32 OR G33 HAVE A “YES”. DID OTHER HOUSEHOLD MEMBERS RECEIVE SNAP BENEFITS DURING TARGET MONTH?
YES 1
NO (GO TO J46) 0
J36. ¿Cuánto en beneficios de SNAP recibieron otros miembros de su hogar en MONTH? (Por favor no incluya los beneficios de cupones de alimentos o ‘food stamps’ recibidos por usted y su esposo(a).)
$ | | |,| | | | FOOD STAMPS
DOES NOT KNOW d
REFUSED r
J37. ¿Puedo ver la declaración que usted recibió mostrando la suma de los beneficios de SNAP recibidos por otros miembros de su hogar en MONTH?
PROBE: La carta de adjudicación (award letter) o notificación de la suma de los beneficios de cupones de alimentos o “food stamps” recibidos.
YES—ALL 1
YES—PARTIAL 2
NO/DOES NOT
HAVE/CAN’T GET
DOCUMENTATION (GO TO J46) 0
DOES NOT KNOW (GO TO J46) d
REFUSED TO SHOW
DOCUMENTATION (GO TO J46) r
J38. INTERVIEWER: ENTER TYPE OF DOCUMENT.
STATEMENT/NOTIFICATION 1
CHECK STUB 2
OTHER (SPECIFY) 3
J39. INTERVIEWER: ENTER AMOUNT SHOWN ON DOCUMENT.
$ | | |,| | | |
AMOUNT NOT ON DOCUMENT n
J40. INTERVIEWER: ENTER THE PERIOD OF PAYMENT.
WEEK 1
TWO WEEKS 2
MONTH 3
OTHER (SPECIFY) 4
PERIOD NOT ON DOCUMENT n
J41. INTERVIEWER: ENTER NUMBER OF TIMES RECEIVED IN MONTH.
| | | NUMBER OF TIMES RECEIVED
NUMBER OF TIMES NOT ON DOCUMENT n
J42. INTERVIEWER: ENTER PERIOD ENDING DATE FROM DOCUMENT.
| | | | | | | | |
MONTH DAY YEAR
END DATE NOT ON DOCUMENT n
J43. INTERVIEWER: ENTER THE YEAR-TO-DATE AMOUNT SHOWN ON THE DOCUMENT.
$| | | |,| | | |
AMOUNT NOT ON DOCUMENT n
J44. INTERVIEWER: COMPUTE THE MONTHLY AMOUNT USING J39, J40, AND J41. COMPARE IT TO THE AMOUNT RECORDED IN J36. IF THERE IS NO MORE THAN $100 DIFFERENCE, OR IF MONTHLY AMOUNT CANNOT BE COMPUTED DUE TO UNAVAILABLE PERIOD, NUMBERS, AMOUNTS, CONTINUE TO J45. IF THERE IS A DIFFERENCE, DISPLAY THE RESULTS AND RESOLVE THE DIFFERENCE WITH THE RESPONDENT, THEN GO TO J45. IF UNRESOLVABLE, CIRCLE CODE AND GO TO J45. CODE RESULT, BELOW.
NO DIFFERENCE OR DIFFERENCE
LESS THAN $100 1
RESOLVED DIFFERENCE(S) TO $100
OR LESS 2
UNRESOLVABLE 3
J45. ¿Participó usted en el Programa de Distribución de Comida en Reservaciones Indias o FDPIR durante MONTH?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
J46. INTERVIEWER: WERE ALL SOURCES OF INCOME DOCUMENTED? CHECK QUESTIONS I2e, I3e, I4e, I5e, I6e, I7e, I8e, I9e, I10e, I11e, I12e, I13e, I14e, I15e, I16e, I17e, I18e, I19e I20e, I21e, I22e, J5, J15, J27, AND J37 FOR ANY QUESTION NOT CODED “1.”
YES (GO TO K1) 1
NO 0
J47. ¿Por qué no puede mostrarme todos los documentos de ingresos?
CIRCLE ALL
THAT APPLY
REFUSES ON OWN BEHALF/
REFUSES TO SHOW OWN DOCUMENTS 1
REFUSES ON BEHALF OF OTHER
HOUSEHOLD MEMBER(S)/REFUSES
TO SHOW OTHER HOUSEHOLD
MEMBERS’ DOCUMENTS 2
DO NOT HAVE DOCUMENTS 3
CAN’T FIND DOCUMENTS 4
TOO MUCH TROUBLE TO GET/
FIND DOCUMENTS 5
OTHER (SPECIFY) 6
DOES NOT KNOW d
REFUSED r
SECTION K: TOTAL MONTHLY INCOME |
K1. La computadora acaba de sumar todas las fuentes de ingreso de los que usted me dijo y la suma total de ingresos del hogar en MONTH (incluyendo los ingresos de personas que ya no están aquí) es AMOUNT [TOTAL FROM ALL SOURCES LISTED IN SECTION I]. ¿Eso le suena correcto?
YES (GO TO K4) 1
NO 0
DOES NOT KNOW (GO TO L1) d
REFUSED (GO TO L1) r
K2. INTERVIEWER: READ OR SHOW RESPONDENT EACH INCOME SOURCE AND AMOUNT AND MAKE ADJUSTMENTS WHERE NEEDED, THEN CONTINUE TO K3.
K3. El ingreso total revisado para MONTH es ahora TOTAL AMOUNT? ¿Eso le suena correcto?
YES 1
NO (GO TO BACK K2 AND
REPEAT PROCEDURES
UNTIL INCOME IS
CORRECT TO THE
RESPONDENT’S
SATISFACTION THEN
CONTINUE TO K4) 0
DOES NOT KNOW d
REFUSED r
K4. ¿La suma de TOTAL AMOUNT que acabamos de registrar para (su hogar/TARGET CHILD) en MONTH es una suma usual, o fue más o fue menos del promedio que usted espera que su ingreso mensual sea en este año escolar?
USUAL AMOUNT (GO TO K6) 1
MORE THAN AVERAGE 2
LESS THAN AVERAGE 3
DOES NOT KNOW (GO TO K6) d
REFUSED (GO TO K6) r
K5. ¿Más o menos cuánto espera que sea el ingreso mensual usual o normal de su hogar en este año escolar?
$ | | | |,| | | |
DOES NOT KNOW d
REFUSED r
K6. INTERVIEWER: CHECK CONTACT SHEET. IS THE MONTH FOR WHICH INCOME WAS REPORTED THE MONTH HOUSEHOLD SUBMITTED AN APPLICATION?
YES (GO TO L1) 1
NO 0
APPLICATION MONTH NOT AVAILABLE 2
K7. ¿La suma de AMOUNT que acabamos de registrar para (su hogar/TARGET CHILD) en MONTH es más o menos lo mismo que (el ingreso de su hogar/su ingreso) en APPLICATION MONTH?
YES (GO TO L1) 1
NO 0
DOES NOT KNOW (GO TO L1) d
REFUSED (GO TO L1) r
K8. ¿Más o menos cuánto fue (el ingreso de su hogar/su ingreso) en APPLICATION MONTH?
$ | | | |,| | | |
DOES NOT KNOW d
REFUSED r
NO SECTION L IN THIS DOCUMENT
SECTION M: DEMOGRAPHIC CHARACTERISTICS |
M1. Sólo unas pocas preguntas más sobre usted. ¿Cuántos años tiene?
| | | AGE
OR
| | | | | YEAR BORN
DOES NOT KNOW d
REFUSED r
M2. INTERVIEWER: CODE OR ASK: ¿Es usted mujer u hombre?
FEMALE 1
MALE 2
DOES NOT KNOW d
REFUSED r
M3. ¿Está usted actualmente casada(o), viviendo con pareja sin estar casados, es viuda(o), divorciada(o), separada(o) o nunca se casó?
CIRCLE ONE
MARRIED 1
LIVING WITH PARTNER TO WHOM
YOU ARE NOT MARRIED 2
WIDOWED 3
DIVORCED 4
SEPARATED 5
SINGLE AND NEVER MARRIED 6
DOES NOT KNOW d
REFUSED r
M4. ¿Cuál es el más alto grado o nivel de estudios que usted ha completado?
INTERVIEWER: IF GED, ENTER 12.
| | | HIGHEST GRADE COMPLETED
OTHER (SPECIFY) 0
ASSOCIATES 1
BACHELORS 2
MASTERS 3
Ph.D. 4
LAW DEGREE 5
M.D 6
DOES NOT KNOW d
REFUSED r
M5. ¿Usted se considera a sí misma(o) ser de origen hispano o latino?
PROBE: ¿Cubana(o), Mexicana(o), Puertorriqueña(o), sudamericana(o) o centroamericana(o) o de otra cultura u origen hispano?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
M6. ¿Es usted india(o)-americana(o) o indígena o nativa(o) de Alaska, asiática(o), negra(o) o africana(o)-americana(o), nativa(o) de Hawái o de otra isla del Pacifico o blanca(o)?
CIRCLE ALL
THAT APPLY
AMERICAN INDIAN OR ALASKA NATIVE 1
ASIAN 2
BLACK OR AFRICAN AMERICAN 3
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4
WHITE 5
HISPANIC 6
OTHER (SPECIFY) 7
DOES NOT KNOW d
REFUSED r
M7. ¿Es usted ciudadana(o) de los Estados Unidos?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
M8. ¿Es TARGET CHILD de origen hispano o latino?
PROBE: ¿Cubana(o), Mexicana(o), Puertorriqueña(o), sudamericana(o) o centroamericana(o) o de otra cultura u origen hispano?
YES 1
NO 0
DOES NOT KNOW d
REFUSED r
M9. ¿Es (ella/él) india(o)-americana(o) o indígena o nativa(o) de Alaska, asiática(o), negra(o) o africana(o)-americana(o), nativa(o) de Hawái o de otra isla del Pacifico o blanca(o)?
CIRCLE ALL
THAT APPLY
AMERICAN INDIAN OR ALASKA NATIVE 1
ASIAN 2
BLACK OR AFRICAN AMERICAN 3
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4
WHITE 5
HISPANIC 6
OTHER (SPECIFY) 7
DOES NOT KNOW d
REFUSED r
M10. Esto es el fin de nuestra entrevista. Muchas gracias por participar en nuestro estudio.
INTERVIEWER: GIVE THE RESPONDENT THE $25.00 GIFT CARD.
TIME INTERVIEW ENDED: | | |:| | | AM 1 HOUR MINUTE PM 2 |
| File Type | application/msword |
| File Title | APEC II HOUSEHOLD SURVEY SPANISH |
| Subject | CAPI |
| Author | Mathematica staff |
| Last Modified By | lywilliams |
| File Modified | 2012-06-27 |
| File Created | 2012-04-23 |
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