Parents/Guardians and Students - Individuals and Households

I3. Parent Interview ENGLISH (Group 2)

This page has been left blank for double-sided copying.

PARENT INTERVIEW

CATI/Web Questionnaire

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-xxxx. The time required to complete this information collection is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. All information will be kept private under the Privacy Act to the extent allowed by law. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-xxxx). Do not return the completed form to this address.

PROGRAMMER:

preload school MPRid, PARENT MPRID, PARENT NAME, student MPRID, LEVEL CCD = E, M, Or H (Child = e and youth = m or h), SECOND DIETARY RECALL FLAG (YES=FLAGGED and NO = NOT FLAGGED), DIETARY RECALL INTERVIEW STATUS, stuDent name, student dob, Student gender, and student grade.

PROGRAMMER:

Responses in all CAPS should be available in CATI mode only. This should only apply to “DON’T KNOW” and “REFUSED” options on most questions.

For web respondents, if any question is left blank (missing) show a check that reads: “Please provide a response below.” And display the following additional response options: 1) Don’t know, 2) Prefer not to answer

Do not allow respondents to go “back” after section breaks.

IF MODE = CATI

LevelCCD = M or H AND YOUTH HAS COMPLETED FIRST DIETARY RECALL THEN FILL “I’m part of the study team…” and “interviewed your child at school about the school meal programs.”

LevelCCD = M or H AND HAS NOT COMPLETED FIRST DIETARY RECALL THEN FILL “I’m part of the study team…” AND “will be interviewing your child about the school meal programs.”

LevelCCD = E AND PARENT INTERVIEW NOT COMPLETE, THEN FILL “Thank you… we will send you $25”

SampMemb

[PARENT OF CHILD] Thank you for completing the first part of the interview about what [CHILD] had to eat and drink. In the second part, I will ask you questions to better understand how parents feel about the meals provided by schools, why they choose to participate or not participate in school meals, and how these decisions are related to children’s overall diets. It will take about 25 minutes, and your cooperation is completely voluntary. All answers you give me will be kept private and no individual results will be presented. As a thank you, we will send you a $25 gift card.

[PARENT OF YOUTH] I’m part of the study team that [interviewed your child at school about the school meal programs/that will be interviewing your child about the school meal programs]. I’m calling now to see if we can do the parent interview. As you may recall from the letter and consent form sent home earlier, this study is being conducted by the U.S. Department of Agriculture/Food and Nutrition Service to better understand how children and parents feel about the meals provided by schools, why they choose to participate or not participate in school meals, and how these decisions are related to children’s overall diets. The interview will take about 25 minutes, and your cooperation is completely voluntary. All answers you give me will be kept private and no individual results will be presented. As a thank you, we will send you a $15 gift card.

I’m going to read a privacy statement to you before we begin:

Authority: Collecting this information is authorized under Section 28(a) of the Richard B. Russell National School Lunch Act.

Purpose: The survey will provide information about parents’ experiences with school meals.

Routine Use: A System of Record Notice titled FNS-8 USDA/FNS Studies and Reports describes how your information is protected.

Disclosure: Your cooperation is completely voluntary. Whether or not you take part has no effect on services you or your student receives or may apply for in the future.

CORRECT RESPONDENT 1

IF MODE = WEB

LevelCCD = M or H THEN FILL “As a thank you…”

LevelCCD = E AND DIETARY RECALL NOT COMPLETE THEN FILL “The second part…”

SampMemb

Welcome to the parent survey of the School Nutrition and Meal Cost Study-II. As you may recall from the letter and consent form sent home earlier, this study is being conducted by the U.S. Department of Agriculture/Food and Nutrition Service to better understand how children and parents feel about the meals provided by schools, why they choose to participate or not participate in school meals, and how these decisions are related to children’s overall diets. The survey will take about 25 minutes. All answers you provide will be kept private and no individual results will be presented.

[PARENT OF CHILD] The second part of the survey is about what your child ate and drank on a specific date. After you complete this portion on the phone with a member of the study team, we will be sending you $25 as thank you.

[PARENT OF YOUTH] As a thank you, we will be sending you a $15 gift card.

[ALL] Authority: Collecting this information is authorized under Section 28(a) of the Richard B. Russell National School Lunch Act.

Purpose: The survey will provide information about parents’ experiences with school meals.

Routine Use: A System of Record Notice titled FNS-8 USDA/FNS Studies and Reports describes how your information is protected.

Disclosure: Your cooperation is completely voluntary. Whether or not you take part has no effect on services you or your student receives or may apply for in the future.

ALL

PREFILL Student NAME FROM Preload file: STUDENT Name

PREFILL with ‘him’ If GENDER=1;

PREFILL WITH ‘HER’ IF GENDER=2

1. First, we are going to ask you about [STUDENT NAME]’s eating habits and the food served at [his/her] school.

Some schools offer meals each day to children for free or at a set, fixed price. Does [STUDENT NAME]’s school have a school breakfast program?

YES 1

NO 0

DON’T KNOW d

REFUSED r

PROGRAMMER BOX Q2

IF NO SCHOOL BREAKFAST (Q.1=0, D, OR R), GO TO Q.9

IF Q1 = 1

PREFILL studenT NAME FROM Preload file: STUDENT Name

2. Does [STUDENT NAME] ever eat a school breakfast, that is, a complete breakfast provided by the school?

YES 1

NO 0 GO TO Q.4

DON’T KNOW d GO TO Q.4

REFUSED r GO TO Q.4

Q2 = 1

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

3. How many days a week does [STUDENT NAME] usually eat a school breakfast?

None, doesn’t usually eat school breakfast 0

One 1

Two 2

Three 3 GO TO Q.5

Four 4 GO TO Q.5

Five 5 GO TO Q.5

DON’T KNOW d GO TO Q.5

REFUSED r GO TO Q.5

Q2= 0,d,r OR Q3=0, 1, OR 2

PREFILL STUDENT NAME FROM Preload file: STUDENT Name;

PREFILL “more frequently” and “more” if Q3 = 1 or 2

4. Which of the following reasons describe why [STUDENT NAME] does not eat school breakfast [more frequently] at school?

PROBE: Is that a reason [STUDENT NAME] doesn’t eat [more] school breakfasts?

	YES	NO	DON’T KNOW	REFUSED
a. Your child prefers to eat at home?	1	0	d	r
b. You prefer your child to eat breakfast at home?	1	0	d	r
c. There isn’t enough time to eat breakfast at school, for example due to the bus arrival time?	1	0	d	r
d. Your child does not like the food served at school?	1	0	d	r
e. Your child does not like to eat breakfast?	1	0	d	r
f. You thought your child couldn’t participate in the School Breakfast Program?	1	0	d	r
g. Your child doesn’t eat school breakfast because (his/her) friends don’t?	1	0	d	r
h. Your child thinks only needy kids eat school breakfast and (he/she) doesn’t want to be thought of that way?	1	0	d	r
i. You don’t want others to think you can’t provide breakfast for your child?	1	0	d	r
j. You don’t think the school breakfasts are a good value?	1	0	d	r
k. You don’t think the food served at school is healthy?	1	0	d	r
l. Is there any other reason? (SPECIFY)	1	0	d	r
IF OTHER SPECIFY (99): Please specify a reason:
(STRING 300)

IF Q1 = 1

PREFILL student NAME FROM Preload file: STUDENT Name

5. Now we’d like to ask you your opinions about the school breakfast served at [STUDENT NAME]’s school. After each statement, please indicate if you strongly agree, agree somewhat, disagree somewhat, or strongly disagree.

	STRONGLY AGREE	AGREE SOMEWHAT	DISAGREE SOMEWHAT	STRONGLY DISAGREE	DON’T KNOW	REFUSED
a. Children like the school breakfasts	1	2	3	4	d	r
b. I receive enough information about the School Breakfast Program	1	2	3	4	d	r
c. School breakfasts are served at a convenient time and place	1	2	3	4	d	r
d. Only children from needy families participate in the School Breakfast Program	1	2	3	4	d	r

PROGRAMMER BOX q6

ASK QS. 6-7 IF STUDENT EVER EATS SCHOOL BREAKFAST

(Q.2=1 AND Q.3 ≠ 0, d, or r)

ALL OTHERS GO TO Q.9

Q.2=1 AND Q.3 ≠ 0, d, or r

IF CATI, FILL: “Don’t know”, “Refused”

6. Would you say the breakfasts served at school are usually…

Very healthy, 1

Somewhat healthy, or 2

Not healthy? 3

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q6 is missing: Your answer to this question is important. In general, would you say the breakfasts served at school are usually very healthy, somewhat healthy, or not healthy?

Q.2=1 AND Q.3 ≠ 0, d, or r

7. Overall, how satisfied are you with the school breakfast provided at your child’s school? Are you…

Very satisfied, 1

Somewhat satisfied, 2

Somewhat dissatisfied, or 3

Very dissatisfied? 4

DON’T KNOW d

REFUSED r

Q7 = 3 or 4

8. Are you dissatisfied with the school breakfast provided by the school because…

	YES	NO	DON’T KNOW	REFUSED
a. Food is not healthy	1	0	d	r
b. Food is of poor quality or doesn’t taste good	1	0	d	r
c. Not enough choices	1	0	d	r
d. Child won’t eat it	1	0	d	r
e. Food doesn’t look appetizing	1	0	d	r
f. Food is not the right temperature	1	0	d	r
g. Not enough food/small portions	1	0	d	r
h. Not good value/cost	1	0	d	r
i. Not enough time to eat/schedule	1	0	d	r
j. Is there any other reason? (SPECIFY)	1	0	d	r
IF OTHER SPECIFY (99): Please specify a reason:
(STRING 300)

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

9. Does [STUDENT NAME] ever eat a school lunch? By school lunch we mean a complete meal provided by the school such as a fruit or vegetable, sandwich and milk, or a hot meal and milk for free or at a set, fixed price.

YES 1

NO 0 GO TO Q.11

DON’T KNOW d GO TO Q.11

REFUSED r GO TO Q.11

Q9 = 1

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

10. How many days a week does [STUDENT NAME] usually eat a school lunch, that is, a complete lunch provided by the school?

None, doesn’t usually eat school lunch 0

One 1

Two 2

Three 3 GO TO Q.12

Four 4 GO TO Q.12

Five 5 GO TO Q.12

DON’T KNOW d GO TO Q.13

REFUSED r GO TO Q.13

Q9 = 0,d,r OR Q10 = 0, 1, or 2

PREFILL STUDENT NAME FROM Preload file: STUDENT Name;

PREFILL WITH ‘more frequently’ AND ‘more’ IF Q10=1 OR 2

11. Which of the following reasons describe why [STUDENT NAME] does not eat school lunch [more frequently] at school?

PROBE: Is that a reason [STUDENT NAME] doesn’t eat [more] school lunches?

	YES	NO	DON’T KNOW	REFUSED
a. Your child does not like the food served at school?	1	0	d	r
b. Your child prefers to eat a lunch brought from home?	1	0	d	r
c. You prefer your child to eat foods sent from home?	1	0	d	r
d. Your child eats lunch at home or off campus?	1	0	d	r
e. Your child doesn’t like waiting in lines for lunch?	1	0	d	r
f. Your child doesn’t have enough time to get and eat lunch in school?	1	0	d	r
g. Your child doesn’t eat school lunches because (his/her) friends don’t?	1	0	d	r
h. You thought your child couldn’t participate in the school lunch program?	1	0	d	r
i. Your child doesn’t eat school lunches because they are too expensive?	1	0	d	r
j. Your child doesn’t eat school lunches because (he/she) is a vegetarian or has a special diet?	1	0	d	r
k. Your child thinks only needy kids eat school lunches and (he/she) doesn’t want to be thought of that way?	1	0	d	r
l. Your child is a picky eater?	1	0	d	r
m. You don’t think the food served at school is healthy?	1	0	d	r
l. Is there any other reason? (SPECIFY)	1	0	d	r
(STRING 300)
IF OTHER SPECIFY (99): Please specify a reason:

PROGRAMMER BOX Q12

IF Q9 = 0, D, or R, OR Q10 = 0, go to Q13

Q10 = 1, 2, 3, 4, or 5

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

PROGRAMMER: Rotate order of responses 1-4 randomly for both modes.

12. Which of the following reasons is the main reason [STUDENT NAME] eats school lunches? Would you say it’s because…

It’s easy for you, 1

It’s easy for your child, 2

Your child likes the lunch, 3

It’s a good value, 4

Your child wouldn’t eat lunch otherwise, 5

Or, something else? (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a reason.

ALL

13. Some schools have vending machines where children can purchase snacks, such as chips and cookies, fruit juices and sodas. In many cases, the school receives money from the companies for allowing the machines to be placed in schools.

Thinking about the school your child attends, do you think having snacks or beverages available in vending machines during the school day is…

A good idea, 1

A bad idea, or 2

Neither a good nor bad idea? 3

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q13 is missing: Your answer to this question is important. Thinking about your child’s school, is having snacks or beverages available in vending machines during the school day a good idea or a bad idea?

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

14. Are there any vending machines available to children in [STUDENT NAME]’s school?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

15. Does your child’s school cafeteria sell foods that children can buy for lunch other than the regular school lunch meal? These might be foods like hamburgers, French fries, pizza, or ice cream, for example.

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

PREFILL WITH ‘his’ IF GENDER=1,

PREFILL WITH ‘her’ IF GENDER=2

16. And does [his/her] school have a school store or snack bar, outside of the cafeteria, where children can buy foods or drinks?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

17. Some schools have contracts with national companies such as McDonald’s, Pizza Hut, and Taco Bell, to provide foods for student meals. Thinking about the school your child attends, do you think having brand name foods available to students in school is…

A good idea, 1

A bad idea, or 2

Neither a good nor bad idea? 3

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q17 is missing: Your answer to this question is important. Thinking about your child’s school, do you think it is a good idea or a bad idea to have brand name foods available to students in school?

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

18. Now we would like to ask you your opinions about the school lunches served at [STUDENT NAME]’s school. After each statement, please indicate if you strongly agree, agree somewhat, disagree somewhat, or strongly disagree.

INTERVIEWER: REPEAT ANSWER CHOICES AS NEEDED.

	STRONGLY AGREE	AGREE SOMEWHAT	DISAGREE SOMEWHAT	STRONGLY DISAGREE	DON’T KNOW	REFUSED
a. Children like the school lunches	1	2	3	4	d	r
b. I receive enough information about the School Lunch Program	1	2	3	4	d	r
c. School lunches are served at a convenient time and place	1	2	3	4	d	r
d. Only children from needy families participate in the School Lunch Program	1	2	3	4	d	r

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name.

19. In general, would you say the lunches served at [STUDENT NAME]’s school are…

Very healthy, 1

Somewhat healthy, or 2

Not healthy 3

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q19 is missing: Your answer to this question is important. In general, would you say the lunches served at [STUDENT NAME]’s school are very healthy, somewhat healthy, or not healthy?

ALL

20. Does your child receive school lunches for free?

YES 1 GO TO 21

NO 0 GO TO 22

DON’T KNOW d GO TO 21

REFUSED r GO TO 21

IF 21a = 1, DK, or R

21. Thinking about the cost of school lunches and the quality of the meals provided, are school lunches…

A very good value, 1

A pretty good value, or 2

Not a good value? 3

DON’T KNOW d

REFUSED r

ALL

22. Overall, how satisfied are you with the school lunches provided at your child’s school. Would you say you are…

Very satisfied, 1 GO TO Q.24

Somewhat satisfied, 2 GO TO Q.24

Somewhat dissatisfied, or 3

Very dissatisfied? 4

DON’T KNOW d GO TO Q.24

REFUSED r GO TO Q.24

Q22 = 3 or 4

23. Are you dissatisfied with the school lunches provided by the school because…

	YES	NO	DON’T KNOW	REFUSED
a. Food is not healthy	1	0	d	r
b. Food is of poor quality or doesn’t taste good	1	0	d	r
c. Not enough choices	1	0	d	r
d. Child won’t eat it	1	0	d	r
e. Food doesn’t look appetizing	1	0	d	r
f. Food is not the right temperature	1	0	d	r
g. Not enough food/small portions	1	0	d	r
h. Not good value/cost	1	0	d	r
i. Not enough time to eat/schedule	1	0	d	r
j. Is there any other reason? (SPECIFY) [B23_10]	1	0	d	r
IF OTHER SPECIFY (99): Please specify a reason:
(STRING 300)

ALL

24. Did you apply for free or reduced price school meals during the current school year?

YES 1

NO 0 GO TO Q.26

You did not apply because there is no school meals application 2 GO TO Q.26

DON’T KNOW d GO TO Q.26

REFUSED r GO TO Q.26

Q24=1

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

25. During the past 30 days, did [STUDENT NAME] receive free or reduced price lunch at school?

YES 1

NO 0

DON’T KNOW d

REFUSED r

Q24 = 1 AND Q1 = 1

PREFILL STUDENT NAME FROM Preload file: student Name

26. During the past 30 days, did [STUDENT NAME] receive free or reduced price breakfast at school?

YES 1

NO 0

DON’T KNOW d

REFUSED r

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

Now we would like to ask you some questions about [STUDENT NAME].

27. In general, would you say [STUDENT NAME]’s health is…

Excellent, 1

Very good, 2

Good, 3

Fair, or 4

Poor? 5

DON’T KNOW d

REFUSED r

ALL

PREFILL with ‘him’ If GENDER=1;

PREFILL WITH ‘her’ IF GENDER=2

28. Do you consider [him/her] to be a…

A very picky eater, 1

A somewhat picky eater, or 2

Not a picky eater? 3

DON’T KNOW d

REFUSED r

ALL

PREFILL with ‘boys’ If GENDER=1;

PREFILL WITH ‘girls’ IF GENDER=2;

PREFILL sTUDENT NAME FROM Preload file: STUDENT Name

29. Compared to other [boys/girls] the same age, would you say [STUDENT NAME] usually eats a larger amount of food, about the same amount of food, or a smaller amount of food?

LARGER AMOUNT 1

SAME AMOUNT 2

SMALLER AMOUNT 3

DON’T KNOW d

REFUSED r

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name;

PREFILL with ‘he’ If GENDER=1;

PREFILL WITH ‘she’ IF GENDER=2

30. Does [STUDENT NAME] have any food allergies or special dietary needs that affect what [he/she] eats?

YES 1

NO 0

DON’T KNOW d

REFUSED r

PROGRAMMER BOX q36

Q.31 TO Q.33 IS ASKED IF LevelCCD = E.

IF LevelCCD = M or H, GO TO Q.34

LevelCCD = E

PREFILL with ‘his’ If GENDER=1;

PREFILL WITH ‘her’ IF GENDER=2;

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

31. Thinking now about how your child spends [his/her] free time . . .

On an average school day, outside of school, about how many hours does [STUDENT NAME] watch TV or DVDs, play video or computer games or use a computer for something that is not school work? Count time spent on things such as Xbox, PlayStation, an iPod, an iPad or other tablet, a Smartphone, YouTube, Facebook or other social networking tools, and the Internet.

interviewer: IF RANGE GIVEN, TAKE THE MID POINT. ROUND TO NEAREST HALF HOUR.

| | | . | | (HOUR NUMBER RANGE: 0-24; DECIMAL NUMBER (0 or 5)

DON’T KNOW d

REFUSED r

SOFT CHECK: IF > 12.0 HOURS: You said your child spends [XX] hours watching TV or DVDs, playing video or computer games or using a computer for something that is not school work, is that correct?

LevelCCD = E

PREFILL with ‘boys’ If GENDER=1;

PREFILL WITH ‘girls’ IF GENDER=2;

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

32. Now we would like to ask a question about exercise or other physical activities. Compared to other [boys/girls] the same age, would you say [STUDENT NAME] is…

Less active, 1

About as active, 2

More active, or 3

Much more active? 4

DON’T KNOW d

REFUSED r

LevelCCD = E

PREFILL STUDENT NAME FROM Preload file: STUDENT Name;

PREFILL with ‘he’ If GENDER=1;

PREFILL WITH ‘she’ IF GENDER=2;

PREFILL WITH ‘his’ IF GENDER=1;

PREFILL WITH ‘her’ IF GENDER=2

33. During the past 7 days, on how many days was [STUDENT NAME] physically active for a total of at least 60 minutes per day? Add up all the time [he/she] spent in any kind of physical activity that increased [his/her] heart rate and made [him/her] breathe hard some of the time. Examples of these activities are competitive sports, running, biking, brisk walking, swimming laps, dancing or pushing a lawn mower.

0 DAYS 0

1 DAY 1

2 DAYS 2

3 DAYS 3

4 DAYS 4

5 DAYS 5

6 DAYS 6

7 DAYS 7

DON’T KNOW d

REFUSED r

IF SAMPLE LOAD FILE IS MISSING DOB THEN RESPONDENT SHOULD BE ASKED THIS QUESTION.

IF NOT MISSING THEN SKIP.

PREFILL STUDENT NAME FROM Preload file: STUDENT Name;

PREFILL WITH ‘his’ IF GENDER=1,

PREFILL WITH ‘her’ IF GENDER=2

34. How old was [STUDENT NAME] on [his/her] last birthday?

| | | (AGE/YEARS NUMBER RANGE: 0-21)

DON’T KNOW d

REFUSED r

SOFT CHECK: IF AGE IS LT 6 OR GT 18; You said [STUDENT NAME] was [XX] years old at his last birthday, is that correct?

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

35. Is [STUDENT NAME] of Hispanic or Latino origin, such as Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin?

YES/HISPANIC OR LATINO 1

NO/NOT HISPANIC OR LATINO 0

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q.35 = D; Your answer to this question is important. Is [STUDENT NAME] of Hispanic or Latino origin?

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

36. What is [STUDENT NAME]’s race?

AMERICAN INDIAN OR ALASKA NATIVE 1

ASIAN 2

BLACK OR AFRICAN AMERICAN 3

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 4

WHITE 5

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q36 = D; Your answer to this question is important. What is [STUDENT NAME]’s race?

ALL

PREFILL STUDENT NAME FROM Preload file: STUDENT Name

37. What is your relationship to [STUDENT NAME]?

interviewer: READ LIST ONLY IF NECESSARY

MOTHER/FATHER/PARENT 1

PARENT’S SPOUSE OR PARTNER 2

GRANDPARENT 3

OTHER RELATIVE 4

LEGAL GUARDIAN 5

OTHER (SPECIFY) 99

(STRING 100)

DON’T KNOW d

REFUSED r

IF OTHER SPECIFY (99): Please specify a response:

ALL

PREFILL STUDent NAME FROM Preload file: STUDENT Name

38. Does [STUDENT NAME] live with you…

INTERVIEWER INSTRUCTION: IF RESPONDENT SAYS CHILD DOES NOT LIVE IN HOUSEHOLD, CODE AS 4.

All of the time, 1

Most of the time, 2

Some of the time, or 3

None of the time? 4

DON’T KNOW d

REFUSED r

ALL

IF 38 = 1, 2, 3, d, OR r, fill “and your household”

Now we would like to ask you some questions about you (and your household).

IF Q.38 = 1, 2, 3, d, OR r

39. Including you, how many people live in your household?

PROBE: ASK FOR WHOLE NUMBER IF RANGE GIVEN

| | | PEOPLE IN HOUSEHOLD

(1 - 20)

DON’T KNOW d

REFUSED r

SOFT CHECK: IF NUMBER IS GT 10: You said [XX] people, including you, live in your household. Is that correct?

SOFT CHECK: IF Q39=1 and Q38=1,2,3: In the previous question you said that [STUDENT NAME] lives with you, but you just said that including yourself there is only 1 person who lives in your household. Is this correct?

If Q.38 = 1, 2, OR 3 AND Q.39 > 1

40. Of these, how many are under the age of 18, or age 18 or older but still in high school?

PROBE: ASK FOR WHOLE NUMBER IF RANGE GIVEN

| | | children

(0 – 20)

DON’T KNOW d

REFUSED r

SOFT CHECK: IF NUMBER IS GT OR EQUAL TO Q39: You said that [XX] children living in your household are under the age of 18, or age 18 or older but still in high school. Is that correct?

If Q40 = 1, 2, 3…OR 20

40a. Of these, how many are age 13 or older?

PROBE: ASK FOR WHOLE NUMBER IF RANGE GIVEN

| | | children

(0 – 20)

DON’T KNOW d

REFUSED r

SOFT CHECK: IF NUMBER IS GT OR EQUAL TO Q40: You said that [XX] of the [FILL from Q40] children living in your household are age 13 or older. Is that correct?

If Q40 = 1, 2, 3…OR 20

40b. What is the age of the oldest child in your household?

PROBE: By child, I mean under the age of 18, or age 18 or older but still in high school.

| | | YEARS

(0 – 21)

DON’T KNOW d

REFUSED r

ALL

41. Are you currently living with a partner or spouse?

YES 1

NO 0

DON’T KNOW d

REFUSED r

SOFT CHECK: IF Q41=1 and Q39 = 1: In a previous question you said that including yourself there is only 1 person who lives in your household, but you just said you live with a partner or a spouse. Please confirm your answer and then continue.

ALL

42. About how many hours a week do you usually spend outside of your home at a paid job, school or job training program?

INTERVIEWER: PICK MIDPOINT IF RANGE GIVEN

| | | HOURS PER WEEK

(1-99)

NONE 0

DON’T KNOW d

REFUSED r

SOFT CHECK: IF HOURS PER WEEK GT 60; You said that you usually spend [XX] hours per week outside your home at a paid job, school or job training program, is that correct?

ALL

43. What is the last grade or highest level of education you completed? Is it…

8th grade or less 1

Some high school 2

High school graduate or GED 3

Some college or technical school 4

Associates or 2 year degree 5

College graduate or 4 year degree 6

Graduate school 7

DON’T KNOW d

REFUSED r

PROGRAMMER BOX q.43

IF Q.41=1, ASK QS. 44-45, OTHERS GO TO PROGRAMMER BOX Q.45

Q41 = 1

PREFILL SOFT CHECK WITH HOURS ENTERED: NUMBER GIVEN

44. About how many hours a week does your partner or spouse usually spend outside of the home at a paid job, school or job training program?

| | | HOURS PER WEEK

(1-99)

NONE 0

DON’T KNOW d

REFUSED r

SOFT CHECK: IF HOURS PER WEEK GT 60; You said your partner or spouse usually spends [NUMBER GIVEN] hours per week outside of the home at a paid job, school or job training program. Is that correct?

Q41 = 1

45. What is the last grade or highest level of education your partner or spouse completed? Is it…

8th grade or less 1

Some high school 2

High school graduate/GED 3

Some college/technical school 4

Associates/2 year degree 5

College graduate/4 year degree 6

Graduate school 7

DON’T KNOW d

REFUSED r

PROGRAMMER BOX 45

IF Q.38=4, GO TO Q.72. ELSE, GO TO Q.46

IF Q.38 = 1, 2, 3, d, OR r

46. We would like your best estimate of your total annual household income before taxes in the year 2019. Please include all forms of income, including wages, salaries, interest, dividends, and other forms of income such as Social Security, SSI or TANF for all household members.

INTERVIEWER: IF NON-SPECIFIC AMOUNT GIVEN, PROBE FOR SPECIFIC AMOUNT. AFTER PROBING, IF NON SPECIFIC AMOUNT GIVEN, MARK 1.

$ | | | | , | | | | record amount GO TO PROGRAMMER BOX 49

(0 – 999,999)

NON-SPECIFIC AMOUNT 1

DON’T KNOW d

REFUSED r

Q.46 = 1, d, OR r

47. Is your total household income less than $50,000?

YES 1 GO TO Q.48

NO 0 GO TO Q.49

DON’T KNOW d GO TO PROGRAMMER BOX 49

REFUSED r GO TO PROGRAMMER BOX 49

Q47 = 1

IF MODE = CATI, fill “I’m going to read you some income categories. Please tell me when I read the range that represents your household’s annual income.”

IF MODE = WEB, fill “Please select the income range that best reflects your household’s annual income.”

48. [I’m going to read you some income categories. Please tell me when I read the range that represents your household’s annual income. / Please select the income range that best reflects your household’s annual income.]

LESS THAN $5,000 1

$5,000 TO LESS THAN $10,000 2

$10,000 TO LESS THAN $15,000 3

$15,000 TO LESS THAN $20,000 4

$20,000 TO LESS THAN $25,000 5

$25,000 TO LESS THAN $30,000 6

$30,000 TO LESS THAN $40,000 7

$40,000 TO LESS THAN $50,000 8

DON’T KNOW d

REFUSED r

GO TO PROGRAMMER BOX 49

Q47 = 0

IF MODE = CATI, fill “I’m going to read you some income categories. Please tell me when I read the range that represents your household’s annual income.”

IF MODE = WEB, fill “Please select the income range that best reflects your household’s annual income.”

49. [I’m going to read you some income categories. Please tell me when I read the range that represents your household’s annual income. / Please select the income range that best reflects your household’s annual income.”

$50,000 TO LESS THAN $60,000 1

$60,000 TO LESS THAN $70,000 2

$70,000 TO LESS THAN $80,000 3

$80,000 TO LESS THAN $90,000 4

$90,000 TO LESS THAN $100,000 5

$100,000 OR MORE 6

DON’T KNOW d

REFUSED r

PROGRAMMER BOX q49

• IF Q39=D OR R AND Q38=1,2,3 THEN THE %FPL SHOULD NOT BE CALCULATED, BUT STILL GO TO Q50.

• IF Q39= D OR R AND Q38=4, D, OR R, THE %FPL SHOULD NOT BE CALCULATED. ONLY ASK Q50-Q53 AND Q71-Q73. WE SHOULD NOT ASK Q54-70.

ELSE:

• IF (Q46 = D OR R) AND (Q47 = D OR R), THEN SET HOUSEHOLD INCOME AS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• IF (Q46 = D OR R) AND (Q47 = 1) AND (Q48 = D OR R), THEN SET HOUSEHOLD INCOME AS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• IF (Q46 = D OR R) AND (Q47 = 0) AND (Q49 = D OR R), THEN SET HOUSEHOLD INCOME AS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• IF (Q46 = 1) AND (Q47 = D OR R), THEN SET HOUSEHOLD INCOME AS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• IF (Q46 = 1) AND (Q47 = 1) AND (Q48 = D OR R), THEN SET HOUSEHOLD INCOME AS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• IF (Q46 = 1) AND (Q47 = 0) AND (Q49 = D OR R), THEN SET HOUSEHOLD INCOME AS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• PROGRAM MUST CALCULATE IF HOUSEHOLD INCOME IS GREATER THAN 200% FPL, GO TO Q.54

• IF HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO 200% (FPL), GO TO Q50

• REFER TO TABLE AT BEGINNING OF PARENT SPECS FOR CALCULATIONS.

HOUSEHOLD INCOME ≤ 200% OF POVERTY OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (Q39 = D OR R AND Q38 = 4, D, OR R)

Next we’d like to know if anyone living in your household currently receives income or benefits from a number of different sources.

50. Does your household receive SNAP (Supplemental Nutrition Assistance Program) benefits or participate in the Food Distribution Program on Indian Reservations?

YES 1

NO 0

DON’T KNOW d

REFUSED r

HOUSEHOLD INCOME ≤ 200% OF POVERTY OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (Q39 = D OR R AND Q38 = 4, D, OR R)

51. Does your household receive assistance from TANF, Public Assistance, TAFDC, EAEDC, or Welfare?

YES 1

NO 0

DON’T KNOW d

REFUSED r

HOUSEHOLD INCOME ≤ 200% OF POVERTY OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (Q39 = D OR R AND Q38 = 4, D, OR R)

FILL: State health insurance name

52. Does your household participate in Medicaid, [STATE HEALTH], or CHIP?

YES 1

NO 0

DON’T KNOW d

REFUSED r

HOUSEHOLD INCOME ≤ 200% OF POVERTY OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (Q39 = D OR R AND Q38 = 4, D, OR R)

53. Does anyone in your household receive benefits under the WIC Program—Women, Infants and Children Program?

YES 1

NO 0

DON’T KNOW d

REFUSED r

(HOUSEHOLD INCOME ≤ 200% OF POVERTY) OR (HOUSEHOLD INCOME > 200% OF POVERTY) OR (Q39 = D OR R AND Q38 = 1, 2, OR 3)

PREFILL WITH ‘you’, ‘I’, “my’ IF Q51=0, D, R

PREFILL WITH ‘your household’, ‘we’, ‘our’ IF Q41=1;

PREFILL ‘CURRENT MONTH’ WITH MONTH OF INTERVIEW

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

54. These next questions are about the food eaten in your household in the last 12 months, since [FILL NAME OF CURRENT MONTH] of last year and whether you were able to afford the food you need.

Which of these statements best describes the food eaten in your household in the last 12 months: [I/we] have…

Enough of the kinds of food [I/we] want to eat 1

Enough, but not always the kinds of food [I/we] want 2

Sometimes not enough to eat, or 3

Often not enough to eat? 4

[DON’T KNOW / Don’t know] d

REFUSED r

PROGRAMMER BOX Q54

IF (HOUSEHOLD INCOME <= FPL200%)

OR

(Q39 = D OR R AND Q38 = 1, 2, OR 3)

OR

(HOUSEHOLD INCOME > FPL200% AND Q54 = 2, 3, 4, D, OR R)

GO TO 55

ELSE

IF 54 = 1 AND HOUSEHOLD INCOME > FPL200%, GO TO 74

Household Stage 1.

IF (HOUSEHOLD INCOME <= FPL200%) OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (HOUSEHOLD INCOME > FPL200% AND Q54 = 2, 3, 4, D, OR R)

PREFILL WITH ‘you’, ‘I’, “my’ IF Q41=0, D, R

PREFILL WITH ‘your household’, ‘we’, ‘our’ IF Q41=1;

PREFILL ‘CURRENT MONTH’ WITH MONTH OF INTERVIEW

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

55. The next questions contain several statements that people have made about their food situation. For these statements, please indicate whether the statement was often true, sometimes true, or never true for [you/your household] in the last 12 months, that is, since last [FILL NAME OF CURRENT MONTH].

The first statement is, “[I/we] worried whether [my/our] food would run out before [I/we] got money to buy more.” For [you/your household] in the last 12 months, was that…

Often true, 1

Sometimes true, or 2

Never true? 3

[DON’T KNOW / Don’t know] d

REFUSED r

IF (HOUSEHOLD INCOME <= FPL200%) OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (HOUSEHOLD INCOME > FPL200% AND Q54 = 2, 3, 4, D, OR R)

PREFILL WITH “you”, ‘I’ IF Q41=0, D, R

PREFILL WITH “your household”, ’we’ IF Q41=1

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

56. “The food that [I/we] bought just didn’t last, and [I/we] didn’t have money to get more.” For [you/your household] in the last 12 months, was that…

Often true, 1

Sometimes true, or 2

Never true? 3

[DON’T KNOW / Don’t know] d

REFUSED r

IF (HOUSEHOLD INCOME <= FPL200%) OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) OR (HOUSEHOLD INCOME > FPL200% AND Q54 = 2, 3, 4, D, OR R)

PREFILL WITH ‘you’, ‘I’ IF Q41=0, D, R

PREFILL WITH ’your household’, ‘we’ IF Q41=1

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

57. “[I/we] couldn’t afford to eat balanced meals.” For [you/your household] in the last 12 months, was that…

Often true, 1

Sometimes true, or 2

Never true? 3

[DON’T KNOW / Don’t know] d

REFUSED r

PROGRAMMER BOX Q57

FIRST LEVEL SCREEN (Screener for Stage 2):

[(Q54 = 3 or 4) OR (Q55, Q56, OR Q57 = 1 OR 2)]

CONTINUE TO STAGE 2 QUESTIONS 58-61.

OTHERWISE:

IF Q40≥1

OR (Q39 = D OR R AND Q38 = 1, 2, OR 3) ;

GO TO Q64;

ELSE GO TO Q.71

Adult Stage 2.

[(Q54 = 3 or 4) OR (Q55, Q56, OR Q57 = 1 OR 2)]

PREFILL ‘you’ IF Q41=0, D, R,

PREFILL ‘you or other adults in your household’ IF Q41=1;

PREFILL ‘CURRENT MONTH’ WITH MONTH OF INTERVIEW

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

58. In the last 12 months, since last [CURRENT MONTH], did [you/you or other adults in your household] ever cut the size of your meals or skip meals because there wasn’t enough money for food?

YES 1 GO TO Q.58a

NO 0 GO TO Q.59

[DON’T KNOW / Don’t know] d GO TO Q.59

REFUSED r GO TO Q.59

Q58 = 1

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

58a. How often did this happen?

Almost every month, 1

Some months, but not every month, or 2

Only one or two months? 3

[DON’T KNOW / Don’t know] d

REFUSED r

[(Q54 = 3 or 4) OR (Q55, Q56, OR Q57 = 1 OR 2)]

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

59. In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

[(Q54 = 3 or 4) OR (Q55, Q56, OR Q57 = 1 OR 2)]

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

60. In the last 12 months, were you ever hungry but didn’t eat because there wasn’t enough money for food?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

[(Q54 = 3 or 4) OR (Q55, Q56, OR Q57 = 1 OR 2)]

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

61. In the last 12 months, did you lose weight because there wasn’t enough money for food?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

PROGRAMMER BOX q61

SECOND LEVEL SCREEN (Screener for Stage 3):

IF (Q58, Q59, Q60, OR Q61 = 1)

CONTINUE TO STAGE 3 QUESTIONS 62 THROUGH 63;

OTHERWISE:

IF Q40≥1

OR (Q39 = D OR R AND Q38 = 1, 2, OR 3),

GO TO Q64;

ELSE GO TO Q.71

Adult Stage 3.

(Q58, Q59, Q60, OR Q61 = 1)

PREFILL ‘you’ IF Q41=0, D, R,

PREFILL ‘you or other adults in your household’ IF Q41=1

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

62. In the last 12 months, did (you/you or other adults in your household) ever not eat for a whole day because there wasn’t enough money for food?

YES 1 GO TO Q.63

NO 0 GO TO PROGRAMMER BOX 63

[DON’T KNOW / Don’t know] d GO TO PROGRAMMER BOX 63

REFUSED r GO TO PROGRAMMER BOX 63

Q62 = 1

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

63. How often did this happen?

Almost every month, 1

Some months, but not every month, or 2

Only one or two months? 3

[DON’T KNOW / Don’t know] d

REFUSED r

PROGRAMMER BOX Q63

IF Q50≥1 (children <18 in HH)

OR (Q39 = D OR R AND Q38 = 1, 2, OR 3),

GO TO Q64;

ELSE GO TO Q.71

Child Stage 1.

IF [(HOUSEHOLD INCOME <= FPL200% AND Q40≥1)]

OR (Q39 = D OR R AND Q38 = 1, 2, OR 3)

OR [(HOUSEHOLD INCOME > FPL200%) AND (Q54 = 2, 3, 4, D, OR R) AND (Q40≥1)]

PREFILL WITH ‘you’, ‘I’, “my’, ‘I was’ IF Q41=0, D, R

PREFILL WITH ‘your household’, ‘we’, ‘our’, ‘we were’ IF Q41=1;

PREFILL WITH ‘child’ IF Q40=1,

PREFILL WITH ‘children’ IF Q40>1.

PREFILL WITH ‘children’ IF Q40=D or R OR MISSING AND Q38 =1, 2, OR 3

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

64. The next questions contain several statements that people have made about the food situation of their children. For these statements, please indicate whether the statement was OFTEN true, SOMETIMES true, or NEVER true in the last 12 months for your [child/children living in the household who are under 18 years old].

“[I/we] relied on only a few kinds of low-cost food to feed [my/our] [child/children] because [I was/we were] running out of money to buy food.” For [you/your household] in the last 12 months, was that…

Often true, 1

Sometimes true, or 2

Never true? 3

[DON’T KNOW / Don’t know] d

REFUSED r

IF [(HOUSEHOLD INCOME <= FPL200%) AND (Q50≥1)]

OR (Q39 = D OR R AND Q38 = 1, 2, OR 3)

OR [(HOUSEHOLD INCOME > FPL200%) AND (Q54 = 2, 3, 4, D, OR R) AND (Q40≥1)]

PREFILL WITH ‘you’, ‘I’, “my’ IF Q41=0, D, R

PREFILL WITH ‘your household’, ‘we’, ‘our’, IF Q41=1;

PREFILL WITH ‘child’ IF Q40=1, and language = ENGLISH

PREFILL WITH ‘children’ IF Q40>1 and language = ENGLISH

PREFILL WITH ‘children’ IF Q40=D or R OR MISSING AND Q38 = 1, 2, OR 3 and language = ENGLISH

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

65. “[I/We] couldn’t feed [my/our] [child/children] a balanced meal because [I/we] couldn’t afford that.” For [you/your household] in the last 12 months, was that…

Often true, 1

Sometimes true, or 2

Never true? 3

[DON’T KNOW / Don’t know] d

REFUSED r

IF [(HOUSEHOLD INCOME <= FPL200%) AND (Q40≥1)]

OR (Q39 = D OR R AND Q38 = 1, 2, OR 3)

OR [(HOUSEHOLD INCOME > FPL200%) AND (Q54 = 2, 3, 4, D, OR R) AND (Q40≥1)]

PREFILL ‘My’, “I”, “you” IF Q41=0, D, R, and language = ENGLISH

PREFILL ‘our child was’ IF Q41=1 AND Q40=1, and language = ENGLISH

PREFILL WITH ‘ The children were’ IF Q40>1 and language = ENGLISH

PREFILL WITH ‘ The children were’ IF Q40=D or R OR MISSING AND Q38 = 1, 2, OR 3 and language = ENGLISH

PREFILL ‘we’ AND ‘your household’ IF Q41=1 and language = ENGLISH

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

66. “[My/Our child was/The children were] not eating enough because [I/we] just couldn’t afford enough food.” For [you/your household] in the last 12 months, was that…

Often true, 1

Sometimes true, or 2

Never true? 3

[DON’T KNOW / Don’t know] d

REFUSED r

PROGRAMMER BOX Q.66

SCREENER FOR CHILD STAGE 2 QUESTIONS.

IF (Q64, Q65, OR Q66 = 1 OR 2)

CONTINUE TO CHILD STAGE 2 QUESTIONS 67 THROUGH 70;

OTHERWISE GO TO Q71.

Child Stage 2.

(Q64, Q65, OR Q66 = 1 OR 2)

PREFILL ‘your child’s’ IF Q40 = 1;

PREFILL ‘your children’s’ IF Q40 > 1 OR D, R, OR MISSING;

PREFILL ‘CURRENT MONTH’ WITH MONTH OF INTERVIEW

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

67. In the last 12 months, since [CURRENT MONTH] of last year, did you ever cut the size of [your child’s/any of the children’s] meals because there wasn’t enough money for food?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

(Q64, Q65, OR Q66 = 1 OR 2)

PREFILL ‘your child’s IF Q40 = 1 and language = ENGLISH;

PREFILL ‘any of your children’ IF Q40 > 1 OR D, R, OR MISSING and language = ENGLISH

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

68. In the last 12 months, did [your child/any of the children] ever skip meals because there wasn’t enough money for food?

YES 1

NO 0 GO TO Q.69

[DON’T KNOW / Don’t know] d GO TO Q.69

REFUSED r GO TO Q.69

Q68 = 1

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

68a. How often did this happen?

Almost every month, 1

Some months, but not every month, or 2

Only one or two months? 3

[DON’T KNOW / Don’t know] d

REFUSED r

(Q64, Q65, OR Q66 = 1 OR 2)

PREFILL WITH ‘was your child’ IF Q40=1,

PREFILL WITH ‘were the children’ IF Q40 >1 OR D, R, OR MISSING.

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

69. In the last 12 months, (was your child/were the children) ever hungry but you just couldn’t afford more food?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

(Q64, Q65, OR Q66 = 1 OR 2)

PREFILL WITH ‘your child’ IF Q40=1,

PREFILL WITH ‘any of the children’ IF Q40 >1 OR D, R, OR MISSING

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

70. In the last 12 months, did (your child/any of the children) ever not eat for a whole day because there wasn’t enough money for food?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

IF 38 = 1, 2, 3, d, OR r

IF CATI, “DON’T KNOW” IF WEB, “Don’t know”

71. In the last 30 days did you or anyone in your household receive free food or meals from food pantries, food banks, shelters, church, soup kitchens, a senior center, or any programs that deliver meals to your home?

YES 1

NO 0

[DON’T KNOW / Don’t know] d

REFUSED r

SECTION H

LEVELCCD = M OR H AND SECOND DIETARY RECALL FLAG = YES AND SECOND DIETARY RECALL IS NOT COMPLETE OR REFUSED

72. Thanks for all of your help today. [STUDENT NAME] was also selected for a second phone interview about what (s/he) ate. This will take place about 3 to 5 days after the first in school interview. We will mail (him/her) an additional $15 gift card for completing the second interview. Can you provide a cell phone where we can reach [STUDENT NAME] to text a reminder to complete this second interview?

INTERVIEWER: RECORD PARENT CELL NUMBER IF RESPONDENT UNWILLING TO PROVIDE STUDENT CELL NUMBER

| | | | - | | | | - | | | | |

(RANGE) (RANGE) (RANGE)

No cell phone 0

Don’t know d

Would rather not provide r

LEVELCCD = M OR H OR LEVELCCD = E AND DIETARY RECALL IS COMPLETE

IF LEVELCCD = M OR H, FILL “$15”

IF LEVELCCD = E, FILL “$25”

73. You are finished with the survey. As a thank you, we will mail you a ($15/$25) gift card. I’d like to confirm your mailing information before you go.

Can you please verify your name?

PROBE: Can you spell that for me please?

(STRING 50)

FIRST NAME

(STRING 50)

LAST NAME

LEVELCCD = M OR H OR LEVELCCD = E AND DIETARY RECALL IS COMPLETE

74. I’d also like to confirm your mailing address.

ADDRESS: What is your current address?

PROBE: Is there an apartment number?

PROBE: This is where we will mail your gift card.

STREET 1

STREET 2

APT. #

CITY

STATE

ZIP