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Cycle 95, FALL 2019
OMB NO. 1205-0453
EXPIRATION DATE: 11/30/2019
9
5
COUNTY FIPS
FARM WORKER ID
[FOR OFFICE USE ONLY]
[REV. October 29, 2019]
NATIONAL AGRICULTURAL WORKERS SURVEY - 2019
CS2
DATE:
CS5
CROP:
/
/
(“NAWS”)
[FOR OFFICE USE ONLY]
CROP CODE
CS6 TASK:
TASK CODE
LANGUAGE DURING INTERVIEW: __________________
GN:
ID:
IF GN REFERRED TO CONTRACTOR, GROWER OR OTHER,
WRITE INFORMATION)
NAME :
_______________________________________
ADDRESS:
_______________________________________
TELEPHONE:
(_________)___________-________________
GN REFERRED TO:
9 “CONTRACTOR”?:
9 OTHER GROWER?
9 OTHER?:_______
WORKER IS ACTUALLY EMPLOYED BY?:
9 1 GROWER
9 2 CONTRACTOR
TYPE OF WORK?: 91 FIELD WORK
92 NURSERY
93 PACKING HOUSE
97 OTHER:________
FARM WORKER’S NAME:
LOCAL ADDRESS:
TELEPHONE:
INTER
VIEWER’S NAME:
CP5 TIME BEGAN:
CS9 INTERVIEWER’S ID:
:
9 AM
9 PM
CP6 TIME ENDED:
:
9 AM
9 PM
Notwithstanding any other provision of law, no person is required to respond to nor shall a person be subject to a
penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction
Act unless that collection of information displays a currently valid Office of Management and Budget control
number. Public reporting burden for this collection of information, which is voluntary, is estimated to average 45
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. Send comments
regarding this burden estimate to the Office of Policy Development, Evaluation and Research, ETA, Department of
Labor, Room N5641, 200 Constitution Avenue, N.W., Washington, D.C. 20210.
HOUSEHOLD GRID
[REV. Aug 5, 2019]
___ ___ ___ ___ ___
95 ___ ___ ___
Farmworker ID
County
A1
NAME
*A2 A3 A5
M
R
A
E
R
L
I
A
T
T
A
I
L
O S
N E S
X T
A
T
U
S
A6
B
I
R
T
H
D
A
Y
**A7
C
O
U
N
T
R
Y
A9
**A10
A8
A4
HIGHEST
C
MONTH [ASK ALL
O
AND
GRADE
IN A1]:
LEVEL
U
YEAR
DOES
[FOR
N
S/HE LIVE
MINORS
FIRST WITH YOU
T
INCLUDE
R
NOW?
PREE
Y
IF NOT,
SCHOOL
N
WHERE?
(“PS”) AND
S
T
[STATE and
B
KINDER
C
E
COUNTRY]
MM
I
(“K”)
[ASK
H
R
/
R
ONLY
O
E
YY
T
WORKER
O
D
H
FOR HIGHEST
[CODE]
L
DEGREE
OBTAINED. ] [CODE] U.S.?
***A31
A32-33
LAST 12
MONTHS,
TRAVELED
TO DO FW
(OR DONE
FW IN
OTHER
WHY CITY)?
NOT IF YES,
[NAME]
?
_ TRAVELED
OR
C
JOINED
O
WITH
D
YOU?
E
IF
NOT
H
E
R
E,
A34-35
A11
PRIOR 12 ANY
MONTHS U.S.
TO (A32-33), S
TRAVELED C
H
TO DO FW
O
(OR DONE
O
FW IN
L
OTHER
LAST
CITY)?
12
IF YES,
M
[NAME]
TRAVELED O
OR JOINED N
WITH YOU? T
H
S?
A36
ANY
U.S.
WORK
LAST
12
M
O
N
T
H
S?
F
S
M
O
HG: _______
Y
Y
Y
N
N
N
/
/
HD: _______
*****HA16
a. illness?:
Y
DK
N
RF
b. injury?:
Y
DK
N
RF
c. routine or
Y
DK
N
RF
NW d. dental treatment or Y
DK
preventive care?:
N
RF
a. illness?:
Y
DK
N
RF
b. injury?:
Y
DK
N
RF
c. routine or
Y
DK
N
RF
NW d. dental treatment or Y
DK
preventive care?:
N
RF
B.
FW
S
M
M
F
/
Y
Y
Y
Y
N
N
N
N
NF
/
O
preventive care?:
C.
/
FW
S
M
M
F
O
*CODES FOR A2 (RELATIONSHIP):
1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR
ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS, UNCLES,
ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
7= OTHER::__________________
Y
Y
Y
Y
N
N
N
N
NF
/
** CODES FOR A7 AND A10 (COUNTRIES AND REGIONS):
1= U.S.A.
8= PACIFIC ISLANDS
2= PUERTO RICO
(THE PHILIPPINES,
3= MEXICO
GUAM, FIJI, ETC.)
4= CENTRAL AMERICA
9= ASIA (CHINA,
5= SOUTH AMERICA
JAPAN, KOREA,
6= CARIBBEAN
ETC.)
7= SOUTH EAST ASIA
95= DK (DON’T KNOW)
(INDONESIA, CAMBODIA,
96= RF (REFUSE)
VIETNAM, LAOS, THAILAND) 97=OTHER:________
***CODES FOR A31
1 = NO CHILD CARE IN
THIS LOCATION
2 = NO HOUSING IN THIS
LOCATION
3 = CHILD IN SCHOOL,
AFFECTED IF MOVED
95= DK (DON’T KNOW)
96= RF (REFUSE)
7= OTHER: _______
2
HA17
*****HA18
ONLY FOR SPOUSE, AND CHILDREN UNDER 22 YEARS OLD
And
When?
the
(Last [For each
last
time)
“NO” IN
In the USA, in the LAST 12
time,
[Enter “HA15"]
MONTHS,
where ‘within” Why did
has [NAME of (spouse) (child)]
did
number [NAME]
used any type of health care
[NAME]
of
not
service from doctors nurses,
go? months access
ago]:
health
dentists, clinics or hospitals
[ENTER
1
care?
for...
CODE]
TO
[ENTER
12]
CODES]
NOTE: Explain that
ILLNESS below refers to:
“A physical illness, as
well as a mental health
problem or substance
abuse.”
A. (FARMWORKER)
M
HA15
__
preventive care?:
****CODES FOR HA16
1 = COMMUNITY/MIGRANT HEALTH
CENTER
2 = PRIVATE MEDICAL CLINIC/ DOCTOR’S
OFFICE
3 = HOSPITAL
4 = EMERGENCY ROOM
7 = DENTIST
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER:__________
*****CODES FOR HA 18
a=
b=
c=
d=
e=
f=
g=
Did not know where to go
No transportation
Too far away
Health Center not open when needed
No need to go / Does not get sick
Too expensive
No insurance
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER: ______________
HOUSEHOLD GRID
[REV. Aug 5, 2019]
___ ___ ___ ___ ___
County
A1
NAME
*A2 A3
R
E
L
A
T
I
O
N
S
E
X
A5
A6
**A7
A9
**A10
A8
M
A
R
I
T
A
L
B
I
R
T
H
D
A
Y
C
O
U
N
T
R
Y
HIGHEST
GRADE
LEVEL
[FOR
MINORS
INCLUDE
PRESCHOOL
(“PS”) AND
KINDER
(“K”)
C
O
U
N
T
R
Y
MONTH
AND
YEAR
S
T
A
T
U
S
MM
/
YY
B
I
R
T
H
S
C
H
O
O
L
[ASK
ONLY
WORKER
FOR HIGHEST
[CODE]
DEGREE
OBTAINED. ] [CODE]
FIRST
E
N
T
E
R
E
D
U.S.?
A4
***A31
A32-33
A34-35
A11
[ASK ALL
IF
LAST 12
PRIOR 12 ANY
IN A1]:
NOT MONTHS,
MONTHS U.S.
TRAVELED TO (A32-33), S
DOES
S/HE LIVE
H TO DO FW TRAVELED C
WITH YOU
E (OR DONE TO DO FW
H
FW IN
NOW?
R
(OR DONE
O
OTHER
IF NOT,
E,
FW IN
O
WHERE?
WHY CITY)?
OTHER
L
[STATE and NOT IF YES,
CITY)?
LAST
[NAME]
COUNTRY]
?
IF YES,
12
_ TRAVELED
[NAME]
M
OR
C
TRAVELED O
JOINED OR JOINED N
O
WITH
D
WITH YOU? T
YOU?
E
H
S?
A36
HA15
*****HA16
M
M
F
Y
DK
Y
DK
N
RF
N
RF
c. routine or preventive Y
care?:
DK
N
RF
d. dental treatment or
preventive care?:
Y
DK
N
RF
Y
DK
b. injury?:
Y
DK
NF c. routine or preventive Y
care?:
DK
NW d. dental treatment or
Y
preventive care?:
DK
a. illness?:Y
DK
FW
b. injury?:
Y
DK
NF c. routine or preventive Y
care?:
DK
NW d. dental treatment or
Y
preventive care?:
DK
N
RF
N
RF
N
RF
N
RF
N
RF
N
RF
N
RF
N
RF
FW
Y
Y
Y
N
N
N
N
/
/
O
NF
NW
E.
b. injury?:
a. illness?:
/
FW
S
M
Y
Y
Y
Y
N
N
N
N
Y
Y
/
M
F
O
F.
/
S
M
M
Y
/
F
*CODES FOR A2 (RELATIONSHIP):
** CODES FOR A7 AND A10 (COUNTRIES AND
REGIONS):
1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS, UNCLES,
ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
7 = OTHER:__________________
1= U.S.A.
2= PUERTO
RICO
3= MEXICO
4= CENTRAL
AMERICA
5= SOUTH
AMERICA
6= CARIBBEAN
7= SOUTHEAST ASIA (INDONESIA,
CAMBODIA, VIETNAM, LAOS,
THAILAND)
8= PACIFIC ISLANDS (THE
PHILIPPINES, GUAM, FIJI, ETC.)
9= ASIA (CHINA, JAPAN, KOREA,
ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER: ________
N
N
N
O
Y
N
***CODES FOR A31
1 = NO CHILD CARE IN THIS
LOCATION
2 = NO HOUSING IN THIS
LOCATION
3 = CHILD IN SCHOOL,
AFFECTED IF MOVED
95= DK (DON’T KNOW)
96= RF (REFUSE)
7 = OTHER:: _________
3
*****HA18
ONLY FOR SPOUSE, AND CHILDREN UNDER 22 YEARS OLD
And
When?
the
(Last [For each
last
time) “NO” IN
time,
[Enter “HA15"]
LAST
In the USA, in the LAST 12
where ‘within” Why did
12
MONTHS, has [NAME of
did
number [NAME]
M
(spouse) (child)] used any type
[NAME]
of
not
O
of health care service from
go? months access
N
doctors nurses, dentists, clinics
ago]:
health
T
or hospitals for...
[ENTER
1
care?
H
CODE]
TO
[ENTER
S?
12]
CODES]
a. illness?:
Y
HA17
ANY
U.S.
WORK
D.
S
95 ___ ___ ___ __
Farmworker ID
****CODES FOR HA16
*****CODES FOR HA 18
1=
a = Did not know where to go
b = No transportation
c = Too far away
d = Health Center not open when needed
e = No need to go / Does not get sick
f = Too expensive
g= No insurance
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER: ______________
COMMUNITY/MIGRANT HEALTH
CENTER
2 = PRIVATE MEDICAL CLINIC/
DOCTOR’S OFFICE
3 = HOSPITAL
4 = EMERGENCY ROOM
7 = DENTIST
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER: ________
HOUSEHOLD GRID
[REV. Aug 5, 2019]
___ ___ ___ ___ ___
County
A1
NAME
*A2
R
E
L
A
T
I
O
N
A3
S
E
X
A5
A6
**A7
A9
**A10
A8
M
A
R
I
T
A
L
B
I
R
T
H
D
A
Y
C
O
U
N
T
R
Y
HIGHEST
GRADE
LEVEL
[FOR
MINORS
INCLUDE
PRESCHOOL
(“PS”) AND
KINDER
(“K”)
C
MONTH
AND
YEAR
S
T
A
T
U
S
MM
/
YY
B
I
R
T
H
O
U
N
T
R
Y
S
C
H
O
O
L
[ASK
ONLY
[CODE] WORKER
FOR HIGHEST
[CODE]
DEGREE
OBTAINED. ]
FIRST
E
N
T
E
R
E
D
U.S.?
A4
***A31
A32-33
A34-35
A11
IF
[ASK ALL
LAST 12
PRIOR 12 ANY
IN A1]:
NOT MONTHS,
MONTHS U.S.
TRAVELED TO (A32-33), S
DOES
S/HE LIVE
H TO DO FW TRAVELED C
WITH YOU
E (OR DONE TO DO FW
H
FW IN
NOW?
R
(OR DONE
O
OTHER
IF NOT,
E,
FW IN
O
WHERE?
WHY CITY)?
OTHER
L
[STATE and NOT IF YES,
CITY)?
LAST
[NAME]
COUNTRY]
?
IF YES,
12
_ TRAVELED
[NAME]
M
OR
C
TRAVELED O
JOINED OR JOINED N
O
WITH
D
WITH YOU? T
YOU?
E
H
S?
A13
ANY
U.S.
WORK
FW
S
M
F
/
Y
Y
Y
Y
N
N
N
N
O
*****HA16
Y
DK
Y
DK
N
RF
N
RF
c. routine or preventive Y
care?:
DK
N
RF
a. illness?:
b. injury?:
NF
/
HA15
NW d. dental treatment or
preventive care?:
H.
FW
/
S
Y
M
M
Y
Y
F
NF
N
N
O
N
N
I.
/
S
Y
M
M
Y
Y
b. injury?:
NF
N
N
O
c. routine or preventive
care?:
d. dental treatment or
NW
preventive care?:
a. illness?:
FW
Y
/
F
a. illness?:
b. injury?:
Y
/
*CODES FOR A2 (RELATIONSHIP):
** CODES FOR A7 AND A10 (COUNTRIES AND REGIONS):
1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR
ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS,
UNCLES, ETC.)__________________
95= DK (DON’T KNOW)
96= RF (REFUSE)
7 = OTHER::__________________
1= U.S.A.
2= PUERTO RICO
3= MEXICO
4= CENTRAL
AMERICA
5= SOUTH
AMERICA
6= CARIBBEAN
7= SOUTHEAST ASIA (INDONESIA,
CAMBODIA, VIETNAM, LAOS,
THAILAND)
8= PACIFIC ISLANDS (THE
PHILIPPINES, GUAM, FIJI, ETC.)
9= ASIA (CHINA, JAPAN, KOREA,
ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
97 = OTHER:___________________
***CODES FOR A31
1 = NO CHILD CARE IN
THIS LOCATION
2 = NO HOUSING IN
THIS LOCATION
3 = CHILD IN SCHOOL,
AFFECTED IF
MOVED
95= DK (DON’T KNOW)
96= RF (REFUSE)
7=
OTHER:__________
4
N
N
HA17
*****HA18
ONLY FOR SPOUSE, AND CHILDREN UNDER 22 YEARS OLD
And
When?
the
(Last [For each
last
time)
“NO” IN
time, [Enter “HA15"]
LAST
In the USA, in the
12
LAST 12 MONTHS, has [NAME where ‘within”
did number Why did
M
of (spouse) (child)] used any
[NAME]
of
[NAME]
O
type of health care service from
go? months
not
N
doctors nurses, dentists, clinics
ago]:
access
T
or hospitals for...
[ENTER
1
health
H
CODE]
TO
care?
S?
12]
[ENTER
CODES]
G.
M
95 ___ ___ ___ __
Farmworker ID
c. routine or preventive
care?:
d. dental treatment or
NW
preventive care?:
Y
DK
N
RF
Y
DK
Y
DK
N
RF
N
RF
Y
DK
N
RF
Y
DK
N
RF
Y
DK
Y
DK
N
RF
N
RF
Y
DK
N
RF
Y
DK
N
RF
****CODES FOR HA16
*****CODES FOR HA 18
1 = COMMUNITY/MIGRANT HEALTH CENTER
2 = PRIVATE MEDICAL CLINIC/ DOCTOR’S OFFICE
3 = HOSPITAL
4 = EMERGENCY ROOM
7 = DENTIST
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER: ________
a=
b=
c=
d=
e=
f=
g=
Did not know where to go
No transportation
Too far away
Health Center not open when needed
No need to go / Does not get sick
Too expensive
No insurance
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER:______________
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
[THESE QUESTIONS REFER TO OTHER INDIVIDUALS WHO LIVE WITH THE WORKER AND WERE NOT MENTIONED IN
THE “HOUSEHOLD GRID”!]: A15 Other than those you have already mentioned, how many people live with you now?:
... TOTAL:
Out of those (TOTAL IN “A15” ), ...how many are: ...
a.
...ADULTS? (18 YEARS OR OLDER)?
b.
...CHILDREN? (17 YEARS OR YOUNGER)?
A20 ...your
relatives?
A16
...doing FW?
...DO NOT KNOW AGE?
c.
INSURANCE QUESTIONS ABOUT RESPONDENT AND HIS/HER FAMILY
(INDIVIDUALS IN THE “HOUSEHOLD GRID”) [DESCRIBE/EXPLAIN “HEALTH INSURANCE”]
A21
A23
In the U.S.A.,... Who has Health (Medical) Insurance in your family? ...
How about...
9 0 NO
a. ...you
9 1 YES
(farmworker)?
9 95 DON’T KNOW
9 0 NO
b. ...your
9 1 YES
spouse?
9 95 DON’T KNOW
[CHILDREN UNDER
AND OVER 18 YRS.
OLD. MATCH TOTAL
WITH FAMILY GRID]
C.
...your
children?
A21c2
Who pays for it?
[USE CODES. MARK ALL THAT APPLY]
91
92
93
94
95
97
9 6:
91
92
93
94
95
92
93
94
9 6:
A24
9 0 NO
(a) How many under 18 yrs?:
9 1 YES, ALL HAVE IT [ASK A23]
9 2 YES, ONLY SOME HAVE IT
(b) How many over 18 yrs?:
91
95
9 6:
9 95 DON’T KNOW
CODES FOR “A23” (WHO PAYS?):
5= GOVERNMENT
7 = PARENT’(S’) INSURANCE
1= I PAY
3= MY EMPLOYER
2= MY SPOUSE 4= MY SPOUSE’S EMPLOYER
G4 In the last 2 years [LAST 24 MONTHS], have you or anyone
D36a [FOR PARENTS OF CHILDREN 12 YEARS OLD OR
YOUNGER]: ...in all the places you’ve lived in
in your household received benefits or used the
services of any of the following social programs?
the USA in the past 12 MONTHS, where have
all your children 12 years old or younger
stayed while you are working (FW in the USA)?
[READ CHOICES. CHECK ALL THAT APPLY]: ...
...Welfare (general assistance) or TANF (Temporary
Assistance for Needy Families)?
9 b. ...Food stamps?
9 c. ...Disability insurance?
9 d. ...Unemployment insurance?
9 e. ...Social Security?
9 h. ...Low income housing?
9 i.
...Public Health Clinic?
9 j.
...Medicaid?
9 k. ...WIC?
9 l. ...Disaster Relief
9 m. ... Legal Advice or Services
9 n. ...Other?:
9
Don’t know
9 none
9 r.
5
6 = OTHER:
[CHECK ALL THAT APPLY]
91
9 13
9 14
9 11
9 12
They've stayed home alone, at least
sometimes
With my spouse, other family
With a neighbor, babysitter, migrant head
start, head start, migrant education, daycare
center, school, etc.
With me in the fields
OTHER:
[REV. Aug 5, 2019]
Do you live in a labor camp or Migrant Center? [IF
D65
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
D33a
YES, PROBE: WHO OWNS OR RUNS IT?]
90
91
92
93
NO
YES, labor camp run by a grower or labor
contractor
YES, labor camp run by migrant center or public
agency
YES, labor camp run by another person/group
Specify: __________________
Where are your living quarters located?
D35b
[READ CHOICES. MARK ONLY ONE]: ...
...OFF FARM IN PROPERTY NOT OWNED OR
ADMINISTERED BY YOUR PRESENT EMPLOYER?
...OFF FARM IN PROPERTY OWNED OR
ADMINISTERED BY YOUR PRESENT EMPLOYER?
...ON FARM OR NEXT TO OR ADJACENT TO A FARM
OWNED BY THE GROWER YOU CURRENTLY WORK
FOR?
...ON A FARM OR NEXT TO OR ADJACENT TO A
FARM NOT OWNED BY THE GROWER YOU
CURRENTLY WORK FOR?
...OTHER?:
91
92
95
96
9 97
D34b
In what type of living quarters do you live
now (housing structure at this location)? [READ
CHOICES. MARK ONLY ONE]: ...Is it a (an)...
91
92
94
9 97
ONLY FOR UTILITIES, CONSIDER IT FREE. DO NOT READ
CHOICES. MARK ONLY ONE]:
9 10 I (OR I AND MY FAMILY) RECEIVE FREE HOUSING
FROM MY EMPLOYER. [SKIP TO G6]
9 3 I PAY FOR HOUSING PROVIDED BY MY EMPLOYER. (I
PAY DIRECTLY OR THROUGH WAGE DEDUCTION).
9 5 I PAY FOR HOUSING PROVIDED BY THE
GOVERNMENT, A CHARITY, OR OTHER NON-WORK
RELATED INSTITUTION.
9 11 DO NOT PAY RENT. (I OR FAMILY MEMBER OWN THE
HOUSE OR LIVE FOR FREE WITH FRIENDS OR
RELATIVES) [SKIP TO G6. ASK IF BUYING OTHERS]
9 12 I RENT FROM NON-EMPLOYER (RELATIVE OR NONRELATIVE)
9 97 OTHER:
9 a.
...Bedrooms?:
9 b.
...Bathrooms?:
9 c.
...Kitchens?:
9 f.
...Other rooms?:
At this location how much do you pay for
housing (including housing for your family if
they live with you)?
D50
91
per week
...MOBILE HOME?
...SINGLE-FAMILY HOME (DETACHED)?
...APARTMENTS (TWO OR MORE IN A BUILDING,
SHARED PARKING SPACES)?
...OTHER:
How many of the following do you have in
your current living quarters (dwelling)...
D54
While you are working for this grower/
contractor, what type of payment arrangement do
you have for your living quarters? [IF PAYMENT IS
$
or
per month $
or
per day
92
93
.
,
.
,
.
DON'T KNOW, TAKEN OUT OF MY PAYCHECK
DON'T KNOW/DON'T REMEMBER, BUT NOT
TAKEN OUT OF MY PAYCHECK
OTHER:
97
G6
$
,
Do you own or are you buying any of the following
items in the U.S.? [READ OPTIONS. MARK ALL “YES”
RESPONSES]
D52
How many people total sleep in these rooms?
[VERIFY RESPONSE BY ADDING TOTAL NUMBER
GIVEN IN HOUSEHOLD GRID PLUS TOTAL IN A15. IF
ANSWERS DO NOT MATCH, MAKE APPROPRIATE
CHANGES]
...a plot of land?
...a type of housing, such as a house, mobile
home, condominium, or apartment?
9 d. ...any kind of vehicle, such as a car or truck?:
9 f. ...other?:
9 a.
9 h.
9
6
None
[REV. Aug 5, 2019]
D37a
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
B13 When was the last time your parents did hired
farm-work in the U.S.?
How far is your current job from your current
residence?
91
92
93
94
95
96
I'M LOCATED AT THE JOB
WITHIN 9 MILES
10-24 MILES
25-49 MILES MILES
50-74 MILES
75 MILES OR MORE
90
91
92
93
9 4
97
E2
At your current job, how do you usually get to
work? [READ CHOICES. MARK ONE]:...
D37
9 1 ...DRIVE CAR? [SKIP TO B10]
9 2 ...WALK [SKIP TO B10]
9 5 ...PUBLIC TRANSPORTATION (BUS, TRAIN,
ETC.)? [SKIP TO B10]
9 6 ...LABOR BUS, TRUCK, VAN?
9 8 ...“RAITERO”:?
9 4 ...RIDE WITH OTHERS (SHARES RIDE)?
9 7 ...OTHER?:
9 0 NO
E4
90
91
92
Could you get a U.S. non-farm job (NF) within a
month?
9 0 NO
9 1 YES
9 7 DON’T KNOW
9 1 YES
Do you pay a fee to (responsible in D37 and/or
"raiteros") for rides to work?
D38
How long do you expect to continue doing farm
work (FW in the U.S.)? [READ CHOICES. MARK
ONLY ONE]
9 1 LESS THAN ONE YEAR
9 2 ONE TO THREE YEARS
9 3 FOUR TO FIVE YEARS
9 4 OVER FIVE YEARS
9 5 OVER FIVE YEARS/ AS LONG AS I AM ABLE
9 7 OTHER?:
Do you have to use the transport (in D37) (IS IT
MANDATORY OR OBLIGATORY)?
D38a
NEVER
NOW / WITHIN LAST YEAR
ONE TO FIVE YEARS AGO
SIX TO TEN YEARS AGO
OVER 10 YEARS AGO
DON’T KNOW
B1
[ASK ALL]
Which of the following describes you?
[READ CHOICES. CHECK ONLY ONE]: ...
NO
YES, A FEE
YES, JUST FOR GAS
91
92
93
95
94
97
B10 In what month and year did you first do any
farm work in the U.S.? (First time FW in the
U.S.) [ASK FOR MONTH AND YEAR]
...MEXICAN-AMERICAN?
...MEXICAN?
...CHICANO?
...PUERTO RICAN?
...OTHER HISPANIC?:
...NOT HISPANIC OR LATINO?
B2 Which of the following do you consider yourself?
MONTH
/
/
[READ CHOICES EXCEPT “OTHER.” MARK ONE OR MORE
RESPONSES]: ...
YEAR
91
92
94
95
96
97
B11 Approximately how many years have you done
farmwork in the U.S.? [COUNT ANY YEAR IN WHICH
15 DAYS OR MORE WERE WORKED].
years
B12
Approximately how many years have you done
non-farmwork in the U.S.? [COUNT ANY YEAR IN
WHICH 15 DAYS OR MORE WERE WORKED]
years
7
...White?
...Black or African American?
...American Indian/Alaska Native?
...Asian?
...Native Hawaiian or Pacific Islander?
...Other?:
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
[IF FOREIGN BORN, ASK];
Where were you born? In what...
B18.
(d) ...STATE?:
(e) ...MUNICIPALITY
(DEPARTMENT) (EQUIVALENT)?:
B26-27
B16.
When you lived in your
country, did you work in...
B17-18. Before coming to the USA, you
lived in what...
(B17)...COUNTRY?:
(f) ...TOWN (OR 9 1 ...AGRICULTURE [FW]?
9 2 ...NON-AGRICULTURE [NF]?
CITY)?:
9 3 ...PART FARM AND PART NON-FARM
[FW AND NF]?
9 5 ...NEVER WORKED?
(B18)...STATE (OR
DEPARTMENT)?:
...And where were your parents born? ...In what...
a. ...COUNTRY?
b. ...STATE (OR EQUIVALENT) c. ...MUNICIPALITY (OR EQUIVALENT)
d. ...TOWN (OR CITY)
(B26a) FATHER:
(B27a) MOTHER?:
LANGUAGE SECTION
B7
How well do you speak English?
B8
B20
How well do you read English?
[READ CHOICES. MARK ONLY ONE RESPONSE]: ...
[READ CHOICES. MARK ONLY ONE RESPONSE]: ...
91
...Not at all?
93
...Somewhat?
92
...A little?
94
...Well?
9 1 ...Not at all?
9 2 ...A little?
9 3 ...Somewhat?
9 4 ...Well?
B21
B24
And now, as an adult, what languages can you speak?
In which language do you
When you were a child,
in what languages
did adults speak
[CHECK
ALL THAT
B22 And
to you at home?
APPLY]
do you speak it?
do you read it?
conversing? [CHECK
[READ CHOICES. MARK
[READ CHOICES. MARK ONLY
ONLY ONE PER CHECK]:
ONE PER CHECK]:
ONE. If fully bilingual,
enter and check both] U
[CHECK ALL THAT
APPLY]
U
U
[FOR EACH CHECKED ANSWER, ASK]:
now, how well
B23 And
now, how well
a ENGLISH
92
b SPANISH
93
94
92
c CREOLE
93
94
92
d MIXTEC
93
94
92
e KANJOBAL
93
94
92
f ZAPOTEC
93
94
92
z OTHER:
93
94
91
92
93
94
...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?
91
92
93
94
...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?
91
92
93
94
...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?
91
92
93
94
...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?
...A LITTLE?
...SOMEWHAT?
...WELL?
91
92
93
94
...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?
...A LITTLE?
...SOMEWHAT?
...WELL?
91
92
93
94
...A LITTLE?
...SOMEWHAT?
...WELL?
...A LITTLE?
...SOMEWHAT?
...WELL?
...A LITTLE?
...SOMEWHAT?
...WELL?
...A LITTLE?
...SOMEWHAT?
...WELL?
8
...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?
believe you are most
dominant (comfortable)
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
REMINDER FOR INTERVIEWER:
BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE DAYS ...HAVE YOU BEEN ILL OR SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU
TRAVELED OUT OF THE COUNTRY?” [USE THE “YES” RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:
WORK GRID
___ ___ ___ ___ ___ 95 ___ ___ ___ ___
[C1-C2 FOR OFFICE USE ONLY]
C15
C3
C4
FW?
PER.
AND
SUB
PER.
NO.
GR
CO
[FW
ONLY]
EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)
CROP
WRITE
ACTIVITY OR TASK NF?
WHILE FW AND NF
[USE CODES FOR
NW?
*NW AND**AB]
AB?
GR
FW
NF
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
NW
AB
CO
FW
NF
GR
NW
AB
CO
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW AND NF]
201 =
202 =
203 =
204 =
LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF SEASON
206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)
RECEIVED
UNEMPLOYMENT?
C1-C2
County
REPORT FROM FIRST PERIOD COVERING OCTOBER 01, 2018 TO PRESENT
C5
C6
C8
C9
C10
C11
DATES FOR
PERIODS OF
FW, NF, NW, AB
FROM:
TO:
# OF
WORK
DAYS
PER
WEEK?
FW &
NF
C12
C13
COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]
STATE
and
C7
***FW
AND
NF:
WHY
LEFT?
COUNTRY
[CODE]
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311 =
312 =
320 =
341 =
359 =
361 =
362 =
369 =
CITY
Farmworker ID
FW IN FAMILY RANCH
FW-HIRED
NF IN OWN BUSINESS: (SPECIFY IN GRID)
NF IN “MAQUILA”
NF- OTHER: (SPECIFY IN GRID)
NW - MEDICAL TREATMENT
NW - VACATION
NW - OTHER: (SPECIFY IN GRID)
9
*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8
10
11
9
= RETIRED
= QUIT
= CHANGE JOBS
= OTHER (SPECIFY):
WORK GRID
[REV. Aug 5, 2019]
___ ___ ___ ___ ___ 95 ___ ___ ___ ___
[C1-C2 FOR OFFICE USE ONLY]
C15
C3
C4
FW?
GR
PER.
AND
SUB
CO
PER. [FW
NO. ONLY]
EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)
CROP
WRITE
ACTIVITY OR TASK NF?
WHILE FW AND NF
[USE CODES FOR
NW?
*NW AND**AB]
AB?
GR
FW
NF
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
NW
AB
CO
FW
NF
GR
NW
AB
CO
FW
NF
GR
NW
AB
CO
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW AND NF]
201 =
202 =
203 =
204 =
LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF SEASON
206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)
RECEIVED
UNEMPLOYMENT?
C1-C2
County
REPORT FROM FIRST PERIOD COVERING OCTOBER 01, 2018 TO PRESENT
C5
C6
C8
C9
C10
C11
DATES FOR
PERIODS OF
FW, NF, NW, AB
FROM:
TO:
# OF
WORK
DAYS
PER
WEEK?
FW &
NF
C12
C13
COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]
STATE
and
C7
***FW
AND
NF:
WHY
LEFT?
COUNTRY
[CODE]
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311 =
312 =
320 =
341 =
359 =
361 =
362 =
369 =
CITY
Farmworker ID
FW IN FAMILY RANCH
FW-HIRED
NF IN OWN BUSINESS: (SPECIFY IN GRID)
NF IN “MAQUILA”
NF- OTHER: (SPECIFY IN GRID)
NW - MEDICAL TREATMENT
NW - VACATION
NW - OTHER: (SPECIFY IN GRID)
10
*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS
9 = OTHER (SPECIFY):
WORK GRID
[REV. Aug 5, 2019]
___ ___ ___ ___ ___ 95 ___ ___ ___ ___
[C1-C2 FOR OFFICE USE ONLY]
C15
C3
C4
NW?
AB?
RECEIVED
UNEMPLOYMENT?
C1-C2
County
REPORT FROM FIRST PERIOD COVERING OCTOBER 01, 2018 TO PRESENT
C5
C6
C8
C9
C10
C11
GR
FW
NF
Y
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
FW?
GR
PER.
AND
SUB
CO
PER.
[FW
NO. ONLY]
EMPLOYER’S NAME (
FARM WORK, NONFARM WORK AND
WORK ABROAD)
CROP
WRITE
ACTIVITY OR TASK
WHILE FW AND NF
[USE CODES FOR
*NW AND**AB]
NW
AB
CO
FW
NF
GR
NW
AB
CO
FW
NF
GR
NW
AB
CO
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW AND NF]
201 =
202 =
203 =
204 =
LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF SEASON
NF?
206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)
DATES FOR
PERIODS OF
FW, NF, NW, AB
FROM:
TO:
# OF
WORK
DAYS
PER
WEEK?
FW &
NF
CITY
C12
C13
COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]
STATE
and
C7
***FW
AND
NF:
WHY
LEFT?
COUNTRY
[CODE]
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311 =
312 =
320 =
341 =
359 =
361 =
362 =
369 =
Farmworker ID
FW IN FAMILY RANCH
FW-HIRED
NF IN OWN BUSINESS: (SPECIFY IN GRID)
NF IN “MAQUILA”
NF- OTHER: (SPECIFY IN GRID)
NW - MEDICAL TREATMENT
NW - VACATION
NW - OTHER: (SPECIFY IN GRID)
11
*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1=
2=
3=
4=
5=
6=
7=
LAID OFF/END OF SEASON
FIRED
FAMILY RESPONSIBILITIES
SCHOOL
MOVED
HEALTH REASON
VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS
9 = OTHER (SPECIFY):
WORK GRID
[REV. Aug 5, 2019]
___ ___ ___ ___ ___
[C1-C2 FOR OFFICE USE ONLY]
C15
C3
C4
REPORT FROM FIRST PERIOD COVERING OCTOBER 01, 2018 TO PRESENT
C5
C6
C8
C9
C10
C11
NW?
AB?
RECEIVED
UNEMPLOYMENT?
C1-C2
GR
FW
NF
Y
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
CO
NW
AB
GR
FW
NF
FW?
GR
PER.
AND
SUB
CO
PER.
[FW
NO. ONLY]
EMPLOYER’S NAME (
FARM WORK, NONFARM WORK AND
WORK ABROAD)
CROP
WRITE
ACTIVITY OR TASK
WHILE FW AND NF
[USE CODES FOR
*NW AND**AB]
FW
NF
GR
NW
AB
CO
FW
NF
GR
NW
AB
CO
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW AND NF]
LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL
NOTICE(AFTER LAYOFF)
205 = WAITING FOR START OF SEASON
NF?
NW
AB
CO
201 =
202 =
203 =
204 =
95 ___ ___ ___ ___
County
206 = FAMILY RESPONSIBILITIES/
WORK IN HOME
207 = IN SCHOOL
208 = LAID UP DUE TO INJURY
209 = IN-TRANSIT BETWEEN JOBS
210 = VACATION
211 = DID NOT LOOK FOR WORK
212 = OTHER: (SPECIFY IN GRID)
DATES FOR
PERIODS OF
FW, NF, NW, AB
FROM:
TO:
# OF
WORK
DAYS
PER
WEEK?
FW &
NF
C12
C13
COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]
STATE
and
C7
***FW
AND
NF:
WHY
LEFT?
COUNTRY
[CODE]
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
Y
COMMUTE FROM
MEXICO TO DO FW?
Y
N
N
** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311 =
312 =
320 =
341 =
359 =
361 =
362 =
369 =
CITY
Farmworker ID
FW IN FAMILY RANCH
FW-HIRED
NF IN OWN BUSINESS: (SPECIFY IN GRID)
NF IN “MAQUILA”
NF- OTHER: (SPECIFY IN GRID)
NW - MEDICAL TREATMENT
NW - VACATION
NW - OTHER: (SPECIFY IN GRID)
12
*** C-7 CODES: WHY LEFT “FW” AND “NF”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS
9 = OTHER (SPECIFY):
In the year before last (FROM OCTOBER 2017
D30 How did you get this job? [DO NOT READ CHOICES. MARK
TO OCTOBER 2018) [YEAR BEFORE THE ONE
ONLY ONE RESPONSE]
COVERED IN WORK GRID], how many months
did you do (FW) in the U.S.? [1 DAY OR MORE PER
9 1 I APPLIED FOR THE JOB ON MY OWN
MONTH EQUALS 1 MONTH]
9 4 I WAS RECRUITED BY A GROWER OR HIS FOREMAN
months
9 5 I WAS RECRUITED BY FARM LABOR CONTRACTOR OR
D2 [IF NON-FARM JOB LISTED ON WORK GRID]: For
HIS FOREMAN
your most recent non-farm (NF) employer, how 9 6 I WAS REFERRED BY THE EMPLOYMENT SERVICE
many hours per week did you work on
9 7 I WAS REFERRED BY THE WELFARE OFFICE
average?
9 8 I WAS REFERRED BY RELATIVE / FRIEND / WORKMATE
hours
D1
D3
9 9 I WAS REFERRED BY LABOR UNION
9 10 DAY LABORER / PICKED UP AT SHAPE UP
[IF NON-FARM JOB LISTED] For your most recent
9 97 Other:
non-farm employer (NF), how much were
you paid per week on average?
NP – HANDLING PESTICIDES
(IN THE U.S.A.)
$
,
.
NP1f.
D27
How many years have you worked for this
(FW) employer? [ONE DAY/PER YEAR=ONE
YEAR]
90
91
years
D22
If you are injured at work or get sick as a
result of your work, does your employer
provide health insurance or pay for your
health care?
90
NO
91
D23
97
NO
YES
97
DON’T KNOW
If you are injured or get sick off the job
(e.g., at home), does your employer
provide health insurance or pay for your
health care? [WHETHER OR NOT THE
WORKER TAKES IT OR USES IT]
90
91
D26
NO
YES
97
NT2a.
DON’T KNOW
If you are injured at work or get sick as a
result of your work, do you get any
payment while you are recuperating (i.e.,
“workers' compensation”)?
90
91
D24
YES
DON’T KNOW
NO
YES
97
DON’T KNOW
NO
YES
NT – TRAINING AND INSTRUCTIONS
In the last 12 months, with your current employer, has
anyone given you training or instructions in the safe use
of pesticides (through video, audio, cassette, classroom
lectures, written material, informal talks or by any other
means)?
9 0 NO
9 1 YES
NS – SANITATION SECTION
“The following questions refer to sanitation at your job with your
current FW employer: ... Does your current employer provide EVERY
DAY...
NS1
90
91
92
97
... (potable) clean drinking water and disposable cups?
NO WATER, NO CUPS
YES, WATER ONLY
YES, WATER AND DISPOSABLE CUPS
DON’T KNOW
NS4
... a toilet (EVERY DAY)?
9 0 NO
9 1 YES
9 7 DON’T KNOW
NS9
... (provide) water to wash hands (EVERY DAY)?
9 0 NO
9 1 YES
9 7 DON’T KNOW
Are you covered by unemployment insurance
if you lose this job?
90
91
In the last 12 months, have you loaded, mixed or applied
pesticides?
13
CURRENT FARM JOB
Now I am going to ask you some questions about
the FW you are CURRENTLY performing for
the EMPLOYER through whom we contacted you
[INCLUDED IN A WORK GRID PERIOD].
D4
D11
9 1 ...BY THE HOUR?
9 2 ...BY THE PIECE? [SKIP TO D13]
9 3 ...COMBINATION HOURLY WAGE AND PIECE
RATE? [ASK D12 THRU D18]
9 4 ...SALARY OR OTHER? [SKIP TO D19]
How many hours did you work last week at
your current farm job?
D12
hours
[D5 TO D8: IF SHE/HE HAS NOT RECEIVED PAYMENT YET
FOR CURRENT CROP, ASK FOR ESTIMATES]: Can you
,
$
.
,
.
NO
91
YES
[IF CREW PIECE RATE]: How many people are
in your crew? [ONE IS NOT A POSSIBLE
ANSWER]
D15
[IF BY PIECE]: How do they pay you/your
crew [i.e., UNIT OF MEASURE SUCH AS BOX, BIN,
BUCKET, ETC.]?
D16
[IF BY PIECE]:
D17
[IF BY PIECE]: How many hours per day you/your
For what time period was that payment?
9 4 ONE MONTH?
9 7 OTHER?:
How many of these (in D15 e.g., boxes,
bins, buckets, etc.) you/your crew do in an average
day?
crew work on average at this task?
How many hours did you work during that period
(in D7)?
hours
D18
hours
D9
INDIVIDUAL [SKIP TO D15]
CREW
Did you get a receipt?
9 1 ONE DAY?
9 2 ONE WEEK?
9 3 TWO WEEKS?
D8
[IF PAID BY THE PIECE]: Are you paid as an
individual or by the crew? [IF THE ANSWER IS
D14
Were you paid by [READ CHOICES. MARK ONE
RESPONSE]:...
90
D7
per hour
.
91
92
9 4 ...OTHER CHECK?
9 1 ...PAYROLL CHECK?
9 2 ...PERSONAL CHECK? 9 5 ...CASH?
9 3 ...CASH AND CHECK? 9 6 ...OTHER:
D62
ONLY BY THE HOUR, ENTER AMOUNT AND SKIP TO
“G1C.” IF COMBINATION, ENTER AMOUNT AND
CONTINUE WITH D13]:
"CREW", ASK QUESTIONS D14 to D18
CONSISTENTLY IN REFERENCE TO THE CREW]
Before taxes:
D6
D61
D13
After taxes:
$
How much per hour (to nearest cent)? [IF PAID
$
tell me how you were paid and the amount your
employer paid you on your last pay day?
D5
Are you paid: ...
...Now - with your current employer - you already
told me that the crop you are currently working
is:...
$
D19
D10 And you told me that - with your current employer
- the task you are now doing is:
14
[IF BY PIECE]: How much do “they” pay you/your
crew on average for each (box bin, bucket, etc. In
D15)?
,
.
[IF PAID BY SALARY, OR OTHER]: Explain fully how
and how much you are paid (salary or other).
Explain thoroughly the method and amount of
payment. [USE BACK OF PAGE IF NEEDED]:
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
“Now I’m going to ask you some questions about your individual and family income for last year (2018)”...
G1C ...What was your total personal income
last year - in 2018 - in U.S. dollars [U.S.
earnings only FOR FW AND NF]?
G2C How much of that income [in “G1C”]
was from agricultural employment (U.S.
earnings only for FW)? [READ OR SHOW
[READ OR SHOW CHOICES. MARK ONLY ONE]
90
9 21
9 22
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 20
9 97
9 96
CHOICES. MARK ONLY ONE]
DID NOT WORK AT ALL IN 2018
LESS THAN 1,000
1,000 TO 2,449
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
40,000 TO 44,999
45,000 TO 54,999
55,000 TO 59,999
60,000 OR MORE
DK (DON’T KNOW)
RF (REFUSE)
90
9 21
9 22
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 20
9 97
9 96
G3C What was your family’s total income
last year - in 2018 - in U.S. dollars [U.S.
earnings for FW AND NF for all in “FAMILY
GRID”]? [READ OR SHOW CHOICES.
MARK ONLY ONE]
DID NOT WORK AT ALL IN 2018
LESS THAN 1,000
1,000 TO 2,449
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
40,000 TO 44,999
45,000 TO 54,999
55,000 TO 59,999
60,000 OR MORE
DK (DON’T KNOW)
RF (REFUSE)
90
9 21
9 22
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 20
9 97
9 96
DID NOT WORK AT ALL IN 2018
LESS THAN 1,000
1,000 TO 2,449
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
40,000 TO 44,999
45,000 TO 54,999
55,000 TO 59,999
60,000 OR MORE
DK (DON’T KNOW)
RF (REFUSE)
GA-2 Now, I am going to ask you some questions about your health...
Over the last 2 weeks, how often have you been bothered by the
following problems?
1
...Feeling nervous, anxious or on edge?
2
...Not being able to stop or control worrying?
(FOR OFFICE CODING: TOTAL SCORE
Not at
all
Several days
More than half the days
0
1
2
0
1
2
+ ________
+ __________
T_________= ________
15
Nearly every day
3
3
+ __________
NH - PERSONAL HEALTH - LIFE HISTORY [ASK ALL]:
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
b. Are you currently taking
c. In the last 12 months, in the U.S. and/or abroad, have you seen a
a. Have you ever – in your whole life -- been told by a
medication, for this condition
doctor or nurse for (condition “YES” in COLUMN “a”)? [IF ANSWER IS
doctor or nurse (health practicioner) that you have the
“YES” FOR THE U.S. AND “AB” MARK BOTH]
(in ”a”), that was prescribed by
following condition...
a medical provider?
9 0 NO
NH5 ...heart disease?
9 0 NO
9 1 YES, IN THE U.S.A.
9 0 NO
9 1 YES:
9 2 YES, “AB”:
[REV. Aug 5, 2019]
9 95 DK
9 96 RF
91
YES
9 0 NO
9 1 YES:
90
NO
9 95 DK
9 96 RF
91
YES
90
NO
91
YES
...asthma?
NH1
...cancer?
NH8
90
NO
9 95 DK
91
YES:
9 96
RF
a.
And have you ever -- in your
whole life – been told by a
doctor or nurse that you
have...
TYPE OF CANCER?
NAME OF COUNTRY
9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:
90
91
92
NO
YES, IN THE U.S.A.
YES, “AB”:
blood pressure?
9 0 NO
9 1 YES
9 95 DK
9 96 RF
NH12
...high cholesterol?
9 0 NO
9 1 YES
9 95 DK
9 96 RF
NAME OF COUNTRY
NH – INDIVIDUAL PERSONAL HEALTH HISTORY (LIFETIME) [INTERVIEWER: FIRST ASK ALL QUESTIONS IN FIRST COLUMN.]
g.
e.
d.
f.
b.
...ever been
tested for
this
condition?
What was the outcome
(result)?
[DON’T ASK “b” and “c” IF
ILLNESS IS NOT DETECTED]
When was the last
test taken?
Where
was the
test
taken?:
*[USE CODE]
NH3 ...high
NAME OF COUNTRY
90
NO
91
YES
9 95 DK
90
NO
91
YES
9 95 DK
91
92
93
94
9 95
91
92
93
NORMAL
PREHYPERTENSION
HIGH
DID NOT RECEIVE IT
DK (FORGOT)
NORMAL
BORDERLINE
HIGH
9 4 DIDN’T RECEIVE IT
9 95 DK (FORGOT)
9 1 0 TO 12 months
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)
9 1 0 TO 12 months
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)
Are you currently taking
medication, for this
condition (in “a”), that was
prescribed by a medical
provider?
90
NO
91
YES
90
NO
91
YES
c.
In the last 12 months, in
the U.S. and/or abroad,
have you seen a doctor or
nurse for (condition in
“a”)?
90
NO
91
YES, IN THE U.S.A.
92
YES, “AB”:
90
NO
91
YES, IN THE U.S.A.
92
YES, “AB”:
ASK ONLY TO FEMALE RESPONDENT (FOR WOMEN ONLY)
NH13
[FOR WOMEN ONLY]:
Have you ever had a PAP
SMEAR TEST (Papanicolau,
Pap Test, Cervical Cancer
Test, or Smear Test)
90
NO
91
YES
9 95 DK
9 96 RF
91
92
94
9 95
NORMAL
ABNORMAL
DID NOT RECEIVE IT
DK (FORGOT)
9 1 0 TO 12 months
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)
*CODES FOR ( COLUMN “g” ): NH3 - NH12 - NH13
1 = COMMUNITY/MIGRANT HEALTH CENTER
2 = PRIVATE MEDICAL DOCTOR’S OFFICE/PRIVATE CLINIC
3 = HOSPITAL
4 = EMERGENCY ROOM
7 = DENTIST
97 = OTHER: __________
16
95 = DK
96 = RF
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
CONTINUATION OF NH – INDIVIDUAL PERSONAL HEALTH HISTORY (LIFETIME) [INTERVIEWER: FIRST ASK ALL QUESTIONS IN FIRST COLUMN.]
a.
And how about these other
conditions, have you ever -- in
your whole life – been told by a
doctor or nurse that you have
the following conditions...
9 0 NO
9 1 YES
9 95 DK
9 96 RF
[IF RESPONDENT IS A
WOMAN, AND ANSWER IS
“YES” ASK]:
Was it diagnosed during
pregnancy?:
9 0 NO
9 1 YES
9 95 DK
[DON’T ASK “b” and “c” IF
ILLNESS IS NOT DETECTED]
f.
When was the last
test taken?
g.
Where was
the test
taken?:
*[ENTER
CODE]
b.
Are you currently
taking medication, for
this condition (in “a”),
that was prescribed by
a medical provider?
c.
In the last 12 months, in the U.S.
and/or abroad, have you seen a
doctor or nurse for this
condition (in “a”)? [IF ANSWER IS
“YES” FOR THE U.S. AND “AB”
MARK BOTH]
90
91
9 95
NO
9 96 RF
...urinary tract infection?
90
91
9 95
NO
YES
DK
9 96 RF
...tuberculosis?
NH4
9 0 NO
9 1 YES
9 95 RF
NO
0 TO 12 MONTHS
92
HIGH SUGAR LEVEL
92
13 TO 24 MONTHS
LOW SUGAR LEVEL
93
2 TO 5 YEARS
9 95 DK
94
DIDN’T RECEIVE IT
94
MORE THAN 5 YRS
90
NO
9 95 DK
90
NO
9 1 YES
9 95 DK
90
NO
9 1 YES
9 96 RF
9 95 DK
90
NO
YES:
9 95 DK
91
93
...other?:
90
91
NORMAL
9 1 YES
9 1 YES
YES
DK
90
91
9 95
DK (FORGOT)
9 95
DK (FORGOT)
91
92
93
94
9 95
POSITIVE
NEGATIVE
INCONCLUSIVE
DIDN’T RECEIVE IT
DK (FORGOT)
91
92
93
94
9 95
0 TO 12 MONTHS
13 TO 24 MONTHS
2 TO 5 YRS
MORE THAN 5 YRS
DK (FORGOT)
91
92
94
9 95
NORMAL
ABNORMAL
DIDN’T RECEIVE IT
DK (FORGOT)
0 TO 12 MONTHS
13 TO 24 MONTHS
2 TO 5 YRS
MORE THAN 5 YRS
DK (FORGOT)
91
92
POSITIVE
NEGATIVE
94
DIDN’T RECEIVE IT
9 95
DK (FORGOT)
91
92
93
94
9 95
91
92
93
94
9 95
91
92
93
94
9 95
90
NO
90
NO
91
YES, IN THE U.S.A.
91
YES
92
YES, “AB”:
90
NO
90
NO
91
91
.
92
YES, IN THE U.S.A
YES
90
NO
90
NO
91
YES, IN THE U.S.A.
91
YES
92
YES, “AB”:
90
90
NO
NO
91
YES, IN THE U.S.A.
91
YES
92
YES, “AB”:
90
NO
91
YES
9 96 RF
...HIV (AIDS)?
NH14
NH10
...ever been
tested for
this
condition?
e.
What was the outcome
(result) of the last test?
...diabetes?
NH2
NH6
d.
NO
9 1 YES
9 96 RF
9 95 DK
91
92
94
9 95
POSITIVE
NEGATIVE
DIDN’T RECEIVE IT
DK (FORGOT)
0 TO 12 MONTHS
13 TO 24 MONTHS
2 TO 5 YRS
MORE THAN 5 YRS
DK (FORGOT)
0 TO 12 MONTHS
13 TO 24 MONTHS
2 TO 5 YRS
MORE THAN 5 YRS
DK (FORGOT)
YES, “AB”:
90
NO
91
YES, IN THE U.S.A.
92
YES, “AB”:
*CODES FOR COLUMN “g”
1
2
COMMUNITY/MIGRANT HEALTH CENTER
PRIVATE CLINIC OR DOCTOR’S OFFICE
3 HOSPITAL
4 EMERGENCY ROOM
5 DENTIST
95 = DK
17
96 = RF
97 OTHER: ____________
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
HA – QUALITY OF AND ACCESS TO HEALTH CARE SECTION
HA1 [INTERVIEWER ]: Now, I would like to ask you a few questions about health care services that you may have used in the last 12 months. [FIRST ASK QUESTIONS IN THE FIRST COLUMN. READ
OPTIONS AND MARK ALL RESPONSES] ...In the LAST YEAR , (LAST 12 MONTHS), in the USA,...have you used any type of health care service from doctors, nurses, dentists, clinics, or hospitals: ...
NOTE: EXPLAIN THAT ILLNESS
BELOW REFERS TO: “A physical
illness, as well as a mental
health problem or substance
abuse.”
9 a ...FOR ILLNESS?
9 0 NO: [ASK HA7]
9 95 DK
91
YES
9 96 RF
9 96 RF
9 d ...FOR DENTAL TREATMENT
OR PREVENTIVE CARE?
9 0 NO:[ASK HA7] 9 1 YES
9 95 DK
9 96 RF
*CODES FOR “HA2”
1 COMMUNITY/MIGRANT
HEALTH CENTER
5 DENTIST
2 PRIVATE CLINIC OR
DOCTOR’S OFFICE
95 = DK
3 HOSPITAL
96 = RF
4 EMERGENCY ROOM
97=OTHER:
______
HA8
9 95 DK
ASK HA10)
with the care YOU received at your
LAST visit for (“YES” in HA2)? [ASK
ALL OPTIONS, MARK ONE ]: Were you...
“NO”, ASK HOW IT WAS
PAID. ENTER CODES ALL THAT APPLY]:
1
91
92
93
...VERY SATISFIED?
9 1.
9 2.
9 3.
9 95
9 0 NO:
LAST MONTH
[ENTER CODES]
2 TO 6 MONTHS
7 TO 12 MONTHS 9 1 YES:
[ENTER CODES]
DK
91
92
93
...VERY SATISFIED?
9 1.
9 2.
9 3.
9 95
9 0 NO:
LAST MONTH
[ENTER CODES]
2 TO 6 MONTHS
9 1 YES:
7 TO 12 MONTHS
[ENTER CODES]
DK
91
92
93
...VERY SATISFIED?
9 1.
9 2.
9 3.
9 95
9 0 NO:
LAST MONTH
[ENTER CODES]
2 TO 6 MONTHS
9 1 YES:
7 TO 12 MONTHS
[ENTER CODES]
DK
91
92
93
...VERY SATISFIED?
2
3
4
5
**CODES FOR “HA4"
I paid the bill out of “my 6 Billed, but did not
own pocket”
pay
Medicaid / Medicare
7 Worker’s
Public clinic did not
compensation
charge
8 I paid some (copay)
Employer provided
health plan
95 = DK
Self or family bought
96 = RF
individual health plan
97 Other: ________
9 1 YES
9 96 RF
1
2
3
4
...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]
...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]
...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]
HA9
[CHECK ALL THAT APPLY]
18
[ ENTER CODES]
...NOT AT ALL SATISFIED? [ASK HA6]
***CODES FOR “HA6"
COST TOO MUCH
5 CONDITION DID NOT
HAD TO WAIT TOO
IMPROVE AFTER
LONG
TREATMENT OR
LANGUAGE
MEDICATION
PROBLEM - COULD 6 DR. DID NOT DIAGNOSE
NOT COMMUNICATE
OR TREAT CONDITION
MISTREATED BY DR. 95 = DK
OR OTHER STAFF
96 = RF
97 OTHER: ____
Did not know where to go
No transportation
Too far away
Health Center not open when needed
****HA7
...SOMEWHAT SATISFIED? [ASK HA6]
Why could you not get the health care you wanted (or needed)?
9a
9b
9c
9d
***HA6
Why weren’t you
[If “NO” in “HA1",
(completely) very ask]: Why have you
satisfied with the
not used the health
health care received services for [“NO” in
“HA1"]
at that visit?
**[ENTER CODE]
9 0 NO:
[ENTER CODES]
9 2. 2 TO 6 MONTHS 9 1 YES:
9 3. 7 TO 12 MONTHS [ENTER CODES]
9 95 DK
And in the LAST 12 MONTHS, in the USA, was there
ever a time when you wanted or needed health care,
but could not get it? (e.g., for a routine exam, a dental
appointment or because you were injured or sick)
9 0 NO (
HA5 In general, how satisfied were YOU
9 1. LAST MONTH
YES
9 c ...FOR ROUTINE OR
PREVENTIVE CARE?
9 0 NO:[ASK HA7] 9 1 YES
9 95 DK
**HA4
HA3
*[ENTER
CODES]
9 96 RF
9 b ...FOR INJURY?
9 0 NO:[ASK HA7]
9 95 DK
91
*HA2
Did you get any help
...And where
to pay for the cost
did you go
When (last time)?
of that health
(last time)?
(kind of place)
service?***[ “YES” OR
9 f Too expensive
9 g No insurance
9 z Other:
****CODES FOR “HA7"
Did not know where to go
No transportation
Too far away
Health Center not open when
needed
5 = No need to go / Does not get sick
6= Too expensive
7= No insurance
1=
2=
3=
4=
95= DK
96= RF
97 = OTHER:___________________
HA10
[ASK ALL]... (How about) In a foreign country (e.g.,
Mexico), have you used any type of health service
in the last year (LAST 12 MONTHS) [IF “YES ,”
ASK AND ENTER COUNTRY]
9 0 NO
9 1 YES, NAME OF COUNTRY?:
[REV. Aug 5, 2019]
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
DA. DIGITAL ACCESS
DA1 Do you or any member of your family
[“Household Grid”] have access to digital
information sources (i.e., internet,
What devices?
cellular phone with internet, etc.)?
[CHECK WHO IF “YES”]
DA2
Computer
[MARK RESPONSES FOR DEVICES “U”]
DA3 Cellular phone with Internet DA4 Cellular phone with Text DA5
Tablet
DA6 Other device?
[Specify]: _________
9 1 Worker?
9 2 Spouse?
9 3 Children?
9 0 NO
9 0 NO
9 0 NO
9 1 YES
9 1 YES
9 1 YES
9 0 NO
9 0 NO
9 0 NO
9 1 YES
9 1 YES
9 1 YES
9 0 NO
9 0 NO
9 0 NO
9 1 YES
9 1 YES
9 1 YES
9 0 NO
9 0 NO
9 0 NO
9 1 YES
9 1 YES
9 1 YES
9 0 NO 9 1 YES
9 0 NO
9 1 YES
9 0 NO 9 1 YES
9 0 NO
9 1 YES
9 0 NO 9 1 YES
9 0 NO
9 1 YES
9 4 Other?:
9 0 NO
9 1 YES
9 0 NO
9 1 YES
9 0 NO
9 1 YES
9 0 NO
9 1 YES
9 0 NO 9 1 YES
9 0 NO
9 1 YES
DA7. Have you used, or has anyone helped
you use, any digital device to seek or
obtain information about ...
DA8.
What devices have you used?
[MARK ALL RESPONSES. FOR WHERE? ASK FOR VENUES]
DA9.
Who helped you use the device
(in “DA8") to seek or obtain the
information (in “DA7")? [MARK
ALL RESPONSES:]
a.
...health or health insurance?
90
b.
90
NO
91
YES
...seeking employment?
NO
91
YES
c.
...training and/or education?
90
NO
d.
90
e.
90
f.
90
g.
91
YES
...child care?
NO
9 1 YES
...housing?
NO
91
YES
...benefits? [e.g., Unemployment, Social
Security, food stamps, retirement, etc.]
NO
91
YES:
SPECIFY:
...other?: [SPECIFY]:
9 1. COMPUTER
Where?:
9 2. TABLET
Where?:
9 3. CELLULAR PHONE WITH INTERNET
9 1. COMPUTER
9 4.
9 2. TABLET
Where?:
9 3. CELLULAR PHONE WITH INTERNET
9 1. COMPUTER
9 4.
9 2. TABLET
Where?:
CELLULAR PHONE WITH TEXTING
Where?:
CELLULAR PHONE WITH TEXTING
Where?:
9 1.
Self
9 2.
Spouse?
9 3. Children?
9 4.
Other?:
9 1.
Self
9 2.
Spouse?
9 3. Children?
9 4.
Other?:
9 1.
Self
9 2.
Spouse?
9 3. CELLULAR PHONE WITH INTERNET
9 4.
9 3. Children?
9 4.
Other?:
9 1. COMPUTER
9 2. TABLET
Where?:
Where?:
9 1.
Self
9 2.
Spouse?
9 3. CELLULAR PHONE WITH INTERNET
9 4.
9 3. Children?
9 4.
Other?:
9 1. COMPUTER
9 2. TABLET
Where?:
9 1.
Self
9 2.
Spouse?
9 3. CELLULAR PHONE WITH INTERNET
9 4.
9 3. Children?
9 4.
Other?:
9 1. COMPUTER
Where?:
9 1.
9 2.
Spouse?
9 2. TABLET
Where?:
9 3. CELLULAR PHONE WITH INTERNET
9 4.
9 1. COMPUTER
9 2. TABLET
9 3. CELLULAR PHONE WITH INTERNET
CELLULAR PHONE WITH TEXTING
CELLULAR PHONE WITH TEXTING
Where?:
CELLULAR PHONE WITH TEXTING
Self
9 3. Children?
9 4. Other?:
Where?:
Where?:
9 1.
Self
9 2.
9 4.
9 3. Children?
9 4.
19
CELLULAR PHONE WITH TEXTING
CELLULAR PHONE WITH TEXTING
Spouse?
Other?:
EDUCATION AND TRAINING
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
ET1. Have you participated in or attended any type of educational program, training or classes that are work-related or important to you in any other way? Even if not completed. They could have
been... [Intwr: first ask all items in first column (“a” to “f”) and explain and provide examples for each one;...
ET5. Have you
ET6.
ET7. And this training
[FOR EACH QUESTION, REFER TO ET2. Where (venue
ET3. When? (Dates: Year ET4. Have you
completed it?
received a credential, Did you pay anything
program, has it helped (will
and total hours and/or
LAST TIME ] ...in the USA, while or provider facility)?
** [ENTER CODES
diploma or license [for for it?
help) you for a better job or
minutes?)
*[GIVE
EXAMPLES.ENTER
doing FW, ...worker safety training?
FOR “NO” AND
program ]? [Specify]
in any other way?
CODE]
Like...
SKIP TO “ET6"]
[WRITE RESPONSE]
Year?: ________
9 USA:
9 0 NO. Why not?: 9 0 NO
9 0 NO
9 0 NO. Why not?:
a ....heat?
9 1 YES [Specify]:
VENUE
9 1 YES. How much?:
Total hours?: _________
9 0 NO
9 1 YES
9 1 YES
9 1 YES. How?:
$__ __ __ ___. __ __
Total minutes?: ________
[REV. Aug 5, 2019]
b ...pesticides?
9
Year?: ________
USA:
VENUE
9 0 NO
9 1 YES
c ... injuries?
9
9 0 NO
USA:
VENUE
9 1 YES
9 0 NO.
9
Total minutes?: ________
9 1 YES
Year?: ________
9 0 NO.
VENUE
Why not?: 9 0 NO
Total hours?: _________
9 1 YES [Specify]:
9
USA:
VENUE
9 1 YES
f. ...besides school,... basic skills
like classes in math, reading and
writing?
NO
91
YES. How much?:
$__ __ __ ___. __ __
Total hours?: _________
9 0 NO.
Total minutes?: ________
9 1 YES
Year?: ________
9 0 NO
Why not?:
9 1 YES [Specify]:
90
Why not?:
9 1 YES.
9 0 NO.
How?:
Why not?:
9 1 YES.
How?:
9 0 NO.
Why not?:
NO
91
YES. How much?:
$__ __ __ ___. __ __
9
Year?: ________
USA:
VENUE
9 1 YES
Why not?:
Total hours?: _________
9 1 YES
9 0 NO
Why not?:
Total hours?: _________
Total minutes?: ________
CENTER
3. COMMUNITY COLLEGE
4. CHURCH
9 0 NO
90
9 1 YES [Specify]:
91
9 0 NO
9 1 YES [Specify]:
NO
YES. How much?:
$ __ __ __ ___. __ __
90
9 1 YES.
How?:
9 0 NO.
Why not?:
NO
9 1 YES.
9 0 NO.
How?:
Why not?:
91
9 1 YES
*CODES FOR “ET2": VENUE
1. WORKPLACE
2. COMMUNITY
90
9 1 YES
9 0 NO.
YES. How much?:
9 0 NO
Total minutes?: ________
9 0 NO
NO
9 1 YES
e. ...English as a Second Language
(ESL)?
9 0 NO
90
91
$__ __ __ ___. __ __
Year?: ________
USA:
d. ,...GED classes?
9 0 NO
9 1 YES [Specify]:
Total hours?: _________
Total minutes?: ________
And,..how about on your own or
through any type of provider, have
you attended (“d”, “e”, “f”)...
Why not?: 9 0 NO
YES. How much?:
$ __ __ __ ___. __ __
9 1 YES.
How?:
**CODES FOR “ET4": “NO, Why not?”
5. ADULT SCHOOL
97. Other: ______
1. Too old to study
2. Did not learn (Will not learn)
20
3. No transportation
4.Too tired to continue
5. No child care
6. Too far
9. Still attending
97. Other: _______
[...continuation: Education and Training...]
[THESE QUESTIONS ARE FOR FW OR NF,
REFER TO LAST TIME . IF YES, ASK AND
WRITE THE TYPE OF TRAINING (SPECIFY)
AND MARK IF “FW” OR “NF” ] Like...
g. ...besides safety training, any
other training received in any
other work (FW or NF) you may
have had (OJT)?
90
91
NO
ET2. Where (venue
or provider facility)?
*[GIVE EXAMPLES.ENTER
CODE] [FOR OTHER COUNTRY,
ENTER COUNTRY AND VENUE]
9
USA:
year and total hours
and/or minutes?)
ET4. Have you
completed it?
** [ENTER CODES
FOR “NO” AND
SKIP TO “ET6"]
Year?: ________
9 0 NO
ET3. When? (Dates:
ET5. Have you
ET6.
received a credential, Did you pay anything for
diploma or license [for it?
program ]? [Specify]
Why not?:
9 0 NO
9 1 YES [Specify]:
Total hours?: _________
VENUE
YES: 9 FW? 9 NF?
Total minutes?: ________
9 1 YES
Year?: ________
9 0 NO.
9 0 NO
ET7. And this training
program, has it helped (will
help) you for a better job or
in any other way?
[WRITE RESPONSE]
9 0 NO. Why not?:
9 1 YES. How much?:
9 1 YES. How?:
$ __ __ __ ___. __ __
SPECIFY TYPE OF TRAINING
h. ...in the USA or any other
country, any kind of training for
any kind of work (FW or NF)?
90
91
NO
9 1 USA:
VENUE
Why not?:
9 0 NO
9 1 YES [Specify]:
Total hours?: _________
YES: 9 FW? 9 NF?
9 2 OTHER COUNTRY:
Total minutes?: ________
9 1 YES
9 0 NO. Why not?:
90
NO
91
YES. How much?:
$ __ __ __ ___. __ __
9 1 YES . How?:
SPECIFY TYPE OF TRAINING
COUNTRY AND VENUE
*CODES FOR “ET2": VENUE
1. WORKPLACE
2. COMMUNITY
CENTER
3. COMMUNITY COLLEGE
4. CHURCH
5. ADULT SCHOOL
97. Other: ______
**CODES FOR “ET4": “NO, Why not?”
1. Too old to study
3. No transportation
2. Did not learn (Will not learn) 4.Too tired to continue
Have you ever considered (thought about) attending some other kind of
vocational training or special classes to help you improve your skills to
obtain better jobs, better pay or change careers, etc.?:
ET8.
9 0 NO
9 e. No child care
9 f. Too far
9 z. Other: __________________
90
9 1 YES
b.
And...why would you choose that (in a)?:
[ASK ET10 and ET11]
ET10.
What kind of training have you heard of?:
ET11.
Why did you not attend that training? [Mark all responses]:
9 a. Too old to study
9 b. Did (Will) not learn
9 c. No transportation
Too old to study
Did (Will) not learn
Other: ____
9 1 YES [ASK “a” an “b”]:
a.
Which training class would you consider attending?
What kind of training or classes?:
NO [SKIP TO ET12]
¿Why not? [Mark all responses and SKIP TO 13]:
9 a.
9 b.
9 z.
Have you heard of training programs for farm workers?:
ET9.
9. Still attending
97. Other: _______
If there were training programs for FARM WORKERS in this location
(city), of any kind, and there were no obstacles to attend, would you
attend a program?
9 0 NO
Why not? [Mark all responses]:
9 a. Too old to study
9 b. Did (Will) not learn
9 c. No transportation
9 1 YES:
ET12.
5. No child care
6. Too far
ET13.
Do you think you are qualified to work in any other job with a better
pay here (current job) or in any other place (employer)?:
90
91
9 d. Too tired to continue 9 g. Applied, did not qualify
9 e. No child care
9 h. Don’t qualify, did not apply
9 f. Too far
9 z. Other: ________________
21
NO
YES. What kind of work?:
S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd
LEGAL STATUS
We are interested in knowing whether any of the following apply to you. Please be assured that no one
besides us will know your response.
L1 What is your current legal status in the U.S.? [READ CHOICES L2b PROGRAMS [DO NOT READ OPTIONS]:
IF NECESSARY]:
9 1 AMNESTY UNDER 5 YEAR PROGRAM
[“TIME”]
91
I AM A U.S. CITIZEN BY BIRTH [SKIP TO NEXT PAGE]
92
9 2 AMNESTY UNDER SAW (90 DAY) PROGRAM
I AM A NATURALIZED U.S. CITIZEN (FOREIGN BORN,
[“FW” - “FIELD WORK”]
NATURALIZED). (ASK: “BEFORE BECOMING A
NATURALIZED U.S. CITIZEN, UNDER WHICH PROGRAM DID 9 3 CUBAN/HAITIAN ENTRANT
YOU APPLY TO OBTAIN YOUR PERMANENT RESIDENCE?”)
9 4 SPOUSAL PETITION PROGRAM/FAMILY
[POSSIBLE ANSWERS IN L2: 1 - 9, 97). THEN ASK: L4-1, L4UNITY
2, AND L4-3]
9 5 LABOR CERTIFICATION PROGRAM
PERMANENT RESIDENT/GREEN CARD (RIGHT TO RESIDE
9 6 REGISTRY PROGRAM
AND WORK IN THE U.S.) (ASK L2: “UNDER WHICH
9 7 POLITICAL ASYLUM
PROGRAM DID YOU APPLY?”) [POSSIBLE ANSWERS: 1
HASTA 9 Y 97). THEN ASK: L4-1 AND L4-2]
9 8 REFUGEE
BORDER CROSSING CARD/COMMUTER CARD (RIGHT TO 9 9 PROTECTIVE STATUS (TEMPORARY)
CROSS THE BORDER AND WORK IN THE U.S.) (ASK L2:
“UNDER WHICH PROGRAM DID YOU APPLY?”) [POSSIBLE 9 10 GUEST WORKER PROGRAM
[“BRACERO”]
ANSWERS: 9, 12, 13, Y 97. THEN ASK: L3, L4-1 AND L4-2]
93
94
9 11 STUDENT
PENDING STATUS (WITHOUT DOCUMENTS, APPLIED,
AWAITING OFFICIAL DECISION) (ASK L2: “UNDER WHICH 9 12 TOURIST
PROGRAM DID YOU APPLY?”) [POSSIBLE ANSWERS: 1- 9, 9 13 BORDER CROSSING CARD/ “PASSPORT”
14, 15 AND 97. THEN ASK: L3, AND L41]
95
96
UNDOCUMENTED (APPLICATION DENIED/DID NOT APPLY 9 14 DACA (Deferred Action for Childhood
Arrivals.
TO ANY PROGRAMS) [POSSIBLE ANSWERS: “NONE.”
• Entered USA under 16 yrs. old before
SKIP TO NEXT PAGE]
97
TEMPORARY RESIDENT - NON IMMIGRANT VISA (ONLY
FOR SPECIFIED TIME) [ASK L2: “UNDER WHICH PROGRAM
DID YOU APPLY?” POSSIBLE ANSWERS: 10 - 97. THEN
ASK: L3 AND L41]
98
OTHER [IF RELEVANT AND APPROPRIATE ASK L2, L3, L4-1, L4-2,
AND L4-3. THEN SKIP TO NEXT PAGE]:
L3 Do
9 97
OTHER:
9 99
NOT ANSWERED
you have general work authorization?:
9 0 NO
9 1 YES
9 7 DON’T KNOW
L4
1
June 15, 2007;
• Under 31 as of June 15, 2012.
• Have continuously resided in the USA
from June 15, 2007 to the present)
When did you apply to the
program (in L2)?
2
DATE STATUS BECAME EFFECTIVE:
[Only for those who responded
"2,3, or 4" in L1]: When did you
obtain your legal status?
/
(Month)
/
9 96 REFUSE
3
[Only for those who
responded "2" in L1]: When
did you obtain your
naturalization/ become a U.S.
citizen?
/
(Year)
(Month)
/
/
(Year)
22
(Month)
/
(Year)
JBS International, Inc.
555 Airport Boulevard, Suite 400
Burlingame, CA 94010-2002
Phone: 650.373.4900
Fax: 650.348.0260
INDIVIDUAL AGREEMENT TO BE A RESEARCH SUBJECT
OMB CONTROL NUMBER: 1205-0453
INTRODUCTION/PURPOSE
You are invited to participate in this survey for the Department of Labor because you are currently working on
a farm. The purpose of the survey is to learn more about the employment, living conditions, and the health of
farm workers.
PROCEDURES TO BE FOLLOWED
You will be asked to answer some questions about your work history and about your health. The interview
will last approximately 45 minutes.
RISKS
Since we will only be asking you questions, there is very little risk to you as a result of being in the survey.
You may refuse to answer any question at any time, with no penalty.
BENEFITS
There are no direct benefits to you from being in the survey. Information obtained through this research,
however, may help federal, state, and private farm worker programs improve services to workers like you.
PRIVACY
Your answers to the interview will be kept private to the extent allowed by law. This means that the
interview record will be kept in a locked file, and only researchers on the survey will be allowed to see it.
Your name will not appear on any reports about the survey. (See back of page for details.)
ALTERNATIVES TO PARTICIPATION
Participating in this survey is voluntary and you can quit at any time. You can also choose not to
participate in any part of the interview at any time, with no penalty. Whether or not you participate in this
survey will not affect benefits and services to which you are normally entitled. You will be paid for the
time you are spending in this interview. At any time, you may ask the researchers to explain any part of the
survey.
WHO TO CALL WITH QUESTIONS
If you have questions about the research survey, including questions about your rights as a research
subject, you may call JBS International (toll free) at 877- SAY-NAWS (or 877-729-6297). They will refer
your questions to Daniel Carroll at the Department of Labor, at (202) 693-2795.
I have read and understand the statement above. My questions about any unclear or confusing
statements have been answered clearly. I agree to participate in this survey as a research subject. I
admit that I have received a copy of this form and $20 for my participation.
-----------------------------------------------------------------Signature of Subject
(See reverse)
Date
-------------------------------------
In accordance with the Privacy Act of 1974, as amended (5 U.S.C.552a),
we are notifying you that this study is authorized by the U.S. Department of
Labor, Employment and Training Administration (ETA). Your voluntary
participation is important to the success of this study and will enable the
ETA to understand the labor market and living experiences of U.S.
farmworkers. Under written agreement with research organizations, the
ETA may release certain information necessary for research but only after
all identifying information has been removed. Unless required by law, or
necessary for litigation or legal proceedings and except as indicated in this
statement, we will hold all personal identifiers (e.g. name, address, and
social security number) in total confidence and will not release them.
Notwithstanding any other provision of law, no person is required to respond to nor shall a person
be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a
currently valid Office of Management and Budget control number. Public reporting burden for this
collection of information, which is voluntary, is estimated to average 45 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. Send
comments regarding this burden estimate to the Office of Policy Development, Evaluation and
Research, ETA, Department of Labor, Room N5641, 200 Constitution Avenue, N.W., Washington,
D.C. 20210.
JBS International, Inc.
555 Airport Boulevard, Suite 400
Burlingame, CA 94010-2002
Phone: 650.373.4900
Fax: 650.348.0260
INDIVIDUAL AGREEMENT TO BE A RESEARCH SUBJECT
OMB CONTROL NUMBER: 1205-0453
INTRODUCTION/PURPOSE
You are invited to participate in this survey for the Department of Labor because you are currently
working on a farm. The purpose of the survey is to learn more about the employment, living conditions,
and the health of farm workers.
PROCEDURES TO BE FOLLOWED
You will be asked to answer some questions about your work history and about your health. The interview
will last approximately 45 minutes.
RISKS
Since we will only be asking you questions, there is very little risk to you as a result of being in the survey.
You may refuse to answer any question at any time, with no penalty.
BENEFITS
There are no direct benefits to you from being in the survey. Information obtained through this research,
however, may help federal, state, and private farm worker programs improve services to workers like you.
PRIVACY
Your answers to the interview will be kept private to the extent allowed by law. This means that the
interview record will be kept in a locked file, and only researchers on the survey will be allowed to see it.
Your name will not appear on any reports about the survey. (See back of page for details.)
ALTERNATIVES TO PARTICIPATION
Participating in this survey is voluntary and you can quit at any time. You can also choose not to
participate in any part of the interview at any time, with no penalty. Whether or not you participate in this
survey will not affect benefits and services to which you are normally entitled. You will be paid for the
time you are spending in this interview. At any time, you may ask the researchers to explain any part of the
survey.
WHO TO CALL WITH QUESTIONS
If you have questions about the research survey, including questions about your rights as a research
subject, you may call JBS International (toll free) at 877- SAY-NAWS (or 877-729-6297). They will refer
your questions to Daniel Carroll at the Department of Labor, at (202) 693-2795.
I have read and understand the statement above. My questions about any unclear or confusing
statements have been answered clearly. I agree to participate in this survey as a research subject. I
admit that I have received a copy of this form and $20 for my participation.
-----------------------------------------------------------------Signature of Subject
(See reverse)
------------------------------------Date
In accordance with the Privacy Act of 1974, as amended (5 U.S.C.552a),
we are notifying you that this study is authorized by the U.S. Department of
Labor, Employment and Training Administration (ETA). Your voluntary
participation is important to the success of this study and will enable the
ETA to understand the labor market and living experiences of U.S.
farmworkers. Under written agreement with research organizations, the
ETA may release certain information necessary for research but only after
all identifying information has been removed. Unless required by law, or
necessary for litigation or legal proceedings and except as indicated in this
statement, we will hold all personal identifiers (e.g. name, address, and
social security number) in total confidence and will not release them.
Notwithstanding any other provision of law, no person is required to respond to nor shall a person
be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a
currently valid Office of Management and Budget control number. Public reporting burden for this
collection of information, which is voluntary, is estimated to average 45 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. Send
comments regarding this burden estimate to the Office of Policy Development, Evaluation and
Research, ETA, Department of Labor, Room N5641, 200 Constitution Avenue, N.W., Washington,
D.C. 20210.
| File Type | application/pdf |
| File Title | S:\4. Questionnaire\2019\CYCLE95\ENGCY95\CY95 ENG OCT 29 2019.wpd |
| Author | jnakamoto |
| File Modified | 2019-10-30 |
| File Created | 2019-10-29 |