Protocol Crosswalk

Enc 11 - Protocol crosswalk.xlsx

Generic Clearance for Questionnaire Pretesting Research

Protocol Crosswalk

OMB: 0607-0725

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Overview

Group 1 - English
Group 2 - English
Group 3 - English
Income Questions - Set 2

Sheet 1: Group 1 - English
Topic V1 - Paper V2 - Paper V1 - CAI V2 - CAI
Household Roster

1a. Let’s create a list of everyone, including people not related to you, living or staying at this address. What is your name? (What is the name of the next person living or staying here?)

The following questions are to make sure everyone is included.

1b. The people you have listed so far are… Other than these people, is there anyone else staying here such as… • Babies • Grandchildren • Foster children • Any other children, related or unrelated to you • Roommates • People or families who have no other place to stay?

The following questions are to make sure everyone we have listed should be included in this survey. I have…

1c. Do any of these people live somewhere else now, such as a college student or someone in the Armed Forces on deployment? I have listed…

1d. Are any of these people staying here for a short visit or for an overnight stay? I have listed…

1e. Are you/Is <Name> staying here for MORE than two months?		 1a. Let’s create a list of everyone living or staying at this address, even if they are not related to you. What is your name? (What is the name of the next person living or staying here?)

The following questions are to make sure everyone is included.

1b. Other than the people you have already mentioned, are there any children living or staying here, such as babies, grandchildren, or foster children? These children could be related or unrelated to you.

1c. Other than the people you have already mentioned, is there anyone else staying here, such as roommates and other people or families who have no other place to stay? I have listed…

1d. Do any of these people live somewhere else, such as a college student or someone in the Armed Forces on deployment? I have listed…

1e. Are any of these people staying here for a short time?
Introduction [ASK AFTER COMPLETING HOUSEHOLD ROSTER (PERSON 12)]
Now I'd like to ask your opinion about some of the questions you have answered so far. 		[ASK AFTER COMPLETING HOUSEHOLD ROSTER (PERSON 12)]
Now I'd like to ask your opinion about some of the questions you have answered so far. 		[ASK AFTER COMPLETING HOUSEHOLD ROSTER (QUESTION 6)]
Now I'd like to ask your opinion about some of the questions you have answered so far. 		[ASK AFTER COMPLETING HOUSEHOLD ROSTER (QUESTION 6)]
Now I'd like to ask your opinion about some of the questions you have answered so far.
Probe 1 Is there anyone living or staying at your address who you did not include when answering these questions? IF YES: Who? Please tell me why you did not include them. Is there anyone living or staying at your address who you did not include when answering these questions? IF YES: Who? Please tell me why you did not include them. We started out by creating a list of everyone living or staying at your address. To help identify everyone, I asked about various types of people who might stay at your home. I also asked about people who are staying at your home for a short visit or who live elsewhere now.

Is there anyone living or staying at your address who you did not include when we created the list? IF YES: Who? Please tell me why you did not include them.		 We started out by creating a list of everyone living or staying at your address. To help identify everyone, I asked about various types of people who might stay at your home. I also asked about people who are staying at your home for a short visit or who live elsewhere now.

Is there anyone living or staying at your address who you did not include when we created the list? IF YES: Who? Please tell me why you did not include them.
Probe 2 Are there any people who you were hesitant or unsure about including when you answered these questions? Are there any people who you were hesitant or unsure about including when you answered these questions? Are there any people who you were hesitant or unsure about including when you answered these questions? Are there any people who you were hesitant or unsure about including when you answered these questions?
Probe 3 [IF YES TO PROBE 2] Who are those people? IF NECESSARY: How are you related or connected to them? [IF YES TO PROBE 2] Who are those people? IF NECESSARY: How are you related or connected to them? [IF YES TO PROBE 2] Who are those people? IF NECESSARY: How are you related or connected to them? [IF YES TO PROBE 2] Who are those people? IF NECESSARY: How are you related or connected to them?
Probe 4 [IF YES TO PROBE 2] Why were you hesitant or unsure about including [him/her/them]? [IF YES TO PROBE 2] Why were you hesitant or unsure about including [him/her/them]? [IF YES TO PROBE 2] Why were you hesitant or unsure about including [him/her/them]? [IF YES TO PROBE 2] Why were you hesitant or unsure about including [him/her/them]?
Probe 5 [IF REPORTED MORE THAN 1 PERSON] When answering these questions, did you include anyone who stays or lives someplace else? IF YES: PROBE TO DETERMINE WHERE THEY STAY AND HOW OFTEN. [IF REPORTED MORE THAN 1 PERSON] When answering these questions, did you include anyone who stays or lives someplace else? IF YES: PROBE TO DETERMINE WHERE THEY STAY AND HOW OFTEN. [IF REPORTED MORE THAN 1 PERSON] When we created the list, did you include anyone who stays or lives someplace else? IF YES: PROBE TO DETERMINE WHERE THEY STAY AND HOW OFTEN. [IF REPORTED MORE THAN 1 PERSON] When we created the list, did you include anyone who stays or lives someplace else? IF YES: PROBE TO DETERMINE WHERE THEY STAY AND HOW OFTEN.
Probe 6 Do you think these questions are asking about people unrelated to you, or not? Why (not)? Do you think these questions are asking about people unrelated to you, or not? Why (not)? Do you think the list of people living or staying at your address should include people unrelated to you, or not? Why (not)? Do you think the list of people living or staying at your address should include people unrelated to you, or not? Why (not)?
Probe 7 How long do you think someone should live or stay with you for you to include them? How long do you think someone should live or stay with you for you to include them? How long do you think someone should live or stay with you for you to include them? How long do you think someone should live or stay with you for you to include them?
Probe 8 This question includes instructions about what types of people should and should not be included. [POINT TO INCLUDE/EXCLUDE INSTRUCTIONS ON SURVEY.] Did you read this text when answering the question, or did you skip over it? IF SKIPPED OVER: What do you think made you skip it? This question includes instructions about what types of people should and should not be included. [POINT TO INCLUDE/EXCLUDE INSTRUCTIONS ON SURVEY.] Did you read this text when answering the question, or did you skip over it? IF SKIPPED OVER: What do you think made you skip it? [SKIP] [SKIP]
Probe 9 [IF READ THE INCLUDE/EXCLUDE TEXT] How did the instructions influence who you did or did not include? [IF READ THE INCLUDE/EXCLUDE TEXT] How did the instructions influence who you did or did not include? [SKIP] [SKIP]
Probe 10 [SKIP] [SKIP] [IF ADDED NAMES TO THE ROSTER AFTER FOLLOW-UP QUESTIONS] When we first created the list of people living or staying at your home, you mentioned [LIST NAMES]. Then I asked about babies, grandchildren, foster children, any other children related or unrelated to you, roommates, and people or families who have no other place to stay, and you mentioned [LIST NAMES]. What do you think made you decide not to mention [him/her/them] when we first created the list? [IF ADDED NAMES TO THE ROSTER AFTER FOLLOW-UP QUESTIONS] When we first created the list of people living or staying at your home, you mentioned [LIST NAMES]. Then I asked about babies, grandchildren, foster children, roommates, and people or families who have no other place to stay, and you mentioned [LIST NAMES]. What do you think made you decide not to mention [him/her/them] when we first created the list?
Probe 11 Now, please look at the instructions about who should and should not be included. Tell me about anything confusing or unclear. IF THEY FIND ANYTHING CONFUSING OR UNCLEAR, PROBE: Why? Now, please look at the instructions about who should and should not be included. Tell me about anything confusing or unclear. IF THEY FIND ANYTHING CONFUSING OR UNCLEAR, PROBE: Why? [SKIP] [SKIP]
Probe 12 [SKIP] [SKIP] After we created the list I asked about babies, grandchildren, and all the other types of people I already mentioned. Then I asked several other questions, such as if any of the people you listed are college students, are in the Armed Forces on deployment, or if they are staying at your home for short time. What was your reaction to me asking all of those follow-up questions? IF NECESSARY: Did you find the questions repetitive? Were any of them confusing? Did you have another reaction to them? After we created the list I asked about babies, grandchildren, and all the other types of people I already mentioned. Then I asked several other questions, such as if any of the people you listed are college students, are in the Armed Forces on deployment, or if they are staying at your home for short time. What was your reaction to me asking all of those follow-up questions? IF NECESSARY: Did you find the questions repetitive? Were any of them confusing? Did you have another reaction to them?
Probe 13 [SKIP] [SKIP] As I mentioned, one of the follow-up questions asked if anyone stayed at your home "for a short visit or for an overnight stay." What do think of as "a short visit?" [SKIP]
Probe 14 [SKIP] [SKIP] How about an "overnight stay?" What do you think that is? [SKIP]
Probe 15 [SKIP] [SKIP] [SKIP] As I mentioned, one of the follow-up questions asked if anyone stayed at your home "for a short time." What do you think of as "a short time?"
Probe 16 [SKIP IF DISCUSSION ON PREVIOUS PROBES WAS EXTENSIVE/TIME-CONSUMING] Other than your current situation, have you ever lived with someone other than immediate family? IF YES: What was the most recent situation and who were you living with? [WAIT FOR RESPONSE.] Would you have included all of those people in the survey? Why (not)? [SKIP IF DISCUSSION ON PREVIOUS PROBES WAS EXTENSIVE/TIME-CONSUMING] Other than your current situation, have you ever lived with someone other than immediate family? IF YES: What was the most recent situation and who were you living with? [WAIT FOR RESPONSE.] Would you have included all of those people in the survey? Why (not)? [SKIP IF DISCUSSION ON PREVIOUS PROBES WAS EXTENSIVE/TIME-CONSUMING] Other than your current situation, have you ever lived with someone other than immediate family? IF YES: What was the most recent situation and who were you living with? [WAIT FOR RESPONSE.] Would you have included all of those people in the survey? Why (not)? [SKIP IF DISCUSSION ON PREVIOUS PROBES WAS EXTENSIVE/TIME-CONSUMING] Other than your current situation, have you ever lived with someone other than immediate family? IF YES: What was the most recent situation and who were you living with? [WAIT FOR RESPONSE.] Would you have included all of those people in the survey? Why (not)?
Probe 17 [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Now I'm going to describe some situations for you and ask you a question about each one. Here is the first situation: Suppose Mary is answering the survey for her family. When answering the first question about the number of people living or staying at this address, she includes herself, her husband Bob, and their two children. Mary is not sure if she should include her husband's son, Billy, who is her stepson. Billy is 19 years old and looking for a job. Sometimes he stays here with Mary and Bob, and sometimes he stays with his mom. When answering the question, should Mary include Billy? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Now I'm going to describe some situations for you and ask you a question about each one. Here is the first situation: Suppose Mary is answering the survey for her family. When answering the first question about the number of people living or staying at this address, she includes herself, her husband Bob, and their two children. Mary is not sure if she should include her husband's son, Billy, who is her stepson. Billy is 19 years old and looking for a job. Sometimes he stays here with Mary and Bob, and sometimes he stays with his mom. When answering the question, should Mary include Billy? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Now I'm going to describe some situations for you and ask you a question about each one. Here is the first situation: Suppose Mary is answering the survey for her family. When answering the first question about the number of people living or staying at this address, she includes herself, her husband Bob, and their two children. Mary is not sure if she should include her husband's son, Billy, who is her stepson. Billy is 19 years old and looking for a job. Sometimes he stays here with Mary and Bob, and sometimes he stays with his mom. When answering the question, should Mary include Billy? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Now I'm going to describe some situations for you and ask you a question about each one. Here is the first situation: Suppose Mary is answering the survey for her family. When answering the first question about the number of people living or staying at this address, she includes herself, her husband Bob, and their two children. Mary is not sure if she should include her husband's son, Billy, who is her stepson. Billy is 19 years old and looking for a job. Sometimes he stays here with Mary and Bob, and sometimes he stays with his mom. When answering the question, should Mary include Billy?
Probe 18 [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] John's cousin is staying with him while he is in town for a 6-week training program. Should John include him when answering this question? Why (not)? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] John's cousin is staying with him while he is in town for a 6-week training program. Should John include him when answering this question? Why (not)? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] John's cousin is staying with him while he is in town for a 6-week training program. Should John include him when answering this question? Why (not)? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] John's cousin is staying with him while he is in town for a 6-week training program. Should John include him when answering this question? Why (not)?
Probe 19 [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Susan lives with her parents in the suburbs. For the last 6 months she has been staying with her boyfriend at least 3 nights a week. Her boyfriend is asked to complete the survey. Should he include Susan when answering this question? Why (not)? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Susan lives with her parents in the suburbs. For the last 6 months she has been staying with her boyfriend at least 3 nights a week. Her boyfriend is asked to complete the survey. Should he include Susan when answering this question? Why (not)? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Susan lives with her parents in the suburbs. For the last 6 months she has been staying with her boyfriend at least 3 nights a week. Her boyfriend is asked to complete the survey. Should he include Susan when answering this question? Why (not)? [IF Probe 16 = NO AND DISCUSSION ON PREVIOUS PROBES WAS BRIEF] Susan lives with her parents in the suburbs. For the last 6 months she has been staying with her boyfriend at least 3 nights a week. Her boyfriend is asked to complete the survey. Should he include Susan when answering this question? Why (not)?
Probe 20 Now I would like you to look at this question. [PROVIDE VERSION 2.] How would you answer this question? AFTER ANSWERING: Do you see this question as the same or as different from the original version? Now I would like you to look at this question. [PROVIDE VERSION 1.] How would you answer this question? AFTER ANSWERING: Do you see this question as the same or as different from the original version? [SKIP] [SKIP]
Probe 21 What do you think about this version of the question? [REFER TO VERSION 2] What do you think about this version of the question? [REFER TO VERSION 1] [SKIP] [SKIP]
Probe 22 Which version of the question do you prefer, the original or the alternate? Why? Which version of the question do you prefer, the original or the alternate? Why? [SKIP] [SKIP]
Transition Please go ahead now and continue filling out the survey. I'll stop you when I have additional questions. Please go ahead now and continue filling out the survey. I'll stop you when I have additional questions. Now I'm going to continue asking you the survey questions, and at the end I'll ask you for more feedback on the questions. Now I'm going to continue asking you the survey questions, and at the end I'll ask you for more feedback on the questions.
Overcount Follow-Up N/A N/A We are conducting research to understand why people stay in more than one place. Earlier in the survey you indicated that <Name(s) from Additional Person(s)> sometimes live(s) somewhere else or is (are) only staying here for a short time.

Could you briefly explain <Name(s) from Additional Person(s)> 's living situation?		 We are conducting research to understand why people stay in more than one place. Earlier in the survey you indicated that <Name(s) from Additional Person(s)> sometime/s live/s somewhere else or is/are only staying here for a short time.

Could you briefly explain <Name(s) from Additional Person(s)> 's living situation?
Probe 1 [SKIP] [SKIP] [ASK AT END OF SURVEY] IF OVERCOUNT FOLLOW-UP QUESTION WAS ASKED: What do you think about that last question about {NAME's} living situation? [ASK AT END OF SURVEY] IF OVERCOUNT FOLLOW-UP QUESTION WAS ASKED: What do you think about that last question about {NAME's} living situation?
Probe 2 [SKIP] [SKIP] How easy or difficult was it to answer that question? How easy or difficult was it to answer that question?
Probe 3 [SKIP] [SKIP] Was anything about the question unclear or confusing? Was anything about the question unclear or confusing?
Septic Systems

14. What is the MAIN type of sewage disposal for this <FILL BUILDING TYPE>?
Public sewer
Septic system or cesspool, or
Another type of sewage disposal		 14a. Is this <FILL BUILDING TYPE> connected to a public sewer?
Yes
No

14b. Is it connected to a septic system or cesspool?
Yes
No
Introduction [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. Please look back at Question 8, which asks about sewage disposal.		 [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. Please look back at Question 8, which asks if your home is connected to a public sewer.		 [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. I'll start by reading you the question again and reminding you of your answer. The first question is: [ASK QUESTION 14]. You answered [QUESTION 14 ANSWER].		 [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. I'll start by reading you one of the questions and reminding you of your answer. The first question is: [ASK QUESTION 14a]. You answered [QUESTION 14a ANSWER].
Probe 1 How did you decide which response option to choose? How did you decide which response option to choose? How did you decide which response option to choose? How did you decide which response option to choose?
Probe 2 Do you know the answer to this question or did you need to guess? Do you know the answer to this question or did you need to guess? Do you know the answer to this question or did you need to guess? Do you know the answer to this question or did you need to guess?
Probe 3 How confident are you in your answer? How confident are you in your answer? How confident are you in your answer? How confident are you in your answer?
Probe 4 What do you think is meant by "sewage disposal?" [SKIP] What do you think is meant by "sewage disposal?" [SKIP]
Probe 5 What do you think is meant by "public sewer?" Can you describe that for me? What do you think is meant by "public sewer?" Can you describe that for me? What do you think is meant by "public sewer?" Can you describe that for me? What do you think is meant by "public sewer?" Can you describe that for me?
Probe 6 What do you think a "septic system" is? Can you describe one for me? What do you think a "septic system" is? Can you describe one for me? What do you think a "septic system" is? Can you describe one for me? [IF Q14a = NO] Next I'll ask you another survey question: [ASK QUESTION 14b]. You answered [QUESTION 14b ANSWER]. What do you think a "septic system" is? Can you describe one for me?
Probe 7 What do think a "cesspool" is? Can you describe one for me? What do think a "cesspool" is? Can you describe one for me? What do think a "cesspool" is? Can you describe one for me? [IF Q14a = YES] What do think a "cesspool" is? Can you describe one for me?
Probe 8 Do you think there is a difference between a "septic system" and a "cesspool," or are they the same thing? [IF THEY THINK THERE IS A DIFFERENCE: What is the difference?] Do you think there is a difference between a "septic system" and a "cesspool," or are they the same thing? [IF THEY THINK THERE IS A DIFFERENCE: What is the difference?] Do you think there is a difference between a "septic system" and a "cesspool," or are they the same thing? [IF THEY THINK THERE IS A DIFFERENCE: What is the difference?] [IF Q14a = YES] Do you think there is a difference between a "septic system" and a "cesspool," or are they the same thing? [IF THEY THINK THERE IS A DIFFERENCE: What is the difference?]
Probe 9 Does your home have more than one type of sewage disposal system? [IF YES: How did you decide which answer to choose?] Does your home have more than one type of sewage disposal system? [IF YES: How did you decide which answer to choose?] Does your home have more than one type of sewage disposal system? [IF YES: How did you decide which answer to choose?] Does your home have more than one type of sewage disposal system? [IF YES: PROBE TO DETERMINE TYPES OF SYSTEMS]
Probe 10 [IF OTHER: You answered that your home has some other type of sewage disposal. What is it? IF NECESSARY: Can you describe it for me?] [IF OTHER: You answered that your home has some other type of system. What is it? IF NECESSARY: Can you describe it for me?] [IF OTHER: You answered that your home has some other type of sewage disposal. What is it? IF NECESSARY: Can you describe it for me?] [IF Q14b = NO] You indicated when answering these survey questions that your home is not connected to a public sewer, septic system, or cesspool. What type of sewage disposal system does your home have? IF NECESSARY: Can you describe it for me?
Home Heating Fuel

22a. To heat this <FILL BUILDING TYPE>, which fuel do you use MOST—
Gas,
Electricity,
Fuel oil or kerosene,
Coal or coke,
Wood,
Solar energy,
or Some other fuel?

22b. Is it natural gas from underground pipes serving the neighborhood?
Yes
No

22c. Is it a gas such as propane or butane?
Yes
No		 22a. To heat this <FILL BUILDING TYPE>, which fuel do you use MOST—
Gas,
Electricity,
Fuel oil or kerosene,
Coal or coke,
Wood,
Solar energy,
or Some other fuel?

22b. Is it natural gas from underground pipes serving the neighborhood?
Yes
No

22c. Is it bottled or tank gas, such as propane or butane?
Yes
No
Introduction Now I'd like to skip ahead and discuss Question 15, which asks about fuel used for heating your home.

INTERVIEWER: WHEN PROBING, NOTE ANY CONFUSION OR COMMENTS ABOUT BUTANE.		 Now I'd like to skip ahead and discuss Question 15, which asks about fuel used for heating your home.

INTERVIEWER: WHEN PROBING, NOTE ANY CONFUSION OR COMMENTS ABOUT BUTANE.		 The next questions I'd like to discuss are about the fuel used for heating your home.

INTERVIEWER: WHEN PROBING, NOTE ANY CONFUSION OR COMMENTS ABOUT BUTANE.		 The next questions I'd like to discuss are about the fuel used for heating your home.

INTERVIEWER: WHEN PROBING, NOTE ANY CONFUSION OR COMMENTS ABOUT BUTANE.
Probe 1 How did you decide which response option to choose? How did you decide which response option to choose? First, I asked this question: [ASK QUESTION 22a]. You answered [ANSWER]. How did you decide which response option to choose? First, I asked this question: [ASK QUESTION 22a]. You answered [ANSWER]. How did you decide which response option to choose?
Probe 2 Is anything about this question confusing or unclear? Is anything about this question confusing or unclear? Is anything about this question confusing or unclear? Is anything about this question confusing or unclear?
Probe 3 How easy or difficult was it to find your answer in the list of options? How easy or difficult was it to find your answer in the list of options? [SKIP] [SKIP]
Probe 4 How many types of fuel are used to heat your home-- is it just one, or more than one? IF MORE THAN ONE: How did you decide which fuel to choose when answering the question? How many types of fuel are used to heat your home-- is it just one, or more than one? IF MORE THAN ONE: How did you decide which fuel to choose when answering the question? How many types of fuel are used to heat your home-- is it just one, or more than one? IF MORE THAN ONE: How did you decide which fuel to choose when answering the question? How many types of fuel are used to heat your home-- is it just one, or more than one? IF MORE THAN ONE: How did you decide which fuel to choose when answering the question?
Probe 5 This question includes separate options for "natural gas" and "gas." What do you think is the difference between the two? This question includes two separate options for gas. What do you think is the difference between the two? [IF 22a = GAS] Now let's discuss two additional questions. The first is [ASK QUESTION 22b]. You answered [ANSWER]. [The next question is one I didn't ask before: / The next question is:] ASK QUESTION 22c]. IF APPLCABLE: You [answered [ANSWER]. What do you think is the difference between the types of gas asked about in each of these questions? Can you describe them for me? [IF 22a = GAS] Now let's discuss two additional questions. The first is [ASK QUESTION 22b]. You answered [ANSWER]. [The next question is one I didn't ask before: / The next question is:] ASK QUESTION 22c]. IF APPLCABLE: You [answered [ANSWER]. What do you think is the difference between the types of gas asked about in each of these questions? Can you describe them for me?
Probe 6 [IF 15 = GAS] Can you tell me more about the gas your home uses? IF NECESSARY: Do you use propane, butane, or something else? [IF 15 = GAS] Can you tell me more about the gas your home uses? IF NECESSARY: Do you use propane, butane, or something else? [IF 22a = GAS] Can you tell me more about the gas your home uses? IF NECESSARY: Do you use propane, butane, or something else? [IF 22a = GAS] Can you tell me more about the gas your home uses? IF NECESSARY: Do you use propane, butane, or something else?
Probe 7 [SKIP] [SKIP] Is anything about these questions confusing or unclear? Is anything about these questions confusing or unclear?
Solar Power

23. Does this <FILL BUILDING TYPE> use solar panels that generate electricity?
Yes
No		 23. Does this <FILL BUILDING TYPE> use solar power or photovoltaic panels that generate electricity?
Yes
No
Introduction Now I'd like to talk about the next question, Question 16. This question asks about solar panels. Now I'd like to talk about the next question, Question 16. This question asks about solar power. Let's move on now to a different survey question. Here is the next question I'd like to discuss: [ASK QUESTION 23]. You answered [ANSWER]. Let's move on now to a different survey question. Here is the next question I'd like to discuss: [ASK QUESTION 23]. You answered [ANSWER].
Probe 1 How did you come up with your answer to this question? How did you come up with your answer to this question? How did you come up with your answer to this question? How did you come up with your answer to this question?
Probe 2 Is anything about this question confusing or unclear? Is anything about this question confusing or unclear? Is anything about this question confusing or unclear? Is anything about this question confusing or unclear?
Probe 3 Have you heard of the term "solar panels" before? IF YES: How would you describe solar panels? Have you heard of the term "solar power" before? IF YES: How would you describe solar power? Have you heard of the term "solar panels" before? IF YES: How would you describe solar panels? Have you heard of the term "solar power" before? IF YES: How would you describe solar power?
Probe 4 [SKIP] Have you heard the term "photovoltaic panels" before? IF YES: Can you describe them for me? IF NO: What would you guess that term refers to? [SKIP] Have you heard the term "photovoltaic panels" before? IF YES: Can you describe them for me? IF NO: What would you guess that term refers to?
Probe 5 IF ANSWERED YES: You answered that your home uses solar panels that generate electricity. Can you describe the system that your home uses? IF ANSWERED YES: You answered that your home uses solar power or photovoltaic panels that generate electricity. Can you describe the system that your home uses? IF ANSWERED YES: You answered that your home uses solar panels that generate electricity. Can you describe the system that your home uses? IF ANSWERED YES: You answered that your home uses solar power or photovoltaic panels that generate electricity. Can you describe the system that your home uses?
Probe 6 IF ANSWERED YES, HOME IS IN A MULTIUNIT BUILDING, AND THE FOLLOWING IS NOT ALREADY APPARENT: Can you tell me more about what parts of the building use solar panels for electricity? IF NECESSARY: Where are the solar panels located? PROBE TO UNDERSTAND WHETHER PARTICIPANT IS REPORTING SOLAR NOT USED IN THEIR UNIT. IF ANSWERED YES, HOME IS IN A MULTIUNIT BUILDING, AND THE FOLLOWING IS NOT ALREADY APPARENT: Can you tell me more about what parts of the building use solar power or photovoltaic panels for electricity? IF NECESSARY: Where are the solar or photovoltaic panels located? PROBE TO UNDERSTAND WHETHER PARTICIPANT IS REPORTING SOLAR NOT USED IN THEIR UNIT. IF ANSWERED YES, HOME IS IN A MULTIUNIT BUILDING, AND THE FOLLOWING IS NOT ALREADY APPARENT: Can you tell me more about what parts of the building use solar panels for electricity? IF NECESSARY: Where are the solar panels located? PROBE TO UNDERSTAND WHETHER PARTICIPANT IS REPORTING SOLAR NOT USED IN THEIR UNIT. IF ANSWERED YES, HOME IS IN A MULTIUNIT BUILDING, AND THE FOLLOWING IS NOT ALREADY APPARENT: Can you tell me more about what parts of the building use solar power or photovoltaic panels for electricity? IF NECESSARY: Where are the solar or photovoltaic panels located? PROBE TO UNDERSTAND WHETHER PARTICIPANT IS REPORTING SOLAR NOT USED IN THEIR UNIT.
Probe 7 IF ANSWERED YES: This question asks about "solar panels that generate electricity." Are those words you would use to describe what your home uses or would you use other words? [PROBE TO DETERMINE WHAT WORDS THEY WOULD USE.] IF ANSWERED YES: This question asks about "solar power or photovoltaic panels that generate electricity." Are those words you would use to describe what your home uses or would you use other words? [PROBE TO DETERMINE WHAT WORDS THEY WOULD USE.] IF ANSWERED YES: This question asks about "solar panels that generate electricity." Are those words you would use to describe what your home uses or would you use other words? [PROBE TO DETERMINE WHAT WORDS THEY WOULD USE.] IF ANSWERED YES: This question asks about "solar power or photovoltaic panels that generate electricity." Are those words you would use to describe what your home uses or would you use other words? [PROBE TO DETERMINE WHAT WORDS THEY WOULD USE.]
Probe 8 Now I would like you to look at this question. [PROVIDE VERSION 2.] How would you answer this question? AFTER ANSWERING: Do you see this question as the same or as different from the original version? Now I would like you to look at this question. [PROVIDE VERSION 1.] How would you answer this question? AFTER ANSWERING: Do you see this question as the same or as different from the original version? Instead of using the phrase "solar panels that generate electricity," we are considering the phrase "solar power or photovoltaic panels that generate electricity." Would you answer the question differently if I used that phrase? AFTER ANSWERING: Do you think those phrases mean the same thing or are they different? Instead of using the phrase "solar power or photovoltaic panels that generate electricity," we are considering the phrase "solar panels that generate electricity." Would you answer the question differently if I used that phrase? AFTER ANSWERING: Do you think those phrases mean the same thing or are they different?
Probe 9 What do you think about this version of the question? [REFER TO VERSION 2] What do you think about this version of the question? [REFER TO VERSION 1] What do you think about that other phrase? What do you think about that other phrase?
Probe 10 This question uses the term "generate electricity?" Can you give me some examples of what that means? This question uses the term "generate electricity?" Can you give me some examples of what that means? This question uses the term "generate electricity?" Can you give me some examples of what that means? This question uses the term "generate electricity?" Can you give me some examples of what that means?
Probe 11 Pretend that you have small solar-powered lights in your garden. Do you think they should be included here? Pretend that you have small solar-powered lights in your garden. Do you think they should be included here? Pretend that you have small solar-powered lights in your garden. Do you think they should be included here? Pretend that you have small solar-powered lights in your garden. Do you think they should be included here?
SNAP [QUESTION IS IN ITS PRESENT LOCATION IN THE SURVEY.] [QUESTION IS MOVED TO THE END OF THE HOUSING SECTION.] [QUESTION IS IN ITS PRESENT LOCATION IN THE SURVEY.]
25. In 2019, did you or any member of this household receive benefits from the Food Stamp Program or SNAP, the Supplemental Nutrition Assistance Program? Do NOT include WIC, the School Lunch Program, or assistance from food banks.
Yes
No		 [QUESTION IS MOVED TO THE END OF THE HOUSING SECTION.]
35. In 2019, did you or any member of this household receive benefits from the Food Stamp Program or SNAP, the Supplemental Nutrition Assistance Program? Do NOT include WIC, the School Lunch Program, or assistance from food banks.
Yes
No
Introduction The last question I'd like to ask you about is Question 18, which asks about benefits received. Please take another look at that question. The last question I'd like to ask you about is Question 27, which asks about benefits received. Please take another look at that question. The last question I'd like to ask you about is this one: [ASK QUESTION 25]. You answered [ANSWER]. The last question I'd like to ask you about is this one: [ASK QUESTION 35]. You answered [ANSWER].
Probe 1 How easy or difficult was it to answer this question? Why? How easy or difficult was it to answer this question? Why? How easy or difficult was it to answer this question? Why? How easy or difficult was it to answer this question? Why?
Probe 2 Do you use an EBT or electronic benefit transfer card for food in grocery stores? IF YES: Were you thinking about that when you answered this question? Do you use an EBT or electronic benefit transfer card for food in grocery stores? IF YES: Were you thinking about that when you answered this question? Do you use an EBT or electronic benefit transfer card for food in grocery stores? IF YES: Were you thinking about that when you answered this question? Do you use an EBT or electronic benefit transfer card for food in grocery stores? IF YES: Were you thinking about that when you answered this question?
Probe 3 What time period were you thinking about when answering this question? IF NECESSARY: What specific months and years were you thinking about? What time period were you thinking about when answering this question? IF NECESSARY: What specific months and years were you thinking about? What time period were you thinking about when answering this question? IF NECESSARY: What specific months and years were you thinking about? What time period were you thinking about when answering this question? IF NECESSARY: What specific months and years were you thinking about?
Probe 4 Question 18 asks about 2019, but the previous question, 17d, asks about "the past 12 months." Do these mean the same thing, or are they different? IF NECESSARY: Tell me more about why they are the [same/different]. Question 27 asks about 2019, but some of the questions on the previous page ask about "the past 12 months." Do these mean the same thing, or are they different? IF NECESSARY: Tell me more about why they are the [same/different]. This question asks about 2019, but the previous question asks about "the past 12 months." Do these mean the same thing, or are they different? IF NECESSARY: Tell me more about why they are the [same/different]. This question asks about 2019, but the previous question asks about "the past 12 months." Do these mean the same thing, or are they different? IF NECESSARY: Tell me more about why they are the [same/different].
Probe 5 Did you or any member of your household receive benefits from the Food Stamp Program or SNAP in the past 12 months? Did you or any member of your household receive benefits from the Food Stamp Program or SNAP in the past 12 months? Did you or any member of your household receive benefits from the Food Stamp Program or SNAP in the past 12 months? Did you or any member of your household receive benefits from the Food Stamp Program or SNAP in the past 12 months?
CLOSING PROBES N/A N/A N/A N/A
Probe 1 [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS.
Probe 2 [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty?

Sheet 2: Group 2 - English
Topic V1 - Paper V2 - Paper V1 - CAI V2 - CAI

























Selection Language SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT. SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT. SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT. SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT.

























Educational Attainment

14. [IF SHOWCARD VERSION: Using this list,] what is the highest grade of school or degree you have/<NAME> has COMPLETED? If you are/<NAME> is currently enrolled, select the previous grade or highest degree received.
Less than grade 1
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12, no diploma
Regular high school diploma
GED or alternative credential
Some college, no degree
Associate's degree (for example: AA, AS)
Bachelor's degree (for example: BA, BS)
Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA)
Professional degree beyond a bachelor's degree (for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)		 14. [IF SHOWCARD VERSION: Using this list,] what is the highest level of school or degree you have/<NAME> has COMPLETED? If you are/<NAME> is currently enrolled, select the previous grade or highest degree received.
Less than 1 year of school completed
Nursery school or preschool
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12, no diploma
Regular high school diploma
GED or alternative credential
Some college, no degree
Associate's degree (for example: AA, AS)
Bachelor's degree (for example: BA, BS)
Master's degree (for example: MA, MS, MEng, MEd, MSW, MBA)
Professional degree beyond a bachelor's degree (for example: MD, DDS, DVM, LLB, JD)
Doctorate degree (for example: PhD, EdD)

























Introduction [ASK AT END OF SURVEY]
Now I'd like to ask your opinion about some of the questions in the survey. Please take a look at Question 11 on Page 12 [HIGHEST GRADE COMPLETED] and then I will ask you some follow-up questions about it.		 [ASK AT END OF SURVEY]
Now I'd like to ask your opinion about some of the questions in the survey. Please take a look at Question 11 on Page 12 [HIGHEST GRADE COMPLETED] and then I will ask you some follow-up questions about it.		 [ASK AT END OF SURVEY]
Now I'd like to ask your opinion about some of the questions in the survey. The first question I'd like to discuss is this one: [ASK Q14 AND PROVIDE FLASHCARDS, REGARDLESS OF WHETHER FLASHCARDS WERE ASSIGNED.] As a reminder, you answered [LIST ANSWERS FOR EACH PERSON].		 [ASK AT END OF SURVEY]
Now I'd like to ask your opinion about some of the questions in the survey. The first question I'd like to discuss is this one: [ASK Q14 AND PROVIDE FLASHCARDS, REGARDLESS OF WHETHER FLASHCARDS WERE ASSIGNED.] As a reminder, you answered [LIST ANSWERS FOR EACH PERSON].

























Probe 1 When you answered about your own education level, how did you determine your answer? REPEAT FOR EACH HH MEMBER: When you answered about [PERSON]'s education level, how did you determine your answer? When you answered about your own education level, how did you determine your answer? REPEAT FOR EACH HH MEMBER: When you answered about [PERSON]'s education level, how did you determine your answer? When you answered about your own education level, how did you determine your answer? REPEAT FOR EACH HH MEMBER: When you answered about [PERSON]'s education level, how did you determine your answer? When you answered about your own education level, how did you determine your answer? REPEAT FOR EACH HH MEMBER: When you answered about [PERSON]'s education level, how did you determine your answer?

























Probe 2 IF HAS CHILD(REN): [Is your child/Are any of your children] homeschooled? IF YES: How did you decide which option(s) to choose for [this child/these children]? NOTE: PROBE IF NEEDED TO DETERMINE IF HOMESCHOOLING IS TYPICAL OR DUE TO COVID-19. SKIP HOMESCHOOL PROBES IF ONLY HOMESCHOOLIN DUE TO COVID-19. IF HAS CHILD(REN): [Is your child/Are any of your children] homeschooled? IF YES: How did you decide which option(s) to choose for [this child/these children]? NOTE: PROBE IF NEEDED TO DETERMINE IF HOMESCHOOLING IS TYPICAL OR DUE TO COVID-19. SKIP HOMESCHOOL PROBES IF ONLY HOMESCHOOLIN DUE TO COVID-19. IF HAS CHILD(REN): [Is your child/Are any of your children] homeschooled? IF YES: How did you decide which option(s) to choose for [this child/these children]? NOTE: PROBE IF NEEDED TO DETERMINE IF HOMESCHOOLING IS TYPICAL OR DUE TO COVID-19. SKIP HOMESCHOOL PROBES IF ONLY HOMESCHOOLIN DUE TO COVID-19. IF HAS CHILD(REN): [Is your child/Are any of your children] homeschooled? IF YES: How did you decide which option(s) to choose for [this child/these children]? NOTE: PROBE IF NEEDED TO DETERMINE IF HOMESCHOOLING IS TYPICAL OR DUE TO COVID-19. SKIP HOMESCHOOL PROBES IF ONLY HOMESCHOOLIN DUE TO COVID-19.

























Probe 3 [IF HAS HOMESCHOOLED CHILD(REN)] How do you decide when [your child / one of your children] has completed a grade level? [IF HAS HOMESCHOOLED CHILD(REN)] How do you decide when [your child / one of your children] has completed a grade level? [IF HAS HOMESCHOOLED CHILD(REN)] How do you decide when [your child / one of your children] has completed a grade level? [IF HAS HOMESCHOOLED CHILD(REN)] How do you decide when [your child / one of your children] has completed a grade level?

























Probe 4 When you answered for yourself, did you find a response option that fits your situation or did none of them seem to fit? Why (not)? REPEAT FOR EACH HH MEMBER: How about when answering about [PERSON]? When you answered for yourself, did you find a response option that fits your situation or did none of them seem to fit? Why (not)? REPEAT FOR EACH HH MEMBER: How about when answering about [PERSON]? When you answered for yourself, did you find a response option that fits your situation or did none of them seem to fit? Why (not)? REPEAT FOR EACH HH MEMBER: How about when answering about [PERSON]? When you answered for yourself, did you find a response option that fits your situation or did none of them seem to fit? Why (not)? REPEAT FOR EACH HH MEMBER: How about when answering about [PERSON]?

























Probe 5 Are there any response options that you considered but ended up not choosing? Are there any response options that you considered but ended up not choosing? Are there any response options that you considered but ended up not choosing? Are there any response options that you considered but ended up not choosing?

























Probe 6 Are you unsure about what any of the options in this question refer to? Are you unsure about what any of the options in this question refer to? Are you unsure about what any of the options in this question refer to? Are you unsure about what any of the options in this question refer to?

























Probe 7 [SKIP] [SKIP] IF ASSIGNED TO RECEIVE FLASHCARDS: Did you use the card when answering this question? IF YES: Did you find it helpful, or did you not find it helpful? IF NECESSARY: PROBE TO DETERMINE WHY/WHY NOT. IF ASSIGNED TO RECEIVE FLASHCARDS: Did you use the card when answering this question? IF YES: Did you find it helpful, or did you not find it helpful? IF NECESSARY: PROBE TO DETERMINE WHY/WHY NOT.

























Probe 8 The question uses the phrase "highest grade of school." What do you think that refers to? Are there any other phrases you would use to describe a "grade of school?" The question uses the phrase "highest level of school." What do you think that refers to? Are there any other phrases you would use to describe a "grade of school?" The question uses the phrase "highest grade of school." What do you think that refers to? Are there any other phrases you would use to describe a "grade of school?" The question uses the phrase "highest level of school." What do you think that refers to? Are there any other phrases you would use to describe a "grade of school?"

























Probe 9 Do you think "grade of school" and "level of school" mean the same thing, or are they different? Do you think "grade of school" and "level of school" mean the same thing, or are they different? Do you think "grade of school" and "level of school" mean the same thing, or are they different? Do you think "grade of school" and "level of school" mean the same thing, or are they different?

























Probe 10 The question includes headings in green font to group some of the options together. Did you notice them, or did you not notice them? IF NOTICED: Did you think you needed to read them? The question includes headings in green font to group some of the options together. Did you notice them, or did you not notice them? IF NOTICED: Did you think you needed to read them? [IF ASSIGNED TO RECEIVE FLASHCARDS] The question includes capitalized headings in bold font to group some of the options together. Did you notice them, or did you not notice them? IF NOTICED: Did you think you needed to read them? [IF ASSIGNED TO RECEIVE FLASHCARDS] The question includes capitalized headings in bold font to group some of the options together. Did you notice them, or did you not notice them? IF NOTICED: Did you think you needed to read them?

























Probe 11 What do you think of these headings? IF NECESSARY: Do you think they are helpful? What do you think of these headings? IF NECESSARY: Do you think they are helpful? [IF ASSIGNED TO RECEIVE FLASHCARDS] What do you think of these headings? IF NECESSARY: Do you think they are helpful? [IF ASSIGNED TO RECEIVE FLASHCARDS] What do you think of these headings? IF NECESSARY: Do you think they are helpful?

























Probe 12 IF SELECTED MULTIPLE RESPONSES FOR A SINGLE PERSON: I noticed that you marked [FILL ANSWERS]. Can you tell me a little bit more about how you decided to mark these? If you had to choose just one option, which one would you choose? IF SELECTED MULTIPLE RESPONSES FOR A SINGLE PERSON: I noticed that you marked [FILL ANSWERS]. Can you tell me a little bit more about how you decided to mark these? If you had to choose just one option, which one would you choose? [SKIP] [SKIP]

























Probe 13 [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] You indicated on an earlier question that you attended school in the last 3 months. What grade or level are you in currently? IF NOT CURRENTLY ENROLLED, DETERMINE GRADE/LEVEL IN THE LAST 3 MONTHS. [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] You indicated on an earlier question that you attended school in the last 3 months. What grade or level are you in currently? IF NOT CURRENTLY ENROLLED, DETERMINE GRADE/LEVEL IN THE LAST 3 MONTHS. [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] You indicated on an earlier question that you attended school in the last 3 months. What grade or level are you in currently? IF NOT CURRENTLY ENROLLED, DETERMINE GRADE/LEVEL IN THE LAST 3 MONTHS. [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] You indicated on an earlier question that you attended school in the last 3 months. What grade or level are you in currently? IF NOT CURRENTLY ENROLLED, DETERMINE GRADE/LEVEL IN THE LAST 3 MONTHS.

























Probe 14 [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] This question includes instructions about how to answer if the person is currently enrolled. Did you notice those instructions? [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] This question includes instructions about how to answer if the person is currently enrolled. Did you notice those instructions? [SKIP] [SKIP]

























Probe 15 [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] What do you think about those instructions-- do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING.] [IF 10a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] What do you think about those instructions-- do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING.] [IF 13a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] The question says, "If you are currently enrolled, select the previous grade or highest degree received." What do you think about those instructions-- do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING.] [IF 13a = YES (I.E., IF ATTENDED SCHOOL IN THE LAST 3 MONTHS)] The question says, "If you are currently enrolled, select the previous grade or highest degree received." What do you think about those instructions-- do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING.]

























Probe 16 This question includes an option for "Less than grade 1." What are some examples of when people should select that option? This question includes an option for "Less than 1 year of school completed." What are some examples of when people should select that option? This question includes an option for "Less than grade 1." What are some examples of when people should select that option? This question includes an option for "Less than 1 year of school completed." What are some examples of when people should select that option?

























Probe 17 Now I would like you to look at this version of the question. [PROVIDE VERSION 2.] The first option in this version says "Less than 1 year of school completed," but in the previous version it says "Less than grade 1." Do you think these mean the same thing, or are they different? IF SAME: What do they mean? IF DIFFERENT: What is the difference between them? Now I would like you to look at this version of the question. [PROVIDE VERSION 1.] The first option in this version says "Less than grade 1," but in the previous version it says "Less than 1 year of school completed." Do you think these mean the same thing, or are they different? IF SAME: What do they mean? IF DIFFERENT: What is the difference between them? Now I would like you to look at this version of the question. [PROVIDE VERSION 2 FLASHCARD.] The first option in this version says "Less than 1 year of school completed," but in the previous version it says "Less than grade 1." Do you think these mean the same thing, or are they different? IF SAME: What do they mean? IF DIFFERENT: What is the difference between them? Now I would like you to look at this version of the question. [PROVIDE VERSION 1 FLASHCARD.] The first option in this version says "Less than grade 1," but in the previous version it says "Less than 1 year of school completed." Do you think these mean the same thing, or are they different? IF SAME: What do they mean? IF DIFFERENT: What is the difference between them?

























Probe 18 In this second version of the question, what do you think is the difference between the first two options, "Less than 1 year of school completed" and "Nursery school or preschool?" In the first version of the question, what do you think is the difference between the first two options, "Less than 1 year of school completed" and "Nursery school or preschool?" In this second version of the question, what do you think is the difference between the first two options, "Less than 1 year of school completed" and "Nursery school or preschool?" In the first version of the question, what do you think is the difference between the first two options, "Less than 1 year of school completed" and "Nursery school or preschool?"

























Probe 19 The first few options are different in this second version of the question. How would you answer the question if it were asked this other way? IF WOULD ANSWER DIFFERENTLY, PROBE TO DETERMINE WHY. The first few options are different in this second version of the question. How would you answer the question if it were asked this other way? IF WOULD ANSWER DIFFERENTLY, PROBE TO DETERMINE WHY. The first few options are different in this second version of the question. How would you answer the question if I asked it this other way? IF WOULD ANSWER DIFFERENTLY, PROBE TO DETERMINE WHY. The first few options are different in this second version of the question. How would you answer the question if I asked it this other way? IF WOULD ANSWER DIFFERENTLY, PROBE TO DETERMINE WHY.

























Probe 20 How do you think someone should answer this question [VERSION 1] if they're answering about a toddler who is enrolled in a daycare center? How about this version [VERSION 2]? How do you think someone should answer this question [VERSION 1] if they're answering about a toddler who is enrolled in a daycare center? How about this version [VERSION 2]? How do you think someone should answer this question [VERSION 1] if they're answering about a toddler who is enrolled in a daycare center? How about this version [VERSION 2]? How do you think someone should answer this question [VERSION 1] if they're answering about a toddler who is enrolled in a daycare center? How about this version [VERSION 2]?

























Probe 21 How do you think someone should answer this version [VERSION 1] if they're answering about a 4-year-old who is currently in preschool? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they're answering about a 4-year-old who is currently in preschool? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they're answering about a 4-year-old who is currently in preschool? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they're answering about a 4-year-old who is currently in preschool? How about this version [VERSION 2]?

























Probe 22 How do you think someone should answer this version [VERSION 1] if they are answering about an adult who has never been to school? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they are answering about an adult who has never been to school? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they are answering about an adult who has never been to school? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they are answering about an adult who has never been to school? How about this version [VERSION 2]?

























Probe 23 How do you think someone should answer this version [VERSION 1] if they are answering about an adult who attended 8th grade but did not complete that year, and never went back to school? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they are answering about an adult who attended 8th grade but did not complete that year, and never went back to school? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they are answering about an adult who attended 8th grade but did not complete that year, and never went back to school? How about this version [VERSION 2]? How do you think someone should answer this version [VERSION 1] if they are answering about an adult who attended 8th grade but did not complete that year, and never went back to school? How about this version [VERSION 2]?

























Health Insurance Coverage

I am now going to ask you some questions about your/<NAME’s> health insurance and health coverage. Do NOT include plans that cover only one type of service, such as dental, drug or vision plans.
23a. Are you/Is <NAME> currently covered by health insurance through a current or former employer, union, or professional association of yours or another family member/<[him/her] or another family member>?
23b. Are you/Is <NAME> currently covered by Medicare, for people age 65 or older or people with certain disabilities?
23c. Are you/Is <NAME> currently covered by Medicaid, the Children’s Health Insurance Program (CHIP) or any kind of government-assistance plan for those with low incomes or a disability?
23d. Are you/Is <NAME> currently covered by health insurance purchased directly from an insurance company, through a State or Federal Marketplace, HealthCare.gov, or a similar website by you or another family member/<[him/her] or another family member>?
23e. Are you/Is <NAME> currently covered by TRICARE or other military health care?
23f. Are you/Is <NAME> currently covered through the VA or enrolled for VA health care?
23g. Are you/Is <NAME> currently covered through the Indian Health Service?
23h. Are you/Is <NAME> currently covered by any other health insurance or health coverage plan?		 I am now going to ask you some questions about your/<NAME’s> health insurance and health coverage. Do NOT include plans that cover only one type of service, such as dental, drug or vision plans.
23a. Are you/Is <NAME> currently covered by health insurance through a current or former employer, union, or professional association of yours or another family member/<[him/her] or another family member>?
23b. Are you/Is <NAME> currently covered by Medicare, for people age 65 or older or people with certain disabilities?
23c. Are you/Is <NAME> currently covered by Medicaid, the Children’s Health Insurance Program (CHIP) or any kind of government-assistance plan for those with low incomes or a disability?
23d. Are you/Is <NAME> currently covered by health insurance purchased directly from an insurance company, through a State or Federal Marketplace, HealthCare.gov, or a similar website by you or another family member/<[him/her] or another family member>?
23e. Are you/Is <NAME> currently covered by TRICARE or other military health care?
23f. Are you/Is <NAME> currently covered through the VA or enrolled for VA health care?
23g. Are you/Is <NAME> currently covered through the Indian Health Service?
23h. Are you/Is <NAME> currently covered by any other health insurance or health coverage plan?

























Introduction Next I'd like to get your feedback on Question 16, which asks about health insurance. Next I'd like to get your feedback on Question 16, which asks about health insurance. Next I'd like to get your feedback on the health insurance questions. [PROVIDE COPY OF QUESTIONS 23a-23h.] As a reminder, you said:
[LIST PEOPLE] is/are covered under [INSURANCE TYPE]
[LIST PEOPLE] is/are covered under [INSURANCE TYPE]
etc. 		Next I'd like to get your feedback on the health insurance questions. [PROVIDE COPY OF QUESTIONS 23a-23h.] As a reminder, you said:
[LIST PEOPLE] is/are covered under [INSURANCE TYPE]
[LIST PEOPLE] is/are covered under [INSURANCE TYPE]
etc.

























Probe 1 How did you come up with your answer for yourself? IF NECESSARY: Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/them]? REPEAT PROBES FOR EACH HH MEMBER: How about for [PERSON]? How did you come up with your answer for yourself? IF NECESSARY: Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/them]? REPEAT PROBES FOR EACH HH MEMBER: How about for [PERSON]? How did you come up with your answer for yourself? IF NECESSARY: Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/them]? REPEAT PROBES FOR EACH HH MEMBER: How about for [PERSON]? How did you come up with your answer for yourself? IF NECESSARY: Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/them]? REPEAT PROBES FOR EACH HH MEMBER: How about for [PERSON]?

























Probe 2 IF 16a = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a current or former employer, union, or professional association. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16a = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a current or former employer, union, or professional association. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23a = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a current or former employer, union, or professional association. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23a = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a current or former employer, union, or professional association. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 3 IF 16b = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicare. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16b = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicare. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23b = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicare. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23b = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicare. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 4 IF 16c = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicaid, CHIP, or any kind of government-assistance plan for those with low incomes or a disability. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16c = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicaid, CHIP, or any kind of government-assistance plan for those with low incomes or a disability. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23c = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicaid, CHIP, or any kind of government-assistance plan for those with low incomes or a disability. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23c = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Medicaid, CHIP, or any kind of government-assistance plan for those with low incomes or a disability. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 5 IF 16d = Yes: You mentioned that [HH MEMBER(S)] have/has insurance purchased directly from an insurance company or through a State or Federal Marketplace, HealthCare.gov, or a similar website. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16d = Yes: You mentioned that [HH MEMBER(S)] have/has insurance purchased directly from an insurance company or through a State or Federal Marketplace, HealthCare.gov, or a similar website. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23d = Yes: You mentioned that [HH MEMBER(S)] have/has insurance purchased directly from an insurance company or through a State or Federal Marketplace, HealthCare.gov, or a similar website. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23d = Yes: You mentioned that [HH MEMBER(S)] have/has insurance purchased directly from an insurance company or through a State or Federal Marketplace, HealthCare.gov, or a similar website. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 6 IF 16e = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through TRICARE or other military health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16e = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through TRICARE or other military health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23e = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through TRICARE or other military health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23e = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through TRICARE or other military health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 7 IF 16f = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through VA health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16f = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through VA health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23f = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through VA health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23f = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through VA health care. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 8 IF 16g = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Indian Health Service. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 16g = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Indian Health Service. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23g = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Indian Health Service. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]? IF 23g = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through Indian Health Service. Can you tell me more about that? How did you know which type of coverage to select for [yourself/that person/those people]?

























Probe 9 IF 16h = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a type of health insurance or health coverage plan not listed in the question. Can you tell me more about that? Why did you select this option for [yourself/that person/those people]? IF 16h = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a type of health insurance or health coverage plan not listed in the question. Can you tell me more about that? Why did you select this option for [yourself/that person/those people]? IF 23h = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a type of health insurance or health coverage plan not listed in the question. Can you tell me more about that? Why did you select this option for [yourself/that person/those people]? IF 23h = Yes: You mentioned that [HH MEMBER(S)] have/has coverage through a type of health insurance or health coverage plan not listed in the question. Can you tell me more about that? Why did you select this option for [yourself/that person/those people]?

























Probe 10 Did you have difficulty choosing a response for yourself [or another household member]? IF YES: Can you tell me more about that? How did you choose your response? Did you have difficulty choosing a response for yourself [or another household member]? IF YES: Can you tell me more about that? How did you choose your response? Did you have difficulty choosing a response for yourself [or another household member]? IF YES: Can you tell me more about that? How did you choose your response? Did you have difficulty choosing a response for yourself [or another household member]? IF YES: Can you tell me more about that? How did you choose your response?

























Probe 11 Did you include any insurance plans that cover only one type of service, such as dental, drug, or vision plans? IF YES: What types of plans did you report? Did you include any insurance plans that cover only one type of service, such as dental, drug, or vision plans? IF YES: What types of plans did you report? Did you include any insurance plans that cover only one type of service, such as dental, drug, or vision plans? IF YES: What types of plans did you report? Did you include any insurance plans that cover only one type of service, such as dental, drug, or vision plans? IF YES: What types of plans did you report?

























Probe 12 The question includes instructions to "NOT include plans that cover only one type of service, such as dental, drug, or vision plans." Do you have coverage that you did NOT report because of these instructions? IF YES: Tell me about that coverage. The question includes instructions to "NOT include plans that cover only one type of service, such as dental, drug, or vision plans." Do you have coverage that you did NOT report because of these instructions? IF YES: Tell me about that coverage. At the beginning of this series of questions, there are instructions to "NOT include plans that cover only one type of service, such as dental, drug, or vision plans." Do you have coverage that you did NOT report because of these instructions? IF YES: Tell me about that coverage. At the beginning of this series of questions, there are instructions to "NOT include plans that cover only one type of service, such as dental, drug, or vision plans." Do you have coverage that you did NOT report because of these instructions? IF YES: Tell me about that coverage.

























Probe 13 What do you think the instructions are asking you to do? Do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING AND WHAT WOULD MAKE THEM EASIER TO UNDERSTAND.] What do you think the instructions are asking you to do? Do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING AND WHAT WOULD MAKE THEM EASIER TO UNDERSTAND.] What do you think the instructions are asking you to do? Do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING AND WHAT WOULD MAKE THEM EASIER TO UNDERSTAND.] What do you think the instructions are asking you to do? Do they make sense or do you think they need to be clarified? [IF NEED CLARIFICATION, PROBE TO DETERMINE WHAT IS CONFUSING AND WHAT WOULD MAKE THEM EASIER TO UNDERSTAND.]

























Probe 14 Do any members of your household have a Medicare Advantage plan? IF YES: Tell me more about that plan. Do any members of your household have a Medicare Advantage plan? IF YES: Tell me more about that plan. Do any members of your household have a Medicare Advantage plan? IF YES: Tell me more about that plan. Do any members of your household have a Medicare Advantage plan? IF YES: Tell me more about that plan.

























Probe 15 [IF SELECTED MORE THAN ONE OPTION FOR ANY HOUSEHOLD MEMBER] Can you tell me more about the insurance plan or plans that [you are/NAME is] covered by? PROBE TO DETERMINE IF THEY ARE DOUBLE REPORTING SINGLE COVERAGE OR IF THEY TRULY HAVE MORE THAN ONE TYPE OF INSURANCE. [IF SELECTED MORE THAN ONE OPTION FOR ANY HOUSEHOLD MEMBER] Can you tell me more about the insurance plan or plans that [you are/NAME is] covered by? PROBE TO DETERMINE IF THEY ARE DOUBLE REPORTING SINGLE COVERAGE OR IF THEY TRULY HAVE MORE THAN ONE TYPE OF INSURANCE. [IF SELECTED MORE THAN ONE OPTION FOR ANY HOUSEHOLD MEMBER] Can you tell me more about the insurance plan or plans that [you are/NAME is] covered by? PROBE TO DETERMINE IF THEY ARE DOUBLE REPORTING SINGLE COVERAGE OR IF THEY TRULY HAVE MORE THAN ONE TYPE OF INSURANCE. [IF SELECTED MORE THAN ONE OPTION FOR ANY HOUSEHOLD MEMBER] Can you tell me more about the insurance plan or plans that [you are/NAME is] covered by? PROBE TO DETERMINE IF THEY ARE DOUBLE REPORTING SINGLE COVERAGE OR IF THEY TRULY HAVE MORE THAN ONE TYPE OF INSURANCE.

























Probe 16 [SKIP IF 16a = Yes FOR ALL HH MEMBERS] Do you [or any members of your household] have health insurance coverage that you are eligible for based on your income? IF YES: How did you decide which responses to select? [SKIP IF 16a = Yes FOR ALL HH MEMBERS] Do you [or any members of your household] have health insurance coverage that you are eligible for based on your income? IF YES: How did you decide which responses to select? [SKIP IF 23a = Yes FOR ALL HH MEMBERS] Do you [or any members of your household] have health insurance coverage that you are eligible for based on your income? IF YES: How did you decide which responses to select? [SKIP IF 23a = Yes FOR ALL HH MEMBERS] Do you [or any members of your household] have health insurance coverage that you are eligible for based on your income? IF YES: How did you decide which responses to select?

























Probe 17 IF ANSWERED NO TO ALL (16a-16h) FOR ANY HH MEMBERS: You answered "No" to all of these health insurance questions when answering about [yourself/PERSON/your household members]. Do [you/PERSON/they/etc.] have any health insurance? IF YES: PROBE TO DETERMINE WHY THEY ANSWERED NO TO ALL. IF NO: DETERMINE WHEN THEY LAST HAD COVERAGE AND WHICH ANSWER THEY WOULD HAVE SELECTED WHEN THEY HAD THAT COVERAGE. IF ANSWERED NO TO ALL (16a-16h) FOR ANY HH MEMBERS: You answered "No" to all of these health insurance questions when answering about [yourself/PERSON/your household members]. Do [you/PERSON/they/etc.] have any health insurance? IF YES: PROBE TO DETERMINE WHY THEY ANSWERED NO TO ALL. IF NO: DETERMINE WHEN THEY LAST HAD COVERAGE AND WHICH ANSWER THEY WOULD HAVE SELECTED WHEN THEY HAD THAT COVERAGE. IF ANSWERED NO TO ALL (23a-23h) FOR ANY HH MEMBERS: You answered "No" to all of these health insurance questions when answering about [yourself/PERSON/your household members]. Do [you/PERSON/they/etc.] have any health insurance? IF YES: PROBE TO DETERMINE WHY THEY ANSWERED NO TO ALL. IF NO: DETERMINE WHEN THEY LAST HAD COVERAGE AND WHICH ANSWER THEY WOULD HAVE SELECTED WHEN THEY HAD THAT COVERAGE. IF ANSWERED NO TO ALL (23a-23h) FOR ANY HH MEMBERS: You answered "No" to all of these health insurance questions when answering about [yourself/PERSON/your household members]. Do [you/PERSON/they/etc.] have any health insurance? IF YES: PROBE TO DETERMINE WHY THEY ANSWERED NO TO ALL. IF NO: DETERMINE WHEN THEY LAST HAD COVERAGE AND WHICH ANSWER THEY WOULD HAVE SELECTED WHEN THEY HAD THAT COVERAGE.

























Probe 18 IF ANSWERED NO TO ALL (16a-16h) FOR ANY HH MEMBERS: How do [you/PERSON/they/etc.] pay for healthcare when [you/they/etc.] are sick? IF ANSWERED NO TO ALL (16a-16h) FOR ANY HH MEMBERS: How do [you/PERSON/they/etc.] pay for healthcare when [you/they/etc.] are sick? IF ANSWERED NO TO ALL (23a-23h) FOR ANY HH MEMBERS: How do [you/PERSON/they/etc.] pay for healthcare when [you/they/etc.] are sick? IF ANSWERED NO TO ALL (23a-23h) FOR ANY HH MEMBERS: How do [you/PERSON/they/etc.] pay for healthcare when [you/they/etc.] are sick?

























Probe 19 Are you familiar with any other types of coverage or plans? Can you tell me about [this type/these types] of coverage? Are you familiar with any other types of coverage or plans? Can you tell me about [this type/these types] of coverage? Are you familiar with any other types of coverage or plans? Can you tell me about [this type/these types] of coverage? Are you familiar with any other types of coverage or plans? Can you tell me about [this type/these types] of coverage?

























Disability (set 1)

The next questions ask about difficulties you/<NAME> may have doing certain activities.
25a. Do you/does <NAME> have difficulty seeing, even if wearing glasses?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

25b. Do you/does <NAME> have difficulty hearing, even if using a hearing aid?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all		 The next questions ask about difficulties you/<NAME> may have doing certain activities.
25a. Do you/does <NAME> have difficulty seeing, even if wearing glasses?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

25b. Do you/does <NAME> have difficulty hearing, even if using a hearing aid?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all




























26a. Do you/does <NAME> have difficulty walking or climbing stairs?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

26b. Do you/does <NAME> have difficulty remembering or concentrating?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all		 26a. Do you/does <NAME> have difficulty walking or climbing steps?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

26b. Do you/does <NAME> have difficulty remembering or concentrating?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all



























NOTE: WORDING OF PART C WILL BE UPDATED TO "Does this person have difficulty with self care, such as washing all over or dressing?" 26c. Do you/does <NAME> have difficulty bathing or dressing?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

26d. Using your/<his/her> usual language, do you/does <NAME> have difficulty communicating, for example understanding or being understood?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all		 26c. Do you/does <NAME> have difficulty with self care, such as washing all over or dressing?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

26d. Using your/<his/her> usual language, do you/does <NAME> have difficulty communicating, for example understanding or being understood?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

























Introduction Next I'd like to talk about Question 19. Next I'd like to talk about Question 19. Now I'd like to ask you about a series of questions in the survey. The questions asked about difficulty doing certain activities like seeing, hearing, and walking. Here are the questions I'll be asking about [PROVIDE COPY OF QUESTIONS 25-27]. Now I'd like to ask you about a series of questions in the survey. The questions asked about difficulty doing certain activities like seeing, hearing, and walking. Here are the questions I'll be asking about [PROVIDE COPY OF QUESTIONS 25-27].

























Probe 1 Question 19a asks about difficulty walking or climbing stairs.
How did you come up with your answer for yourself? REPEAT PROBES FOR EACH HH MEMBER: How about for [PERSON]?		 Question 19a asks about difficulty walking or climbing steps. How did you come up with your answer for yourself? REPEAT PROBES FOR EACH HH MEMBER: How about for [PERSON]? Question 26a asks about difficulty walking or climbing stairs.

PRESENT ALL RESPONSES THAT ARE NOT "NO DIFFICULTY:"
As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY] [FILL ACTIVITY];
[PERSON] has [LEVEL OF DIFFICULTY] [FILL ACTIVITY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty walking or climbing stairs.

How did you come up with your answer for yourself? REPEAT PROBE FOR EACH HH MEMBER: How about for [PERSON]?		 Question 26a asks about difficulty walking or climbing steps.
PRESENT ALL RESPONSES THAT ARE NOT "NO DIFFICULTY:"

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY] [FILL ACTIVITY];
[PERSON] has [LEVEL OF DIFFICULTY] [FILL ACTIVITY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty walking or climbing steps.

How did you come up with your answer for yourself? REPEAT PROBE FOR EACH HH MEMBER: How about for [PERSON]?

























Probe 2 Tell me what you think it means to have difficulty climbing stairs? Tell me what you think it means to have difficulty climbing steps? Tell me what you think it means to have difficulty climbing stairs? Tell me what you think it means to have difficulty climbing steps?

























Probe 3 Suppose Question 19a instead asked about difficulty walking or climbing steps. Do you think the words "stairs" and "steps" mean the same thing in this question, or are they different? [IF DIFFERENT: PROBE TO DETERMINE HOW THEY DIFFER OR IF THEY CAN GIVE SOME EXAMPLES.] Suppose Question 19a instead asked about difficulty walking or climbing stairs. Do you think the words "stairs" and "steps" mean the same thing in this question, or are they different? [IF DIFFERENT: PROBE TO DETERMINE HOW THEY DIFFER OR IF THEY CAN GIVE SOME EXAMPLES.] Suppose the question instead asked about difficulty walking or climbing steps. Do you think the words "stairs" and "steps" mean the same thing in this question, or are they different? [IF DIFFERENT: PROBE TO DETERMINE HOW THEY DIFFER OR IF THEY CAN GIVE SOME EXAMPLES.] Suppose the question instead asked about difficulty walking or climbing stairs. Do you think the words "stairs" and "steps" mean the same thing in this question, or are they different? [IF DIFFERENT: PROBE TO DETERMINE HOW THEY DIFFER OR IF THEY CAN GIVE SOME EXAMPLES.]

























Probe 4 Question 19b asks about difficulty remembering or concentrating. Can you explain to me why you answered the way you did [IF MULTIPLE HH MEMBERS: for each member of your household]? IF PARTICIPANT EXHIBITS ANY CONFUSION OR UNCERTAINTY ABOUT HOW TO ANSWER: How did you decide which option to select? Question 19b asks about difficulty remembering or concentrating. Can you explain to me why you answered the way you did [IF MULTIPLE HH MEMBERS: for each member of your household]? IF PARTICIPANT EXHIBITS ANY CONFUSION OR UNCERTAINTY ABOUT HOW TO ANSWER: How did you decide which option to select? Question 26b asks about difficulty remembering or concentrating.

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY] remembering or concentrating;
[PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty remembering or concentrating.

Can you explain to me why you answered the way you did [IF MULTIPLE HH MEMBERS: for each member of your household]? IF PARTICIPANT EXHIBITS ANY CONFUSION OR UNCERTAINTY ABOUT HOW TO ANSWER: How did you decide which option to select? 		Question 26b asks about difficulty remembering or concentrating.

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY] remembering or concentrating;
[PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty remembering or concentrating.

Can you explain to me why you answered the way you did [IF MULTIPLE HH MEMBERS: for each member of your household]? IF PARTICIPANT EXHIBITS ANY CONFUSION OR UNCERTAINTY ABOUT HOW TO ANSWER: How did you decide which option to select?

























Probe 5 [IF CONFUSED OR UNCLEAR WHEN ANSWERING PREVIOUS PROBE] What were you thinking about when you were answering this question [Q19b]? How did you come up with your answer? [IF CONFUSED OR UNCLEAR WHEN ANSWERING PREVIOUS PROBE] What were you thinking about when you were answering this question [Q19b]? How did you come up with your answer? [IF CONFUSED OR UNCLEAR WHEN ANSWERING PREVIOUS PROBE] What were you thinking about when you were answering this question [Q26b]? How did you come up with your answer? [IF CONFUSED OR UNCLEAR WHEN ANSWERING PREVIOUS PROBE] What were you thinking about when you were answering this question [Q26b]? How did you come up with your answer?

























Probe 6 [IF SELECTED SOME, A LOT, OR CANNOT ON 19b] You said that [PERSON] has difficulty remembering or concentrating. What is their level of difficulty with remembering? What is their level of difficulty with concentrating? [IF SELECTED SOME, A LOT, OR CANNOT ON 19b] You said that [PERSON] has difficulty remembering or concentrating. What is their level of difficulty with remembering? What is their level of difficulty with concentrating? [IF SELECTED SOME, A LOT, OR CANNOT ON 26b] You said that [PERSON] has difficulty remembering or concentrating. What is their level of difficulty with remembering? What is their level of difficulty with concentrating? [IF SELECTED SOME, A LOT, OR CANNOT ON 26b] You said that [PERSON] has difficulty remembering or concentrating. What is their level of difficulty with remembering? What is their level of difficulty with concentrating?

























Probe 7 SKIP IF SELECTED SOME, A LOT, OR CANNOT ON 26b FOR ALL HH MEMBERS.

This question asks about both remembering and concentrating, but for a moment, I'd like you to think only about remembering. Do you [or [FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty remembering? (PROBE TO DETERMINE WHO.)

How about concentrating-- do you [or FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty concentrating? (PROBE TO DETERMINE WHO.)

IF A HH MEMBER HAS DIFFICULTY WITH ONE BUT NOT THE OTHER: How did you decide which option to select when answering Question 19b for [PERSON]?		 SKIP IF SELECTED SOME, A LOT, OR CANNOT ON 26b FOR ALL HH MEMBERS.

This question asks about both remembering and concentrating, but for a moment, I'd like you to think only about remembering. Do you [or [FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty remembering? (PROBE TO DETERMINE WHO.)

How about concentrating-- do you [or FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty concentrating? (PROBE TO DETERMINE WHO.)

IF A HH MEMBER HAS DIFFICULTY WITH ONE BUT NOT THE OTHER: How did you decide which option to select when answering Question 19b for [PERSON]?		 SKIP IF SELECTED SOME, A LOT, OR CANNOT ON 26b FOR ALL HH MEMBERS.

This question asks about both remembering and concentrating, but for a moment, I'd like you to think only about remembering. Do you [or [FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty remembering? (PROBE TO DETERMINE WHO.)

How about concentrating-- do you [or FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty concentrating? (PROBE TO DETERMINE WHO.)

IF A HH MEMBER HAS DIFFICULTY WITH ONE BUT NOT THE OTHER: How did you decide which option to select when answering Question 26b for [PERSON]?		 SKIP IF SELECTED SOME, A LOT, OR CANNOT ON 26b FOR ALL HH MEMBERS.

This question asks about both remembering and concentrating, but for a moment, I'd like you to think only about remembering. Do you [or [FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty remembering? (PROBE TO DETERMINE WHO.)

How about concentrating-- do you [or FILL HH MEMBERS WITH NO DIFFICULTY] have difficulty concentrating? (PROBE TO DETERMINE WHO.)

IF A HH MEMBER HAS DIFFICULTY WITH ONE BUT NOT THE OTHER: How did you decide which option to select when answering Question 26b for [PERSON]?

























Probe 8 ASK ABOUT ADULTS IN HOUSEHOLD: We're interested in how people with different types of conditions answer these questions. Do any members of your household have a condition that affects their memory or concentration? IF YES: When answering Question 19b, did you report the difficulty they have due to their condition, or did you not consider that when answering the question?

ASK ABOUT CHILDREN IN HOUSEHOLD, IF ANY: Do any children in your household have difficulty learning? IF YES: When answering Question 19b, did you report the difficulty they have learning, or did you not consider that when answering the question?		 ASK ABOUT ADULTS IN HOUSEHOLD: We're interested in how people with different types of conditions answer these questions. Do any members of your household have a condition that affects their memory or concentration? IF YES: When answering Question 19b, did you report the difficulty they have due to their condition, or did you not consider that when answering the question?

ASK ABOUT CHILDREN IN HOUSEHOLD, IF ANY: Do any children in your household have difficulty learning? IF YES: When answering Question 19b, did you report the difficulty they have learning, or did you not consider that when answering the question?		 ASK ABOUT ADULTS IN HOUSEHOLD: We're interested in how people with different types of conditions answer these questions. Do any members of your household have a condition that affects their memory or concentration? IF YES: When answering Question 26b, did you report the difficulty they have due to their condition, or did you not consider that when answering the question?

ASK ABOUT CHILDREN IN HOUSEHOLD, IF ANY: Do any children in your household have difficulty learning? IF YES: When answering Question 26b, did you report the difficulty they have learning, or did you not consider that when answering the question?		 ASK ABOUT ADULTS IN HOUSEHOLD: We're interested in how people with different types of conditions answer these questions. Do any members of your household have a condition that affects their memory or concentration? IF YES: When answering Question 26b, did you report the difficulty they have due to their condition, or did you not consider that when answering the question?

ASK ABOUT CHILDREN IN HOUSEHOLD, IF ANY: Do any children in your household have difficulty learning? IF YES: When answering Question 26b, did you report the difficulty they have learning, or did you not consider that when answering the question?

























Probe 9 Can you give me some examples of health conditions that make it difficult to remember or concentrate? Can you give me some examples of health conditions that make it difficult to remember or concentrate? Can you give me some examples of health conditions that make it difficult to remember or concentrate? Can you give me some examples of health conditions that make it difficult to remember or concentrate?

























Probe 10 Let's move on to Question 19c. How did you come up with your answer for yourself? [REPEAT FOR EACH HH MEMBER: How about for [PERSON]? Let's move on to Question 19c. How did you come up with your answer for yourself? [REPEAT FOR EACH HH MEMBER: How about for [PERSON]? Question 26c asks about difficulty bathing or dressing.

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY] bathing or dressing;
[PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty bathing or dressing.

How did you come up with your answer for yourself? [REPEAT FOR EACH HH MEMBER: How about for [PERSON]?		 Question 26c asks about difficulty washing all over or dressing.

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY] washing all over or dressing;
[PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty washinga ll over or dressing.

How did you come up with your answer for yourself? [REPEAT FOR EACH HH MEMBER: How about for [PERSON]?

























Probe 11 Question 19c asks about difficulty "bathing or dressing." What do you think that refers to? Question 19c asks about difficulty "washing all over or dressing." What do you think that refers to? Question 26c asks about difficulty "bathing or dressing." What do you think that refers to? Question 26c asks about difficulty "washing all over or dressing." What do you think that refers to?

























Probe 12 What is meant by the phrase "bathing or dressing"? What is meany by the phrase "washing all over or dressing?" What is meant by the phrase "bathing or dressing"? What is meant by the phrase "washing all over or dressing?"

























Probe 13 What other phrases would you use for "bathing or dressing?" What other phrases would you use for "washing all over or dressing?" What other phrases would you use for "bathing or dressing?" What other phrases would you use for "washing all over or dressing?"

























Probe 14 If someone says they have difficulty bathing or dressing when answering this question, what do you think that means? IF NEEDED: How do you think that person gets clean? If someone says they have difficulty washing all over or dressing when answering this question, what do you think that means? IF NEEDED: How do you think that person gets clean? If someone says they have difficulty bathing or dressing when answering this question, what do you think that means? IF NEEDED: How do you think that person gets clean? If someone says they have difficulty washing all over or dressing when answering this question, what do you think that means? IF NEEDED: How do you think that person gets clean?

























Probe 15 How did you choose an answer for Question 19d? How did you choose an answer for Question 19d? Question 26d asks about the person's difficulty communicating using their usual language.

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY] communicating;
[PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty communicating.

How did you choose an answer for this question?
 Question 26d asks about the person's difficulty communicating using their usual language.

As a reminder, you said [PERSON] has [LEVEL OF DIFFICULTY] communicating;
[PERSON] has [LEVEL OF DIFFICULTY];
[PERSON] has [LEVEL OF DIFFICULTY];
etc.

IF NO DIFFICULTY REPORTED FOR ANY HH MEMBERS:
As a reminder, you said you [IF MULTIPLE HH MEMBERS: and your household members] do not have difficulty communicating.

How did you choose an answer for this question?

























Probe 16 What do you think is meant by "communication"? What do you think is meant by "communication"? What do you think is meant by "communication"? What do you think is meant by "communication"?

























Probe 17 What do you think is meant by "usual language"? What do you think is meant by "usual language"? What do you think is meant by "usual language"? What do you think is meant by "usual language"?

























Probe 18 [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A CHILD ON 19d] On Question 19d, you reported that [NAME] has difficulty communicating. Can you tell me more about that? [PROBE TO DETERMINE WHAT CONDITIONS ARE BEING CONSIDERED. NOTE IF RESPONDENT IS INCLUDING YOUNG CHILDREN WHO HAVE NOT LEARNED HOW TO TALK.] [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A CHILD ON 19d] On Question 19d, you reported that [NAME] has difficulty communicating. Can you tell me more about that? [PROBE TO DETERMINE WHAT CONDITIONS ARE BEING CONSIDERED. NOTE IF RESPONDENT IS INCLUDING YOUNG CHILDREN WHO HAVE NOT LEARNED HOW TO TALK.] [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A CHILD ON 26d] You reported that [NAME] has difficulty communicating. Can you tell me more about that? [PROBE TO DETERMINE WHAT CONDITIONS ARE BEING CONSIDERED. NOTE IF RESPONDENT IS INCLUDING YOUNG CHILDREN WHO HAVE NOT LEARNED HOW TO TALK.] [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A CHILD ON 26d] You reported that [NAME] has difficulty communicating. Can you tell me more about that? [PROBE TO DETERMINE WHAT CONDITIONS ARE BEING CONSIDERED. NOTE IF RESPONDENT IS INCLUDING YOUNG CHILDREN WHO HAVE NOT LEARNED HOW TO TALK. ]

























Probe 19 [ASK FOR ANY HH MEMBERS FOR WHOM: 14a = Yes (i.e., SPEAK LANGUAGE OTHER THAN ENGLISH AT HOME) AND 19d = SOME DIFFICULTY/A LOT OF DIFFICULTY/CANNOT DO AT ALL AND RESPONSE TO PROBE 15 DID NOT MAKE IT CLEAR WHICH LANGUAGE R WAS REFERENCING] When answering this question about communication difficulty [IF MULTIPLE HH MEMBERS: for yourself/for PERSON] , were you thinking about English, [LANGUAGE], both, or something else? [ASK FOR ANY HH MEMBERS FOR WHOM: 14a = Yes (i.e., SPEAK LANGUAGE OTHER THAN ENGLISH AT HOME) AND 19d = SOME DIFFICULTY/A LOT OF DIFFICULTY/CANNOT DO AT ALL AND RESPONSE TO PROBE 15 DID NOT MAKE IT CLEAR WHICH LANGUAGE R WAS REFERENCING] When answering this question about communication difficulty [IF MULTIPLE HH MEMBERS: for yourself/for PERSON] , were you thinking about English, [LANGUAGE], both, or something else? [ASK FOR ANY HH MEMBERS FOR WHOM: 21a = Yes (i.e., SPEAK LANGUAGE OTHER THAN ENGLISH AT HOME) AND 26d = SOME DIFFICULTY/A LOT OF DIFFICULTY/CANNOT DO AT ALL AND RESPONSE TO PROBE 15 DID NOT MAKE IT CLEAR WHICH LANGUAGE R WAS REFERENCING.] When answering this question about communication difficulty [IF MULTIPLE HH MEMBERS: for yourself/for PERSON] , were you thinking about English, [LANGUAGE], both, or something else? [ASK FOR ANY HH MEMBERS FOR WHOM: 21a = Yes (i.e., SPEAK LANGUAGE OTHER THAN ENGLISH AT HOME) AND 26d = SOME DIFFICULTY/A LOT OF DIFFICULTY/CANNOT DO AT ALL AND RESPONSE TO PROBE 15 DID NOT MAKE IT CLEAR WHICH LANGUAGE R WAS REFERENCING] When answering this question about communication difficulty [IF MULTIPLE HH MEMBERS: for yourself/for PERSON] , were you thinking about English, [LANGUAGE], both, or something else?

























Disability (set 2)

27. Do you/does <NAME> have difficulty doing errands alone such as visiting a doctor’s office or shopping?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
 27. Because of a physical, mental, or emotional condition, do you/does <NAME> have difficulty doing errands alone such as visiting a doctor’s office or shopping?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

























Probe 1 [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A HOUSEHOLD MEMBER ON 20] On Question 20, you reported that [NAME] has difficulty doing errands alone. Can you tell me more about that? [PROBE TO DETERMINE WHAT SORT OF DIFFICULTY IS BEING CONSIDERED. REPEAT FOR ALL APPLICABLE HH MEMBERS.] [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A HOUSEHOLD MEMBER ON 20] On Question 20, you reported that [NAME] has difficulty doing errands alone. Can you tell me more about that? [PROBE TO DETERMINE WHAT SORT OF DIFFICULTY IS BEING CONSIDERED. REPEAT FOR ALL APPLICABLE HH MEMBERS.] [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A HOUSEHOLD MEMBER ON 20] On Question 27, you reported that [NAME] has difficulty doing errands alone. Can you tell me more about that? [PROBE TO DETERMINE WHAT SORT OF DIFFICULTY IS BEING CONSIDERED. REPEAT FOR ALL APPLICABLE HH MEMBERS.] [IF SELECTED "SOME DIFFICULTY," "A LOT OF DIFFICULTY," OR "CANNOT DO AT ALL" FOR A HOUSEHOLD MEMBER ON 20] On Question 27, you reported that [NAME] has difficulty doing errands alone. Can you tell me more about that? [PROBE TO DETERMINE WHAT SORT OF DIFFICULTY IS BEING CONSIDERED. REPEAT FOR ALL APPLICABLE HH MEMBERS.]

























Probe 2 Question 20 asks about difficulty doing errands alone. What do you think that refers to? Can you give me some examples of what kinds of difficulties that might include? Question 20 asks about difficulty doing errands alone. What do you think that refers to? Can you give me some examples of what kinds of difficulties that might include? Question 27 asks about difficulty doing errands alone. What do you think that refers to? Can you give me some examples of what kinds of difficulties that might include? Question 27 asks about difficulty doing errands alone. What do you think that refers to? Can you give me some examples of what kinds of difficulties that might include?

























Probe 3 When answering Questions 19 and 20, did you make any adjustments to the level of difficulty you reported for someone because of their age? [PROBE TO DETERMINE WHAT ADJUSTMENTS THEY MADE AND WHY.] When answering Questions 19 and 20, did you make any adjustments to the level of difficulty you reported for someone because of their age? [PROBE TO DETERMINE WHAT ADJUSTMENTS THEY MADE AND WHY.] When answering Questions 26 and 27, did you make any adjustments to the level of difficulty you reported for someone because of their age? [PROBE TO DETERMINE WHAT ADJUSTMENTS THEY MADE AND WHY.] When answering Questions 26 and 27, did you make any adjustments to the level of difficulty you reported for someone because of their age? [PROBE TO DETERMINE WHAT ADJUSTMENTS THEY MADE AND WHY.]

























Probe 4 Now I'm going to describe a situation and ask you a question about it. Susan is answering the survey for her family. She lives with her husband and her 85-year-old mother, Dorothy. Dorothy lives in a separate area of the house with her own bedroom, bathroom, sitting room, and kitchenette. Her health is good. With her walker, she can get around the house, and to the bus to go shopping. How should Susan respond for her mother, Dorothy, with regard to difficulty walking or climbing stairs? Now I'm going to describe a situation and ask you a question about it. Susan is answering the survey for her family. She lives with her husband and her 85-year-old mother, Dorothy. Dorothy lives in a separate area of the house with her own bedroom, bathroom, sitting room, and kitchenette. Her health is good. With her walker, she can get around the house, and to the bus to go shopping. How should Susan respond for her mother, Dorothy, with regard to difficulty walking or climbing steps? Now I'm going to describe a situation and ask you a question about it. Susan is answering the survey for her family. She lives with her husband and her 85-year-old mother, Dorothy. Dorothy lives in a separate area of the house with her own bedroom, bathroom, sitting room, and kitchenette. Her health is good. With her walker, she can get around the house, and to the bus to go shopping. How should Susan respond for her mother, Dorothy, with regard to difficulty walking or climbing stairs? Now I'm going to describe a situation and ask you a question about it. Susan is answering the survey for her family. She lives with her husband and her 85-year-old mother, Dorothy. Dorothy lives in a separate area of the house with her own bedroom, bathroom, sitting room, and kitchenette. Her health is good. With her walker, she can get around the house, and to the bus to go shopping. How should Susan respond for her mother, Dorothy, with regard to difficulty walking or climbing steps?

























Probe 5 Dorothy manages everything from social events to daily medications using her calendar. Susan helps her mother fill in the calendar each week. Occasionally, Dorothy misses an appointment or forgets to take her medication, but otherwise the calendar is very effective. How would you respond for Dorothy with regard to difficulty remembering or concentrating? Dorothy manages everything from social events to daily medications using her calendar. Susan helps her mother fill in the calendar each week. Occasionally, Dorothy misses an appointment or forgets to take her medication, but otherwise the calendar is very effective. How would you respond for Dorothy with regard to difficulty remembering or concentrating? Dorothy manages everything from social events to daily medications using her calendar. Susan helps her mother fill in the calendar each week. Occasionally, Dorothy misses an appointment or forgets to take her medication, but otherwise the calendar is very effective. How would you respond for Dorothy with regard to difficulty remembering or concentrating? Dorothy manages everything from social events to daily medications using her calendar. Susan helps her mother fill in the calendar each week. Occasionally, Dorothy misses an appointment or forgets to take her medication, but otherwise the calendar is very effective. How would you respond for Dorothy with regard to difficulty remembering or concentrating?

























CLOSING PROBES N/A N/A N/A N/A

























Probe 1 [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS.

























Probe 2 [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty?

























Sheet 3: Group 3 - English
Topic V1 - Paper V2 - Paper V1 - CAI V2 - CAI
Selection Language SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT. SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT. SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT. SELECTION LANGUAGE WILL BE READ AFTER ANSWERING THE BASIC PERSON SECTION. SEE FULL SELECTION TEXT IN THE PROTOCOL INTRO TEXT DOCUMENT.
Electric Vehicles

21. Are any of the following types of electric vehicles kept at home for use by members of this household?

A plug-in electric vehicle?
Another type of electric vehicle?		 21. At this <FILL BUILDING TYPE>, do you or any member of this household own or lease any of the following types of electric vehicles?

A plug-in electric vehicle?
A hybrid electric vehicle?
Introduction [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. Please look back at Questions 14a and 14b, which ask about electric vehicles.		 [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. Please look back at Questions 14a and 14b, which ask about electric vehicles.		 [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. I'll start by asking you two of the questions again, and then I'll ask follow-up questions to get your feedback. Here are the questions: [ASK QUESTION 14a]. You answered [ANSWER] [ASK QUESTION 14b]. You answered [ANSWER].		 [ASK AT CONCLUSION OF HOUSING MODULE]
Now I'd like to get your feedback on some of the questions you just answered. I'll start by asking you two of the questions again, and then I'll ask follow-up questions to get your feedback. Here are the questions: [ASK QUESTION 14a]. You answered [ANSWER] [ASK QUESTION 14b]. You answered [ANSWER].
Probe 1 How did you determine which answers to select on these questions? How did you determine which answers to select on these questions? How did you determine which answers to select on these questions? How did you determine which answers to select on these questions?
Probe 2 IF YES TO 14a: You reported a plug-in electric vehicle. What make and model were you thinking about? IF YES TO 14a: You reported a plug-in electric vehicle. What make and model were you thinking about? IF YES TO 14a: You reported a plug-in electric vehicle. What make and model were you thinking about? IF YES TO 14a: You reported a plug-in electric vehicle. What make and model were you thinking about?
Probe 3 IF YES TO 14a: Is this vehicle owned or is it leased? IF YES TO 14a: Is this vehicle owned or is it leased? IF YES TO 14a: Is this vehicle owned or is it leased? IF YES TO 14a: Is this vehicle owned or is it leased?
Probe 4 IF YES TO 14a: Whose vehicle is that? IF YES TO 14a: Whose vehicle is that? IF YES TO 14a: Whose vehicle is that? IF YES TO 14a: Whose vehicle is that?
Probe 5 IF YES TO 14a: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?] IF YES TO 14a: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?] IF YES TO 14a: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?] IF YES TO 14a: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?]
Probe 6 IF YES TO 14b: You reported another type of electric vehicle. What make and model were you thinking about? IF YES TO 14b: You reported a hybrid electric vehicle. What make and model were you thinking about? IF YES TO 14b: You reported another type of electric vehicle. What make and model were you thinking about? IF YES TO 14b: You reported a hybrid electric vehicle. What make and model were you thinking about?
Probe 7 IF YES TO 14b: Is this vehicle owned or is it leased? IF YES TO 14b: Is this vehicle owned or is it leased? IF YES TO 14b: Is this vehicle owned or is it leased? IF YES TO 14b: Is this vehicle owned or is it leased?
Probe 8 IF YES TO 14b: Whose vehicle is that? IF YES TO 14b: Whose vehicle is that? IF YES TO 14b: Whose vehicle is that? IF YES TO 14b: Whose vehicle is that?
Probe 9 IF YES TO 14b: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?] IF YES TO 14b: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?] IF YES TO 14b: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?] IF YES TO 14b: How is the vehicle charged? [PROBE TO DETERMINE IF THE VEHICLE REQUIRES CONNECTING TO AN ELECTRICAL SOURCE, e.g., What is the process?]
Probe 10 [SKIP IF ANSWERED ABOUT ANOTHER HH MEMBER'S VEHICLE] When answering these questions, did you think about vehicles that are used by any member of your household, or did you only think about vehicles that you use? [SKIP IF ANSWERED ABOUT ANOTHER HH MEMBER'S VEHICLE] When answering these questions, did you think about vehicles that are used by any member of your household, or did you only think about vehicles that you use? [SKIP IF ANSWERED ABOUT ANOTHER HH MEMBER'S VEHICLE] When answering these questions, did you think about vehicles that are used by any member of your household, or did you only think about vehicles that you use? [SKIP IF ANSWERED ABOUT ANOTHER HH MEMBER'S VEHICLE] When answering these questions, did you think about vehicles that are used by any member of your household, or did you only think about vehicles that you use?
Probe 11 [SKIP IF ANY OF THE VEHICLES ARE LEASED] Do you think this question is asking about vehicles that are being leased, or do you think it is asking only about vehicles that are owned? [SKIP IF ANY OF THE VEHICLES ARE LEASED] Do you think this question is asking about vehicles that are being leased, or do you think it is asking only about vehicles that are owned? [SKIP IF ANY OF THE VEHICLES ARE LEASED] Do you think this question is asking about vehicles that are being leased, or do you think it is asking only about vehicles that are owned? [SKIP IF ANY OF THE VEHICLES ARE LEASED] Do you think this question is asking about vehicles that are being leased, or do you think it is asking only about vehicles that are owned?
Probe 12 Are there any other vehicles that you thought about when answering these questions? [IF YES, PROBE FOR MORE INFO: WHAT TYPE OF VEHICLE? HOW DID THEY DECIDE WHICH TO REPORT?] Are there any other vehicles that you thought about when answering these questions? [IF YES, PROBE FOR MORE INFO: WHAT TYPE OF VEHICLE? HOW DID THEY DECIDE WHICH TO REPORT?] Are there any other vehicles that you thought about when answering these questions? [IF YES, PROBE FOR MORE INFO: WHAT TYPE OF VEHICLE? HOW DID THEY DECIDE WHICH TO REPORT?] Are there any other vehicles that you thought about when answering these questions? [IF YES, PROBE FOR MORE INFO: WHAT TYPE OF VEHICLE? HOW DID THEY DECIDE WHICH TO REPORT?]
Transition Please go ahead now and continue filling out the survey. I'll stop you when I have additional questions. Please go ahead now and continue filling out the survey. I'll stop you when I have additional questions. Now I'm going to continue asking you the survey questions, and at the end I'll ask you for more feedback on the questions. Now I'm going to continue asking you the survey questions, and at the end I'll ask you for more feedback on the questions.
Commuting Mode

25. Using this list, LAST WEEK, how did you/<NAME> USUALLY get to work?

Car, truck, or van
Bus
Subway or elevated rail
Long-distance train or commuter rail
Light rail, streetcar, or trolley
Ferryboat
Taxi or ride-hailing services
Motorcycle
Bicycle
Walked
Worked from home
Other Method		 25. Using this list, LAST WEEK, how did you/<NAME> USUALLY get to work?

Car, truck, or van
Bus
Subway or elevated rail
Long-distance train or commuter rail
Light rail, streetcar, or trolley
Ferryboat
Ride-hailing services (including taxi)
Motorcycle
Bicycle
Walked
Worked from home
Other Method
Introduction [ASK AT END OF SURVEY]
Now I'd like to get your opinion about Question 32.		 [ASK AT END OF SURVEY]
Now I'd like to get your opinion about Question 32.		 [ASK AT END OF SURVEY]
Next I'd like to get your feedback on the question about commuting to work. I'll read that question to you now. [ASK QUESTION 25] You said that you usually get to work by [ANSWER]. [PROVIDE FLASHCARDS IF ASSIGNED TO RECEIVE FLASHCARDS.]		 [ASK AT END OF SURVEY]
Next I'd like to get your feedback on the question about commuting to work. I'll read that question to you now. [ASK QUESTION 25] You said that you usually get to work by [ANSWER]. [PROVIDE FLASHCARDS IF ASSIGNED TO RECEIVE FLASHCARDS.]
Probe 1 How did you decide which response option to choose? How did you decide which response option to choose? How did you decide which response option to choose? How did you decide which response option to choose?
Probe 2 What do you think about the response options? Are any of them unclear or confusing? What do you think about the response options? Are any of them unclear or confusing? What do you think about the response options? Are any of them unclear or confusing? What do you think about the response options? Are any of them unclear or confusing?
Probe 3 IF 32 = OTHER: You selected "Other." Can you tell me more about that? How do you usually get to work? IF 32 = OTHER: You selected "Other." Can you tell me more about that? How do you usually get to work? IF 25 = OTHER: You selected "Other." Can you tell me more about that? How do you usually get to work? IF 25 = OTHER: You selected "Other." Can you tell me more about that? How do you usually get to work?
Probe 4 [SKIP IF 32 = OTHER METHOD] Do you use any modes of transportation to get to work that are not listed in this question? [IF YES, PROBE TO DETERMINE THE MODES AND HOW OFTEN EACH MODE IS USED.] [SKIP IF 32 = OTHER METHOD] Do you use any modes of transportation to get to work that are not listed in this question? [IF YES, PROBE TO DETERMINE THE MODES AND HOW OFTEN EACH MODE IS USED.] [SKIP IF 25 = OTHER METHOD] Do you use any modes of transportation to get to work that are not listed in this question? [IF YES, PROBE TO DETERMINE THE MODES AND HOW OFTEN EACH MODE IS USED.] [SKIP IF 25 = OTHER METHOD] Do you use any modes of transportation to get to work that are not listed in this question? [IF YES, PROBE TO DETERMINE THE MODES AND HOW OFTEN EACH MODE IS USED.]
Probe 5 Can you think of any ways people travel to work that are not already listed in this question, even if you do not use them? [IF YES, PROBE TO DETERMINE THE WAYS.] Can you think of any ways people travel to work that are not already listed in this question, even if you do not use them? [IF YES, PROBE TO DETERMINE THE WAYS.] Can you think of any ways people travel to work that are not already listed in this question, even if you do not use them? [IF YES, PROBE TO DETERMINE THE WAYS.] Can you think of any ways people travel to work that are not already listed in this question, even if you do not use them? [IF YES, PROBE TO DETERMINE THE WAYS.]
Probe 6 One of the options includes "ride-hailing services." What do you think this means? IF NECESSARY: Can you give me some examples of ride-hailing services? One of the options includes "ride-hailing services." What do you think this means? IF NECESSARY: Can you give me some examples of ride-hailing services? One of the options includes "ride-hailing services." What do you think this means? IF NECESSARY: Can you give me some examples of ride-hailing services? One of the options includes "ride-hailing services." What do you think this means? IF NECESSARY: Can you give me some examples of ride-hailing services?
Probe 7 IF 32 = TAXI OR RIDE-HAILING SERVICES: You said you usually get to work using taxi or ride-hailing services. When you don't use taxi or ride-hailing services, what other method of transportation do you typically use to get to work? IF 32 = RIDE-HAILING SERVICES: You said you usually get to work using ride-hailing services. When you don't use ride-hailing services, what other method of transportation do you typically use to get to work? IF 25 = TAXI OR RIDE-HAILING SERVICES: You said you usually get to work using taxi or ride-hailing services. When you don't use taxi or ride-hailing services, what other method of transportation do you typically use to get to work? IF 25 = RIDE-HAILING SERVICES: You said you usually get to work using ride-hailing services. When you don't use ride-hailing services, what other method of transportation do you typically use to get to work?
Probe 8 IF 32 IS NOT TAXI OR RIDE-HAILING SERVICES: Do you ever take a taxi or ride-hailing service to get to work? IF YES: How often? When (I.E., IN WHAT SITUATIONS)? IF 32 IS NOT RIDE-HAILING SERVICES: Do you ever take a ride-hailing service or taxi to get to work? IF YES: How often? When (I.E., IN WHAT SITUATIONS)? IF 25 IS NOT TAXI OR RIDE-HAILING SERVICES: Do you ever take a taxi or ride-hailing service to get to work? IF YES: How often? When (I.E., IN WHAT SITUATIONS)? IF 25 IS NOT RIDE-HAILING SERVICES: Do you ever take a ride-hailing service or taxi to get to work? IF YES: How often? When (I.E., IN WHAT SITUATIONS)?
Probe 9 [SKIP IF ALREADY MENTIONED] Which option would you select for taking Uber or Lyft? [SKIP IF ALREADY MENTIONED] Which option would you select for taking Uber or Lyft? [SKIP IF ALREADY MENTIONED] Which option would you select for taking Uber or Lyft? [SKIP IF ALREADY MENTIONED] Which option would you select for taking Uber or Lyft?
Probe 10 IF 32 = CAR, TRUCK, OR VAN: You selected "Car, truck, or van." Do you usually drive alone to work or do you travel with others? IF TRAVEL WITH OTHERS: Can you tell me more about that? IF 32 = CAR, TRUCK, OR VAN: You selected "Car, truck, or van." Do you usually drive alone to work or do you travel with others? IF TRAVEL WITH OTHERS: Can you tell me more about that? IF 25 = CAR, TRUCK, OR VAN: You selected "Car, truck, or van." Do you usually drive alone to work or do you travel with others? IF TRAVEL WITH OTHERS: Can you tell me more about that? IF 25 = CAR, TRUCK, OR VAN: You selected "Car, truck, or van." Do you usually drive alone to work or do you travel with others? IF TRAVEL WITH OTHERS: Can you tell me more about that?
Income (Set 1)

32a. When did you/<NAME> last work, even for a few days?
Within the past 12 months
1 to 5 years ago
Over 5 years ago or never worked

32b. In 2019, did you/<NAME> work at a job or business at any time, even for a few days?
Yes
No

33. During the weeks that you/<NAME> WORKED in 2019, how many hours did you/<NAME> usually work each week?

34a. In 2019, did you/<NAME> work EVERY week? Include all jobs and count paid vacation, paid sick leave, and military service as work.
Yes
No

34b. Of the 52 weeks in 2019, how many WEEKS did you/<NAME> work for at least one day? Include all jobs, paid time off, and weeks when you/<NAME> only worked for a few hours.		 32a. When did you/<NAME> last work, even for a few days?
Within the past 12 months
1 to 5 years ago
Over 5 years ago or never worked

32b. In 2019, did you/<NAME> work at a job or business at any time, even for a few days?
Yes
No

33. During the weeks that you/<NAME> WORKED in 2019, how many HOURS did you/<NAME> usually work each WEEK?

34a. In 2019, did you/<NAME> work EVERY WEEK? Include all jobs and count paid vacation, paid sick leave, and military service as work.
Yes
No

34b. Of the 52 weeks in 2019, how many WEEKS did you/<NAME> work for at least one day? Include all jobs, paid time off, and weeks when you/<NAME> only worked for a few hours.
Interviewer Note [INTERVIEWER: NOTE ANY ISSUES THE RESPONDENT HAS WITH SKIP PATTERNS] [INTERVIEWER: NOTE ANY ISSUES THE RESPONDENT HAS WITH SKIP PATTERNS]

Introduction Next I'd like to discuss some of the questions about work. Next I'd like to discuss some of the questions about work. Next I'd like to discuss some of the questions you answered about work. Here are the questions I'll be asking about [PROVIDE COPY OF QUESTIONS 32-34]. As a reminder, you answered [LIST ALL ANSWERS]. Next I'd like to discuss some of the questions you answered about work. Here are the questions I'll be asking about [PROVIDE COPY OF QUESTIONS 32-34]. As a reminder, you answered [LIST ALL ANSWERS].
Probe 1 Let's start with Question 39 on Page 17. Question 39 has two parts, a and b. Please take a moment to review them. [PAUSE] What were you thinking about when answering these questions? Let's start with Question 39 on Page 17. Question 39 has two parts, a and b. Please take a moment to review them. [PAUSE] What were you thinking about when answering these questions? Let's start with Question 32. Question 32 has two parts, a and b. Please take a moment to review them. [PAUSE] What were you thinking about when answering these questions? Let's start with Question 32. Question 32 has two parts, a and b. Please take a moment to review them. [PAUSE] What were you thinking about when answering these questions?
Probe 2 How easy or difficult was it for you to come up with answers to these questions? How easy or difficult was it for you to come up with answers to these questions? How easy or difficult was it for you to come up with answers to these questions? How easy or difficult was it for you to come up with answers to these questions?
Probe 3 IF USUAL HOURS WORKED PER WEEK < 32 AND/OR WEEKS WORKED IN THE YEAR < 48: Tell me more about your work experience in 2019. [PROBE TO LEARN ABOUT PART-TIME WORK, PERIODS OF UNEMPLOYMENT, ETC. GET A GENERAL SENSE OF THEIR 2019 WORK HISTORY TO SEE WHAT THEY ARE INCLUDING AND SCLUDING.] IF USUAL HOURS WORKED PER WEEK < 32 AND/OR WEEKS WORKED IN THE YEAR < 48: Tell me more about your work experience in 2019. [PROBE TO LEARN ABOUT PART-TIME WORK, PERIODS OF UNEMPLOYMENT, ETC. GET A GENERAL SENSE OF THEIR 2019 WORK HISTORY TO SEE WHAT THEY ARE INCLUDING AND SCLUDING.] IF USUAL HOURS WORKED PER WEEK < 32 AND/OR WEEKS WORKED IN THE YEAR < 48: Tell me more about your work experience in 2019. [PROBE TO LEARN ABOUT PART-TIME WORK, PERIODS OF UNEMPLOYMENT, ETC. GET A GENERAL SENSE OF THEIR 2019 WORK HISTORY TO SEE WHAT THEY ARE INCLUDING AND SCLUDING.] IF USUAL HOURS WORKED PER WEEK < 32 AND/OR WEEKS WORKED IN THE YEAR < 48: Tell me more about your work experience in 2019. [PROBE TO LEARN ABOUT PART-TIME WORK, PERIODS OF UNEMPLOYMENT, ETC. GET A GENERAL SENSE OF THEIR 2019 WORK HISTORY TO SEE WHAT THEY ARE INCLUDING AND SCLUDING.]
Probe 4 How did you come up with your answer to Question 40? How did you come up with your answer to Question 40? How did you come up with your answer to Question 33? How did you come up with your answer to Question 33?
Probe 5 IF WORK ARRANGEMENT IS UNCLEAR AFTER PREVIOUS PROBE, CLARIFY WITH QUESTIONS SUCH AS: Do you work the same number of hours each week? Do your work hours or work schedule change throughout the year? Do you work more than one job? How did you determine the number of hours to report? IF WORK ARRANGEMENT IS UNCLEAR AFTER PREVIOUS PROBE, CLARIFY WITH QUESTIONS SUCH AS: Do you work the same number of hours each week? Do your work hours or work schedule change throughout the year? Do you work more than one job? How did you determine the number of hours to report? IF WORK ARRANGEMENT IS UNCLEAR AFTER PREVIOUS PROBE, CLARIFY WITH QUESTIONS SUCH AS: Do you work the same number of hours each week? Do your work hours or work schedule change throughout the year? Do you work more than one job? How did you determine the number of hours to report? IF WORK ARRANGEMENT IS UNCLEAR AFTER PREVIOUS PROBE, CLARIFY WITH QUESTIONS SUCH AS: Do you work the same number of hours each week? Do your work hours or work schedule change throughout the year? Do you work more than one job? How did you determine the number of hours to report?
Probe 6 Can you please tell me what Question 40 is asking in your own words? Can you please tell me what Question 40 is asking in your own words? Can you please tell me what Question 33 is asking in your own words? Can you please tell me what Question 33 is asking in your own words?
Probe 7 Was anything about this question [Question 40] confusing or unclear? Was anything about this question [Question 40] confusing or unclear? Was anything about this question [Question 33] confusing or unclear? Was anything about this question [Question 33] confusing or unclear?
Probe 8 How did you come up with your answer(s) to Question 41? How did you come up with your answer(s) to Question 41? How did you come up with your answer(s) to Question 34? How did you come up with your answer(s) to Question 34?
Probe 9 IF PARTICIPANT DID NOT WORK EVERY WEEK/52 WEEKS: PROBE TO UNDERSTAND WHETHER THEY ARE ONLY INCLUDING WEEKS THEY ACTUALLY WORKED IN THEIR ANSWER. IF PARTICIPANT DID NOT WORK EVERY WEEK/52 WEEKS: PROBE TO UNDERSTAND WHETHER THEY ARE ONLY INCLUDING WEEKS THEY ACTUALLY WORKED IN THEIR ANSWER. IF PARTICIPANT DID NOT WORK EVERY WEEK/52 WEEKS: PROBE TO UNDERSTAND WHETHER THEY ARE ONLY INCLUDING WEEKS THEY ACTUALLY WORKED IN THEIR ANSWER. IF PARTICIPANT DID NOT WORK EVERY WEEK/52 WEEKS: PROBE TO UNDERSTAND WHETHER THEY ARE ONLY INCLUDING WEEKS THEY ACTUALLY WORKED IN THEIR ANSWER.
Probe 10 IF NEEDED: Would your answer to Question 40 change if you only counted time you worked in the [FILL] weeks from 41b in your answer? IF NEEDED: Would your answer to Question 40 change if you only counted time you worked in the [FILL] weeks from 41b in your answer? IF NEEDED: Would your answer to Question 33 change if you only counted time you worked in the [FILL] weeks from 34b in your answer? IF NEEDED: Would your answer to Question 33 change if you only counted time you worked in the [FILL] weeks from 34b in your answer?
Probe 11 IF NEEDED: Can you tell me what 41a and 41b are asking in your own words? IF NEEDED: Can you tell me what 41a and 41b are asking in your own words? IF NEEDED: Can you tell me what 34a and 34b are asking in your own words? IF NEEDED: Can you tell me what 34a and 34b are asking in your own words?
Probe 12 On Question 41a, which answer do you think someone should select if the person worked every Thursday but did not work any other days of the week? On Question 41a, which answer do you think someone should select if the person worked every Thursday but did not work any other days of the week? On Question 34a, which answer do you think someone should select if the person worked every Thursday but did not work any other days of the week? On Question 34a, which answer do you think someone should select if the person worked every Thursday but did not work any other days of the week?
Probe 13 How do you think someone should answer 41a if they worked for 3 months last year? IF NEEDED: Does it matter which months they worked? How do you think someone should answer 41a if they worked for 3 months last year? IF NEEDED: Does it matter which months they worked? How do you think someone should answer 34a if they worked for 3 months last year? IF NEEDED: Does it matter which months they worked? How do you think someone should answer 34a if they worked for 3 months last year? IF NEEDED: Does it matter which months they worked?
Probe 14 How about if they worked one job for the first half of the year and another job for the second half? How should they answer 41a? How about if they worked one job for the first half of the year and another job for the second half? How should they answer 41a? How about if they worked one job for the first half of the year and another job for the second half? How should they answer 34a? How about if they worked one job for the first half of the year and another job for the second half? How should they answer 34a?
Probe 15 How do you think someone should answer 41b if they work 4 hours per week? What about someone who works 60 hours per week? How do you think someone should answer 41b if they work 4 hours per week? What about someone who works 60 hours per week? How do you think someone should answer 34b if they work 4 hours per week? What about someone who works 60 hours per week? How do you think someone should answer 34b if they work 4 hours per week? What about someone who works 60 hours per week?
Probe 16 How about if someone's hours vary quite a bit from week to week? How should they answer 41b? How about if someone's hours vary quite a bit from week to week? How should they answer 41b? How about if someone's hours vary quite a bit from week to week? How should they answer 34b? How about if someone's hours vary quite a bit from week to week? How should they answer 34b?
Probe 17 How do you think someone should answer 41b if they worked for only one day all year? How do you think someone should answer 41b if they worked for only one day all year? How do you think someone should answer 34b if they worked for only one day all year? How do you think someone should answer 34b if they worked for only one day all year?
Probe 18 If a person had a job all year in 2019 but they took 1 week off for paid vacation and another week off with paid sick leave, how should they answer? If a person had a job all year in 2019 but they took 1 week off for paid vacation and another week off with paid sick leave, how should they answer? If a person had a job all year in 2019 but they took 1 week off for paid vacation and another week off with paid sick leave, how should they answer? If a person had a job all year in 2019 but they took 1 week off for paid vacation and another week off with paid sick leave, how should they answer?
Income (Set 2) [Questions are too long to fit here. See Sheet named "Income Questions - Set 2"] [Questions are too long to fit here. See Sheet named "Income Questions - Set 2"] [Questions are too long to fit here. See Sheet named "Income Questions - Set 2"] [Questions are too long to fit here. See Sheet named "Income Questions - Set 2"]
Introduction Next I'd like to discuss the questions about income. Please look at Questions 43 and 44 on Page 18. [PAUSE TO ALLOW TIME TO REVIEW QUESTIONS] Next I'd like to discuss the questions about income. Please look at Questions 43 and 44 on Page 18. [PAUSE TO ALLOW TIME TO REVIEW QUESTIONS] Next I'd like to discuss some of the questions you answered about income. Here are the questions I'll be asking about [PROVIDE COPY OF QUESTIONS 36a-36m]. As a reminder, you answered [LIST ALL ANSWERS]. Next I'd like to discuss some of the questions you answered about income. Here are the questions I'll be asking about [PROVIDE COPY OF QUESTIONS 36a-36m]. As a reminder, you answered [LIST ALL ANSWERS].
Probe 1 How did you come up with your answer on [ASK ABOUT THE FIRST QUESTION THEY ANSWERED "YES" TO.] REPEAT WITH ONE OR TWO OTHER QUESTIONS (IF YES) TO DETERMINE WHICH TIME PERIOD THEY CONSIDERED. How did you come up with your answer on [ASK ABOUT THE FIRST QUESTION THEY ANSWERED "YES" TO.] REPEAT WITH ONE OR TWO OTHER QUESTIONS (IF YES) TO DETERMINE WHICH TIME PERIOD THEY CONSIDERED. How did you come up with your answer on [ASK ABOUT THE FIRST QUESTION THEY ANSWERED "YES" TO.] REPEAT WITH ONE OR TWO OTHER QUESTIONS (IF YES) TO DETERMINE WHICH TIME PERIOD THEY CONSIDERED. How did you come up with your answer on [ASK ABOUT THE FIRST QUESTION THEY ANSWERED "YES" TO.] REPEAT WITH ONE OR TWO OTHER QUESTIONS (IF YES) TO DETERMINE WHICH TIME PERIOD THEY CONSIDERED.
Probe 2 Thinking about Questions 43 and 44 overall, what time period were you thinking about when answering these questions? [PROBE TO DETERMINE MONTH(S) AND YEAR(S). IF USED TIME PERIOD OUTSIDE OF 2019, PROBE TO DETERMINE WHY.] Thinking about Questions 43 and 44 overall, what time period were you thinking about when answering these questions? [PROBE TO DETERMINE MONTH(S) AND YEAR(S). IF USED TIME PERIOD OUTSIDE OF 2019, PROBE TO DETERMINE WHY.] Thinking about all of the questions on the sheet I gave you, what time period were you thinking about when answering these questions? [PROBE TO DETERMINE MONTH(S) AND YEAR(S). IF USED TIME PERIOD OUTSIDE OF 2019, PROBE TO DETERMINE WHY.] Thinking about all of the questions on the sheet I gave you, what time period were you thinking about when answering these questions? [PROBE TO DETERMINE MONTH(S) AND YEAR(S). IF USED TIME PERIOD OUTSIDE OF 2019, PROBE TO DETERMINE WHY.]
Probe 3 Do you think income that isn't reported for tax purposes should be reported in any of these questions? [PROBE FOR MORE INFO: E.G., IF YES: IN WHICH QUESTION(S)? IF NO: WHY DO YOU SAY THAT?] Do you think income that isn't reported for tax purposes should be reported in any of these questions? [PROBE FOR MORE INFO: E.G., IF YES: IN WHICH QUESTION(S)? IF NO: WHY DO YOU SAY THAT?] Do you think income that isn't reported for tax purposes should be reported in any of these questions? [PROBE FOR MORE INFO: E.G., IF YES: IN WHICH QUESTION(S)? IF NO: WHY DO YOU SAY THAT?] Do you think income that isn't reported for tax purposes should be reported in any of these questions? [PROBE FOR MORE INFO: E.G., IF YES: IN WHICH QUESTION(S)? IF NO: WHY DO YOU SAY THAT?]
Probe 4 [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have a side job or a side gig? IF YES: Did you report that income in Question 43? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report? [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have a side job or a side gig? IF YES: Did you report that income in Question 43? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report? [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have a side job or a side gig? IF YES: Did you report that income in these questions? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report? [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have a side job or a side gig? IF YES: Did you report that income in these questions? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report?
Probe 5 [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have self-employment income? IF YES: Can you tell me about it? [E.G., DESCRIPTION OF WORK]. Did you report that income in Question 43? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report? [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have self-employment income? IF YES: Can you tell me about it? [E.G., DESCRIPTION OF WORK]. Did you report that income in Question 43? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report? [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have self-employment income? IF YES: Can you tell me about it? [E.G., DESCRIPTION OF WORK]. Did you report that income in Question 36? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report? [TAILOR PROBES AS NEEDED IF ALREADY DISCUSSED.] Do any members of your household have self-employment income? IF YES: Can you tell me about it? [E.G., DESCRIPTION OF WORK]. Did you report that income in Question 36? IF REPORTED: In which question? IF NOT REPORTED: Can you tell me more about that? How did you decide which income to report?
Probe 6 IF 43b = NO: Now let's look at Question 43b. Can you give me some examples of what you think this question is asking you to report? IF 43b = NO: Now let's look at Question 43b. Can you give me some examples of what you think this question is asking you to report? IF 36c = NO: Now let's look at Question 36c. Can you give me some examples of what you think this question is asking you to report? IF 36c = NO: Now let's look at Question 36c. Can you give me some examples of what you think this question is asking you to report?
Probe 7 [IF Q43c = YES] What types of income did you report on 43c? IF MORE THAN ONE: How easy or difficult was it to add up the separate types? [SKIP] [SKIP] [SKIP]
Probe 8 [IF Q43c = NO] Did you have any income from being a landlord or from a rental? IF YES: Can you tell me more about that? [PROBE TO CONFIRM THEY ARE A LANDLORD AS OPPOSED TO SOMEONE WHO PAYS RENT] [IF Q43d = NO] Did you have any income from being a landlord or from a rental? IF YES: Can you tell me more about that? [PROBE TO CONFIRM THEY ARE A LANDLORD AS OPPOSED TO SOMEONE WHO PAYS RENT] [IF Q36e = NO] Did you have any income from being a landlord or from a rental? IF YES: Can you tell me more about that? [PROBE TO CONFIRM THEY ARE A LANDLORD AS OPPOSED TO SOMEONE WHO PAYS RENT] [IF Q36e = NO] Did you have any income from being a landlord or from a rental? IF YES: Can you tell me more about that? [PROBE TO CONFIRM THEY ARE A LANDLORD AS OPPOSED TO SOMEONE WHO PAYS RENT]
Probe 9 [IF Q43c = LOSS] You reported a loss on 43c. Can you tell me more about that? [IF Q43d = LOSS] You reported a loss on 43d. Can you tell me more about that? [SKIP] [SKIP]
Probe 10 [IF Q43c = Yes] You answered "Yes" on 43c. Can you tell me about that income? What is it from? [PROBE TO DETERMINE TYPES OF INCOME REPORTED] [IF Q43c = Yes] You answered "Yes" on 43c. Can you tell me about that income? What is it from? [PROBE TO DETERMINE TYPES OF INCOME REPORTED] [SKIP] [SKIP]
Probe 11 [SKIP] [IF Q43d = Yes] You answered "Yes" on 43d. Can you tell me about that income? What is it from? [PROBE TO DETERMINE IF THEY ARE REPORTING INCOME RECEIVED AS A LANDLORD VERSUS INCOME PAID TO A LANDLORD.] [IF Q36e = Yes] You answered "Yes" on 36e. Can you tell me about that income? What is it from? [PROBE TO DETERMINE IF THEY ARE REPORTING INCOME RECEIVED AS A LANDLORD VERSUS INCOME PAID TO A LANDLORD.] [IF Q36e = Yes] You answered "Yes" on 36e. Can you tell me about that income? What is it from? [PROBE TO DETERMINE IF THEY ARE REPORTING INCOME RECEIVED AS A LANDLORD VERSUS INCOME PAID TO A LANDLORD.]
Probe 12 [IF RENTAL INCOME REPORTED ON Q43c AND NOT A LOSS] How would you answer 43c if you lost money or broke even on your rental property? [IF Q43d = Yes AND NOT A LOSS] How would you answer 43d if you lost money or broke even on your rental property? [IF RENTAL INCOME REPORTED ON Q36e AND NOT A LOSS] How would you answer 36e if you lost money or broke even on your rental property? [IF RENTAL INCOME REPORTED ON Q36e AND NOT A LOSS] How would you answer 36e if you lost money or broke even on your rental property?
Probe 13 Now let's look at Question 43f. Can you give me some examples of what you think this question is asking you to report? Now let's look at Question 43g. Can you give me some examples of what this question is asking you to report? Now let's look at Question 36i. Can you give me some examples of what this question is asking you to report? Now let's look at Question 36i. Can you give me some examples of what this question is asking you to report?
Probe 14 How did you determine what answer to provide on this question? How did you determine what answer to provide on this question? How did you determine what answer to provide on this question? How did you determine what answer to provide on this question?
Probe 15 [IF Q43f = YES] You answered "Yes" on this question. Can you tell me more specifically what type of public assistance or welfare payments you received? [IF Q43g = YES] You answered "Yes" on this question. Can you tell me more specifically what type of financial assistance you received from the welfare office? [IF Q36i = YES] You answered "Yes" on this question. Can you tell me more specifically what type of public assistance or welfare payments you received? [IF Q36i = YES] You answered "Yes" on this question. Can you tell me more specifically what type of financial assistance you received from the welfare office?
Probe 16 [IF Q43f = YES] Did you receive any public assistance or welfare payments that you did not report on this question? IF YES: Can you tell me more about how you decided which payments to report? [IF Q43g = YES] Did you receive any financial assistance from the welfare office that you did not report on this question? IF YES: Can you tell me more about how you decided which payments to report? [IF Q36i = YES] Did you receive any public assistance or welfare payments that you did not report on this question? IF YES: Can you tell me more about how you decided which payments to report? [IF Q36i = YES] Did you receive any financial assistance from the welfare office that you did not report on this question? IF YES: Can you tell me more about how you decided which payments to report?
Probe 17 Now let's focus on Question 44. Please think about how you answered Question 44 for all members of your household. What sources of income did you consider? [PROBE TO DETERMINE IF THERE WERE ANY OTHERS] Now let's focus on Question 44. Please think about how you answered Question 44 for all members of your household. What sources of income did you consider? [PROBE TO DETERMINE IF THERE WERE ANY OTHERS] Now let's focus on Question 36m. Please think about how you answered 36m for all members of your household. What sources of income did you consider? [PROBE TO DETERMINE IF THERE WERE ANY OTHERS] Now let's focus on Question 36m. Please think about how you answered 36m for all members of your household. What sources of income did you consider? [PROBE TO DETERMINE IF THERE WERE ANY OTHERS]
Probe 18 Did you exclude any types of income? [IF YES, PROBE TO DETERMINE TYPES AND REASONS FOR EXCLUDING] Did you exclude any types of income? [IF YES, PROBE TO DETERMINE TYPES AND REASONS FOR EXCLUDING] Did you exclude any types of income? [IF YES, PROBE TO DETERMINE TYPES AND REASONS FOR EXCLUDING] Did you exclude any types of income? [IF YES, PROBE TO DETERMINE TYPES AND REASONS FOR EXCLUDING]
Probe 19 Were there any types of income that you were unsure about whether to include in Question 44? Were there any types of income that you were unsure about whether to include in Question 44? Were there any types of income that you were unsure about whether to include in Question 36m? Were there any types of income that you were unsure about whether to include in Question 36m?
Probe 20 Is there anything else you'd like to discuss about Questions 43 and 44? Is there anything else you'd like to discuss about Questions 43 and 44? Is there anything else you'd like to discuss about all parts of Question 36? Is there anything else you'd like to discuss about all parts of Question 36?
HOA/Condominium Fees (Round 2 only)



Probe 1 What do you think is meant by the term "condominium"? What do you think is meant by the term "condominium"? What do you think is meant by the term "condominium"? What do you think is meant by the term "condominium"?
Probe 2 You answred [R'S ANSWER]. How do you know if your house/apartment/mobile home is part of a condominium? You answred [R'S ANSWER]. How do you know if your house/apartment/mobile home is part of a condominium? You answred [R'S ANSWER]. How do you know if your house/apartment/mobile home is part of a condominium? You answred [R'S ANSWER]. How do you know if your house/apartment/mobile home is part of a condominium?
Probe 3 [IF YES AND NONE] You answered 'None' for your monthly condominium fee. How did you decided on your answer? [IF YES AND NONE] You answered 'None' for your monthly condominium fee. How did you decided on your answer? [IF YES AND NONE] You answered 'None' for your monthly condominium fee. How did you decided on your answer? [IF YES AND NONE] You answered 'None' for your monthly condominium fee. How did you decided on your answer?
Probe 4 [IF YES AND MONTHLY AMOUNT PROVIDED] How did you come up with this number? [IF YES AND MONTHLY AMOUNT PROVIDED] How did you come up with this number? [IF YES AND MONTHLY AMOUNT PROVIDED] How did you come up with this number? [IF YES AND MONTHLY AMOUNT PROVIDED] How did you come up with this number?
Probe 5 [IF YES AND MONTHLY AMOUNT PROVIDED] What types of fees are included in the monthly amount you provided? [IF MORE THAN 1 TYPE OF FEE MENTIONED] Are all of these fees mandatory? [IF MORE THAN 1 TYPE OF FEE MENTIONED] If needed, would you be able to break down the amount by type of fee? [IF YES AND MONTHLY AMOUNT PROVIDED] What types of fees are included in the monthly amount you provided? [IF MORE THAN 1 TYPE OF FEE MENTIONED] Are all of these fees mandatory? [IF MORE THAN 1 TYPE OF FEE MENTIONED] If needed, would you be able to break down the amount by type of fee? [IF YES AND MONTHLY AMOUNT PROVIDED] What types of fees are included in the monthly amount you provided? [IF MORE THAN 1 TYPE OF FEE MENTIONED] Are all of these fees mandatory? [IF MORE THAN 1 TYPE OF FEE MENTIONED] If needed, would you be able to break down the amount by type of fee? [IF YES AND MONTHLY AMOUNT PROVIDED] What types of fees are included in the monthly amount you provided? [IF MORE THAN 1 TYPE OF FEE MENTIONED] Are all of these fees mandatory? [IF MORE THAN 1 TYPE OF FEE MENTIONED] If needed, would you be able to break down the amount by type of fee?
CLOSING PROBES N/A N/A N/A N/A
Probe 1 [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS. [IF MORE THAN 1 HH MEMBER] Thinking back over the entire survey, how did it feel answering questions about the other people you included? IF NO MENTION OF PRIVACY CONCERNS, ASK: Did you have any concerns about the privacy of other people you reported when answering those questions? PROBE IF NEEDED TO DETERMINE CONCERNS.
Probe 2 [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty? [IF MORE THAN 1 HH MEMBER] What was it like answering questions about other members of your household? Did you have any difficulty?

Sheet 4: Income Questions - Set 2
V1 - Paper V2 - Paper V1 - CAI V2 - CAI Subteam Comments


The next few questions are about all types of income, taxable and non-taxable, received in 2019 (from January 1, 2019 to December 31, 2019). The next few question are about all types of income, taxable and non-taxable, received in 2019 (from January 1, 2019 to December 31, 2019).



For income received jointly, report the appropriate share for each person – or, if that’s not possible, report the whole amount for only one person and do not report the income for the other person. For income received jointly, report the appropriate share for each person – or, if that’s not possible, report the whole amount for only one person and do not report the income for the other person.



36a. Did you/<NAME> receive any wages or salary in 2019? 36a. Did you/<NAME> receive any wages or salary in 2019?



If yes: How much did you/<NAME> receive in wages and salary from all jobs before deductions for taxes, bonds, dues or other items? If yes: How much did you receive in wages and salary from all jobs before deductions for taxes, bonds, dues or other items?



36b. Did you/<NAME> receive any commissions, bonuses, or tips in 2019? 36b. Did you/<NAME> receive any commissions, bonuses, or tips in 2019?




If yes: How much did you/<NAME> receive in tips, bonuses, or commissions from all jobs before deductions for taxes, bonds, dues, or other items? If yes: How much did you/<NAME> receive in tips, bonuses, or commissions from all jobs before deductions for taxes, bonds, dues or other items?



36c. Did you/<NAME> receive any self-employment income in 2019? Report income from own businesses (farm or non-farm) including proprietorships and partnerships. 36c. Did you/<NAME> regularly receive any self-employment income in 2019, including work paid for in cash? Report income from own businesses (farm or non-farm) including proprietorships and partnerships.



If yes: What was the amount? Report NET income after business expenses. If yes: What was the amount? Report NET income after business expenses.



36d. Did you/<NAME> receive any interest or dividends in 2019? Report even small amounts credited to an account. 36d. Did you/<NAME> receive any interest or dividends in 2019? Report even small amounts credited to an account.



If yes: What was the amount? If yes: What was the amount?



36e. Did you/<NAME> receive any net rental income in 2019? Net rental income is the total amount after expenses. 36e. Did you/<NAME> receive any net rental income in 2019? Net rental income is the total amount after expenses.



If yes: What was the net amount? If yes: What was the net amount?



36f. Did you/<NAME> receive any royalty income or income from estates and trusts in 2019? 36f. Did you/<NAME> receive any royalty income or income from estates and trusts in 2019?



If yes: What was the amount? If yes: What was the amount?



36g. Did you/<NAME> receive any Social Security or Railroad Retirement benefits in 2019? 36g. Did you/<NAME> receive any Social Security or Railroad Retirement benefits in 2019?



If yes: What was the amount? If yes: What was the amount?



36h. Did you/<NAME> receive any Supplemental Security Income (SSI) payments in 2019? 36h. Did you/<NAME> receive any Supplemental Security Income (SSI) payments in 2019?



If yes: What was the amount? If yes: What was the amount?



36i. Did you/<NAME> receive public assistance or public welfare payments from the state or local welfare office in 2019? 36i. Did you/<NAME> receive any financial assistance from the state or local welfare office in 2019?



If yes: What was the amount? Do not include SSI. If yes: What was the amount? Do NOT include non-cash benefits, such as energy or housing assistance, The Food Stamp Program, or SNAP.



36j. Did you/<NAME> receive any survivor or disability income in 2019? 36j. Did you/<NAME> receive any survivor or disability income in 2019?



If yes: What was the amount? Do not include Social Security. If yes: What was the amount? Do not include Social Security.



36k. Did you/<NAME> receive a pension or any retirement income from a previous employer or union, or any regular withdrawals or distributions from retirement accounts such as 401(k), 403(b), IRA, Roth IRA, or other accounts designed specifically for retirement in 2019? 36k. Did you/<NAME> receive a pension or any retirement income from a previous employer or union, or any regular withdrawals or distributions from retirement accounts such as 401(k), 403(b), IRA, Roth IRA, or other accounts designed specifically for retirement in 2019?






If yes: What was the amount? Do not include Social Security. If yes: What was the amount? Do not include Social Security.







36L. Did you/<NAME> receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support, or alimony in 2019? 36L. Did you/<NAME> receive income on a REGULAR basis from any other sources such as Department of Veterans Affairs (VA) payments, unemployment compensation, child support, or alimony in 2019?







If yes: What was the amount from all sources? Do not include lump sum payments such as money from an inheritance or sale of a home. If yes: What was the amount from all sources? Do not include lump sum payments such as money from an inheritance or sale of a home.







36m. What is the best estimate of the TOTAL income you/<NAME> received from all sources in 2019? 36m. What is your best estimate of the TOTAL income you/<NAME> received from all sources in 2019?







If yes: What was the amount? Do not include SSI.

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