Annual Social and Economic Supplement to the Current Population Survey

Attachment A

2018 Annual Social and Economic Supplement
Items Booklet - Feb/March/April 2018

2018 ANNUAL SOCIAL AND ECONOMIC SUPPLEMENT
CPS FIELD REPRESENTATIVE / CATI INTERVIEWER

ITEMS BOOKLET

This document does not contain any Title 13 data or other Personally Identifiable
Information. All data are fictitious and any resemblance to actual data is coincidental.
Consistent with Field Division Policy, any names referenced in practice interviews or other
exercises are not meant to refer to any actual businesses, schools, group quarters, or
persons, especially any current or former Census Bureau employees.

Table of Contents
1

BASIC CPS ITEMS ........................................................................................................................................... 3
1.1
1.2
1.3

MOVER ITEMS .............................................................................................................................................3
FAMILY INCOME .........................................................................................................................................3
INCDKR........................................................................................................................................................3

2

INTRODUCTION AND WORK EXPERIENCE ...................................................................................................... 4

3

EARNED INCOME ......................................................................................................................................... 10

4

INCOME SOURCES ....................................................................................................................................... 23
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
4.13
4.14
4.15
4.16
4.17
4.18
4.19

5

UNEMPLOYMENT AND WORKERS COMPENSATION (SOURCE)...................................................................25
SOCIAL SECURITY (SOURCE) ........................................................................................................................27
SOCIAL SECURITY FOR CHILDREN (SOURCE) ................................................................................................28
SUPPLEMENTAL SECURITY INCOME (SSI) (SOURCE) ....................................................................................29
SUPPLEMENTAL SECURITY INCOME FOR CHILDREN(SSI) (SOURCE) ............................................................30
DISABILITY INCOME (SOURCE) ....................................................................................................................31
VETERANS PAYMENTS (SOURCE) ................................................................................................................33
SURVIVOR BENEFITS (SOURCE) ...................................................................................................................34
PUBLIC ASSISTANCE (SOURCE) ....................................................................................................................35
FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (SOURCE) ...........................36
PENSIONS (SOURCE) ...................................................................................................................................37
ANNUITIES (SOURCE)..................................................................................................................................39
RETIREMENT ACCOUNTS (SOURCE)............................................................................................................39
INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT (SOURCE) .........................................................41
PROPERTY INCOME (SOURCE) ....................................................................................................................42
EDUCATION ASSISTANCE (SOURCE) ...........................................................................................................43
CHILD SUPPORT (SOURCE) ..........................................................................................................................44
REGULAR FINANCIAL ASSISTANCE (SOURCE)..............................................................................................45
OTHER MONEY INCOME (SOURCE).............................................................................................................45

INCOME AMOUNTS ..................................................................................................................................... 46
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
5.12
5.13
5.14
5.15
5.16
5.17
5.18
5.19
5.20
5.21
5.22

UNEMPLOYMENT AND WORKER’S COMPENSATION (AMOUNTS) ..............................................................46
SOCIAL SECURITY (AMOUNTS) ....................................................................................................................53
SOCIAL SECURITY DISABILITY (AMOUNTS) ..................................................................................................55
SOCIAL SECURITY FOR CHILDREN (AMOUNTS) ............................................................................................58
SUPPLEMENTAL SECURITY INCOME (SSI) (AMOUNTS) ................................................................................60
SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (AMOUNTS) ...............................................................62
DISABILITY INCOME (AMOUNTS) ................................................................................................................64
VETERANS PAYMENTS (AMOUNTS) ............................................................................................................67
SURVIVOR BENEFITS – AMOUNTS ...............................................................................................................71
PUBLIC ASSISTANCE (AMOUNTS) ................................................................................................................76
FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (AMOUNTS) ........................78
PENSIONS (AMOUNTS) ...............................................................................................................................80
ANNUITIES (AMOUNTS) ..............................................................................................................................83
WITHDRAWALS/DISTRIBUTIONS FROM RETIREMENT PLAN (AMOUNTS)...................................................85
INTEREST/DIVIDENDS ON RETIREMENT ACCOUNTS(AMOUNTS) ..............................................................89
INTEREST/DIVIDENDS ON NON- RETIREMENT ACCOUNTS (AMOUNTS).....................................................91
PROPERTY INCOME (AMOUNTS) .................................................................................................................93
EDUCATIONAL ASSISTANCE (AMOUNTS) ...................................................................................................95
CHILD SUPPORT (AMOUNTS) ......................................................................................................................98
REGULAR FINANCIAL ASSISTANCE (AMOUNTS) ........................................................................................100
OTHER MONEY INCOME (AMOUNTS) .......................................................................................................101
CONTRIBUTIONS TO RETIREMENT ACCOUNTS (AMOUNTS) .....................................................................103

6

HEALTH INSURANCE .................................................................................................................................. 104
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9

INTRODUCTION TO HEALTH INSURANCE SECTION .................................................................................104
CURRENT COVERAGE ..............................................................................................................................104
TYPE OF COVERAGE ................................................................................................................................105
MONTHS OF COVERAGE .........................................................................................................................111
OTHER HOUSEHOLD MEMBERS ..............................................................................................................114
ADDITIONAL PLANS.................................................................................................................................115
EMPLOYER-SPONSORED INSURANCE OFFERS AND TAKEUP ...................................................................116
HEALTH STATUS ......................................................................................................................................117
MEDICAL EXPENDITURES ........................................................................................................................117

7

EMPLOYER’S PENSION PLAN ...................................................................................................................... 119

8

LOW INCOME ITEMS .................................................................................................................................. 119
8.1
8.2
8.3
8.4

9

MIGRATION ............................................................................................................................................... 122
9.1

10

SCHOOL LUNCHES ...................................................................................................................................119
PUBLIC HOUSING ....................................................................................................................................120
WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC) .........................................................120
ENERGY ASSISTANCE...............................................................................................................................121
1- YEAR MIGRATION ....................................................................................................................................122

SUPPLEMENTAL POVERTY MEASURE ......................................................................................................... 127
10.1
10.2
10.3

PROPERTY VALUE/PRESENCE OF MORTGAGE ....................................................................................127
CHILD CARE ........................................................................................................................................127
CHILD SUPPORT PAID .........................................................................................................................129

2

1 BASIC CPS ITEMS
1.1 MOVER ITEMS
HH32b
Did (you/name of reference person) live at this address during the week of
November 19, 2017?
1
2

Yes
No

HH32d
Did any of the following household members live here during the week of
November 19, 2017?
1
2

Yes
No

1.2 FAMILY INCOME
S_FAMINC
Which category represents the total combined income of all members of this
FAMILY during the past 12 months?
This includes money from jobs, net income from business, farm or rent, pensions,
dividends, interest, social security payments and any other money income received
by members of this family who are 15 years of age or older?
1
2
3
4
5
6
7
8

Less than $5,000
5,000 to 7,499
7,500 to 9,999
10,000 to 12,499
12,500 to 14,999
15,000 to 19,999
20,000 to 24,999
25,000 to 29,999

9
10
11
12
13
14
15
16

30,000 to 34,999
35,000 to 39,999
40,000 to 49,999
50,000 to 59,999
60,000 to 74,999
75,000 to 99,999
100,000 to 149,000
150,000 to more

1.3 INCDKR
Is the combined income of all members of this FAMILY during the past 12 months
above or below $75,000?
1
2

Above
Below
3

2 INTRODUCTION and WORK EXPERIENCE
Pr_incom
?[F1] Importance of responding
Wording of introduction is optional.
The questions you just answered were about your job and economic status last week.
The next set of questions ask about your job and economic status last year.
1

Enter 1 to Continue

Q29a
Did (name/you) work at a job or business at any time during 2017?
1
2

Yes
No

Q29b
Did (you/he/she) do any temporary, part-time, or seasonal work even
for a few days during 2017?
Include any Military Reserves or National Guard work.
1
2

Yes
No

Q30
Even though (name/you) did not work in 2017, did (you/he/she) spend any time
trying to find a job or on layoff?
1
2

Yes
No

Q31
How many different weeks (was/were) (name/you) looking for work or on layoff
from a job?
(01-52) Number of weeks
________________
4

Q32
What was the main reason (you/he/she) did not work in 2017?
Read categories if necessary
1
2
3
4
5
6

Ill, or disabled and unable to work
Retired
Taking care of home or family
Going to school
Could not find work
Doing something else

Q33
During 2017 in how many weeks did (name/you) work even for a few hours?
Include paid vacation and sick leave as work.
(01-52) Number of weeks
Enter 97 if respondent can only answer in months
________________
Q33mon
Enter number of months worked
(1-12)
________________
Q33ver
Then (name/you) worked about (number) weeks. Is that correct?
1
2

Yes
No – back to Q33 and obtain estimate

Q35
Did (name/you) lose any full weeks of work in 2017 because (you/he/she)
(were/was) on layoff from a job or lost a job?
Number of weeks worked in 2017: (number)
1
2
7

Yes
No
Mistake made in number of weeks worked last year - Specify in Q35SP

Q35SP
5

Specify mistake made in number of weeks worked last year
_________________________________________________
Q36
You said (name/you) worked about (number) (week/weeks).
How many OF THE REMAINING (number) WEEKS (was/were)
(you/he/she) looking for work or on layoff from a job?
Enter 0 for none
________________
Q37
Were the (number) weeks (name/you) (was/were) looking for work or on layoff all in
one stretch?
1
2
3

Yes – one stretch
No – two stretches
No – 3 or more stretches

Q38
What was the main reason (name/you) (was/were) not working or looking for work
in the remaining weeks of 2017?
Read list only if respondent is having difficulty answering the question
1
2
3

Ill, or disabled and unable to work
Taking care of home or family
Going to school

4
5
6

Retired
No work available
Other (Specify - Q38sp)

Q38sp
Enter verbatim response
_________________________________________________
Q39
For how many employers did (name/you) work in 2017?
If more than one at the same time, only count it as one employer.
1
2
3

One
Two
Three or more

Q41
6

In the (one week/weeks) that (name/you) worked, how many hours did (you/he/she)
(work that week?/usually work per week?)
Enter number of hours
_______________
Q43
During 2017, were there one or more weeks in which (name/you) worked less than
35 hours?
Exclude time off with pay because of holidays, vacation, days off, or sickness.
1
2

Yes
No

Q44
In the weeks that (name/you) worked, how many weeks did (name/you) work less
than 35 hours in 2017?
Number of weeks worked in 2017: (number)
(Number of weeks was reported in item Q33)
(1-52)
________________
Q45
What was the main reason (name/you) worked less than 35 hours per week?
Read list only if respondent is having difficulty answering the question
1
2
3
4

Could not find a full time job
Wanted to work part time or only able to work part time
Slack work or material shortage
Other reason

Q46
What was (name's/your) longest job during 2017?
Was it:
(IO1NAM:) (name of employer)
(IO1IND:) (kind of business or industry)
(IO1OCC:) (occupation)
(IO1DT:) (duties)
7

CLASS OF WORKER: (PRIVATE/ FEDERAL GOVERNMENT/ STATE
GOVERNMENT/ LOCAL GOVERNMENT/WORKING WITHOUT PAY IN
FAMILY BUS./ SELF EMPLOYED--INCORPORATED/ SELF EMPLOYED-UNINCORPORATED)
1
2

Same as listed
Different job

Q47a
For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job
during 2017?))
Name of Company, business, organization or other employer
(blank/ IO1NAM:) (entry)
The current employer is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/ If longest job last year is military job, enter Armed Forces)
(blank/ Enter N for no work done at all during 2017)
_________________________________________________
Q47b
What kind of business or industry is this?
For example: TV and radio manufacturing, retail shoe store, farm
(blank/ IO1IND:) (entry)
The current business or industry type is pre-filled in the Form Pane below. Press ENTER
if Same)
(blank/ If longest job last year is military job, enter NA)
_________________________________________________
Q47b1
Is this business or organization mainly manufacturing, retail trade, wholesale trade,
or something else?
(blank/ IO1MFG:) (entry)
The current business or organization type is pre-filled in the Form Pane below. Press
ENTER if Same)
(blank/ If longest job last year is military job, enter 4)
1
2

Manufacturing
Retail trade
8

3
4

Wholesale trade
Something else

Q47c
What kind of work (was/were) (you/he/she) doing?
For example: Electrical Engineer, Stock Clerk, Typist
(blank/ IO1OCC:) (entry)
The current occupation is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/ If longest job last year is military job, enter Armed Forces)
_________________________________________________
Q47d1
What were (your/his/her) most important activities or duties?
For example: Types, keeps account books, files, sells cars, operates printing press,
finishes concrete.
(blank/ IO1DT:) (entry)
The current job description is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/ If longest job last year is military job, enter NA)
_________________________________________________
Q47d2
What were (your/his/her) most important activities or duties?
For example: Types, keeps account books, files, sells cars, operates printing press,
finishes concrete.
(blank/ IO1DT:) (entry)
The current job description is pre-filled in the Form Pane below. Press ENTER if Same)
(blank/ If longest job last year is military job, enter NA)
_________________________________________________

Q47E1
Ask Only If Necessary
(Were/Was) (you/he/she) employed by government, by a PRIVATE company, a
nonprofit organization, or (was/were) (you/he/she) self-employed or working in a
family business?
1
2

Government
Private for profit company
9

3
4
5

Non profit organization including tax exempt and charitable organizations
Self employed
Working in family business

Q47E1a
Would that be the federal, state, or local government?
1
2
3

Federal
State
Local (county, city, township)

Q47E1b
Was this business incorporated?
1
2

Yes
No

Q47E1c
(Were/Was) (you/name) the owner of the business?
1
2

Yes
No

Q4788
Counting all locations where (this employer/(name/you)) (operates/operate), what is
the total number of persons who work for ((name's/your) employer)/name/you))?
Read categories if necessary
1
2
3
4
5
6

under 10
10-49
50-99
100-499
500-999
1,000+

3 EARNED INCOME
Beginning with the 2015 CPS ASEC, the Earnings and Income question series include
range follow-up questions presented anytime a respondent doesn’t know or refuses to
provide an exact dollar amount for a source they (or someone in the household) indicates
as having received. Follow-up questions allow respondents that do not feel comfortable
giving exact dollar values to report an income range. There are three sets of categories
used for the income range follow-up questions: high-range, mid-range, and low-range.
10

The income range used in the follow-up range questions depends on the source of the
income. See Attachment A to this items booklet for the three levels of income range
follow up questions. See Attachment B for a table that displays the income source and
the range level used for the follow-up questions.
Q48aa
How much did (name/you) earn from this employer before taxes and other
deductions during 2017?
Enter dollar amount
Enter 0 for none
________________
Q48aarn1 Ask only if the respondent “Doesn’t know” or ‘Refused” Q48aa
Could you tell me if (name/you) earned
less than $45,000
between $45,000 and $60,000
or over $60,000
for the TOTAL yearly amount from this employer before taxes and other
deductions during 2017?
1 Less than $45,000
2 Between $45,000 and $60,000
3 Over $60,000
Q48aarn2
Did (name/you) earn
less than $15,000
between $15,000 and $30,000
or over $30,000
from this employer during 2017?
1 Less than $15,000
2 Between $15,000 and $30,000
3 Over $30,000
Q48aap
Read if necessary
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
11

1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q48a1
For how many (weekly/every other week/twice a month/monthly) pay periods did
(name/you) earn (fill from Q48aa) from this employer in 2017?
(1-12/1-24/1-26/1-52)
________________
Q48aC2
Do not read to the respondent.
The annual rate appears out of range. The total annual earnings entered is (amount). Is
this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q48aV
According to my calculations (name/you) earned (total) altogether from this
employer in 2017 before deductions. Does that sound about right?
1
2

Yes
No

Q48a2
What is your best estimate of (name's/your) correct total amount of earnings from
this employer during 2017 before deductions?
PREVIOUS ENTRIES:

Q48aa: (amount)
Q48aap: (periodicity)
Q48a1: (number of pay periods)

Enter dollar amount
________________
Q48a3
Does this amount include all tips, bonuses, overtime pay, or commissions
(name/you) may have received from this employer in 2017?
1
2

Yes
No

Q48aad
12

How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from
this employer in 2017?
Enter dollar amount
________________
Q48aadrn1 Ask only if the respondent “Doesn’t know” or “Refused” Q48aad
Could you tell me if (name/you) earned
less than $1,000
between $1,000 and $3,000
or over $3,000
in tips, bonuses, overtime pay, or commissions from this employer during 2017?
1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000
Q48aadrn2
Did (name/you) earn
less than $100
between $100 and $500
or over $500
in tips, bonuses, overtime pay, or commissions from this employer during 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q48b
What were (name's/your) net earnings from this business/farm after expenses
during 2017?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
________________
Q48b_char
13

Enter “L” for Lost Money
________________
Q48BL
Enter amount of money lost in 2017
Enter annual amount only
________________
Q48brn1 Ask only if the respondent “Doesn’t know” or “Refused” Q48b.
Could you tell me if (name/you) earned
less than $45,000
between $45,000 and $60,000
or over $60,000
for the TOTAL yearly amount from this business/farm after expenses during 2017?
1 Less than $45,000
2 Between $45,000 and $60,000
3 Over $60,000
Q48brn2
Did (name/you) earn
less than $15,000
between $15,000 and $30,000
or over $30,000
from this business/farm after expenses during 2017?
1 Less than $15,000
2 Between $15,000 and $30,000
3 Over $30,000
Q48bp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly
amount?
1
2
3
4
5
7

Weekly
Every other week
Twice a month
Monthly
Quarterly
Yearly
14

Q48B1A
Do not read to the respondent.
The annual rate appears out of range. The total annual business loss entered is (amount).
Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q48B1B
Do not read to the respondent.
The annual rate appears out of range. The total annual business income entered is
(amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q48b2
What is your best estimate of (name's/your) ANNUAL net earnings from this
business/farm after expenses in 2017?
PREVIOUS ENTRIES: Q48b : (amount)
Q48bp: (periodicity)
Enter dollar amount

Q48b2L
What is your best estimate of (name's/your) ANNUAL net LOSS from this
business/farm after expenses in 2017?
PREVIOUS ENTRIES: Q48bL: (amount)
Q48bp: (periodicity)
Enter dollar amount
________________
Q48b3
What were (name's/your) net earnings from this business/farm during the FIRST
quarter of 2017?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is “Lost Money” press enter
Enter dollar amount
________________
Q48b3_char
15

Enter "L" for Lost Money
________________
Q48B3L
Enter amount of money lost in the first quarter of 2017.
________________
Q48b4
What were (name's/your) net earnings from this business/farm during the SECOND
quarter of 2017?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
________________
Q48b4_char
Enter "L" for Lost Money
________________
Q48B4L
Enter amount of money lost in the second quarter of 2017.
________________
Q48b5
What were (name's/your) net earnings from this business/farm during the THIRD
quarter of 2017?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
________________
Q48b5_char
Enter "L" for Lost Money
________________
Q48B5L
Enter amount of money lost in the third quarter of 2017.
16

________________
Q48b6
What were (name's/your) net earnings from this business/farm during the FOURTH
quarter of 2017?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
________________
Q48b6_char
Enter "L" for Lost Money
________________
Q48B6L
Enter amount of money lost in the fourth quarter of 2017.
________________
Q48b7
Does this amount include all tips, bonuses, overtime pay, or commissions
(name/you) may have received from this business in 2017?
1
2

Yes
No

Q48bad
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions
in 2017?
Enter dollar amount
________________
Q48badrn1 Ask only if the respondent “Doesn’t know” or “Refused” Q48bad.
Could you tell me if (name/you) earned
less than $1,000
between $1,000 and $3,000
or over $3,000
in tips, bonuses, overtime pay, or commissions from this business during 2017?
17

1
2
3

Less than $1,000
Between $1,000 and $3,000
Over $3,000

Q48badrn2
Did (name/you) earn
less than $100
between $100 and $500
or over $500
in tips, bonuses, overtime pay, or commissions during 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q49a
Did (name/you) earn money from any other work (you/he/she) did during 2017?
1
2

Yes
No

Q49b1d
How much did (name/you) earn from all other employers before taxes and other
deductions during 2017?
Enter dollar amount
Enter “0” for None
________________
Q49b1drn1 Ask only if the respondent “Doesn’t know” or “Refused” Q48b1d.
Could you tell me if (name/you) earned
less than $10,000
between $10,000 and $20,000
or over $20,000
from all other employers before taxes and other deductions during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
18

Q49b1drn2
Did (name/you) earn
less than $1,000
between $1,000 and $5,000
or over $5,000
from all other employers before taxes and other deductions during 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q49b1p
Read if necessary
Is this a weekly, every other week, twice a month, monthly, or yearly amount?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q49B11
For how many (weekly/every other week/twice a month/monthly) pay periods did
(name/you) earn (fill from Q49b1d) from all other employers in 2017?
(1-12/1-24/1-26/1-52)
________________
Q49B1C
Do not read to the respondent.
The total annual earnings entered from all other employers is (amount). Is this a correct
entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q49B1V
According to my calculations (name/you) earned (total) altogether from all other
employers in 2017. Does that sound about right?
1
2

Yes
No
19

Q49B12
What is your best estimate of (name's/your) correct total amount of earnings from
all other employers during 2017?
PREVIOUS ENTRIES:

Q49b1d: (amount)
Q49b1p: (periodicity)
Q49b11: (number of pay periods)

Enter dollar amount
________________
Q49b13
Does this amount include all tips, bonuses, overtime pay, or commissions
(name/you) may have received from all other employers in 2017?

1
2

Yes
No

Q49B1A
How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from
all other employers in 2017?
Enter dollar amount
________________
Q49B1ARN1 Ask only if the respondent “Doesn’t know” or “Refused” Q49B1A.
Could you tell me if (name/you) earned
less than $1,000
between $1,000 and $3,000
or over $3,000
in tips, bonuses, overtime pay, or commissions from all other employers in 2017?
1 Less than $1,000 (proceed to Q49B1ARN2)
2 Between $1,000 and $3,000
3 Over $3,000
Q49B1ARN2
Did (name/you) receive
20

less than $100
between $100 and $500
or over $500
in tips, bonuses, overtime pay, or commissions from all other employers in 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q49b2
How much did (name/you) earn from (blank/any other businesses of) (your/his/her)
(own/own business) after expenses?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter annual amount only
________________
Q49b2rn1 Ask only if the respondent “Doesn’t know” or “Refused” Q49b2
Could you tell me if (name/you) earned
less than $10,000
between $10,000 and $20,000
or over $20,000
from (blank/any other businesses of) (your/his/her) (own/own business) after
expenses?
1
2
3

Less than $10,000 (proceed to Q49b2rn2)
Between $10,000 and $20,000
Over $20,000

Q49b2rn2
Could you tell me if (name/you) earned
less than $1,000
between $1,000 and $5,000
or over $5,000
from (blank/any other businesses of) (your/his/her) (own/own business) after
expenses?
1

Less than $1,000
21

2
3

Between $1,000 and $5,000
Over $5,000

Q49b2_char
Enter "L" for Lost Money
________________
Q49b3
Enter annual amount lost only
____________
Q49b4
How much did (name/you) earn from (your/his/her) farm after expenses?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost money" press enter
Enter annual amount only
_______________
Q49b4rn1 Ask only if the respondent “Doesn’t know” or “Refused” Q49b4.
Could you tell me if (name/you) earned
less than $10,000
between $10,000 and $20,000
or over $20,000
from (your/his/her) farm after expenses?
1
2
3

Less than $10,000 (proceed to Q49b4rn2)
Between $10,000 and $20,000
Over $20,000

Q49b4rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
from (blank/any other businesses of) (your/his/her) (own/own business) after
expenses?
22

1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

Q49b4_char
Enter "L" for Lost Money
________________
Q49b5
Enter annual amount lost only
________________

4 INCOME SOURCES
In the ASEC income section the order of the questions changes based on the household
composition (Low-income, Householder or Spouse Aged 62 or Older, or Default); see chart on
the following page. All low-income transfer program questions are asked in each interview
regardless of household family income.

23

Default

Householder or Spouse
62 Years +

Low Income

3

Earnings- Person Level
Unemployment/Workers
Compensation
Social Security/SS for
Children
Supplemental Security
Income (SSI)/SSI Children

4

Disability

2

5

Veterans

3

Food Stamps (SNAP)
Social Security/SS for
Children
Supplemental Security
Income (SSI)/SSI Children

6

Survivor Benefits

4

Disability

6

Survivor Benefits

7

Public Assistance / TANF

5

Veterans

9

Pensions

8

Food Stamps (SNAP)

6

Survivor Benefits

10

9

Pensions

9

Pensions

11
12

13

Property Income

12

Annuities
Retirement Accounts (within)
– Withdrawals or
distributions
Other Income Earning Assets
(outside of retirement)

Annuities
Retirement Accounts
(within) –Withdrawals or
distributions
Other Income Earning Assets
(outside of retirement)

1
2

10

1

Earnings- Person Level
Unemployment/Workers
Compensation

1

7

Public Assistance / TANF

2

8

3

Earnings- Person Level
Unemployment/Workers
Compensation
Social Security/SS for
Children
Supplemental Security
Income (SSI)/SSI Children

4

Disability

5

Veterans

12

Annuities
Retirement Accounts (within)
– Withdrawals or
distributions
Other Income Earning Assets
(outside of retirement)

13

Property Income

13

Property Income

14

Education Assistance

14

15

15

16

Child Support
Financial Assistance from
friends or relatives

17

Other Income

11

10

11

7

Public Assistance / TANF

8

Food Stamps (SNAP)

Education Assistance

14

Education Assistance

15

16

Child Support
Financial Assistance from
friends or relatives

16

Child Support
Financial Assistance from
friends or relatives

17

Other Income

17

Other Income

*

Health Insurance

18

Employers Pension Plan

19

School Lunches- no amount collection

20

Public Housing- no amount collection

21

WIC- no amount collection

22

Energy Assistance

24

4.1 UNEMPLOYMENT AND WORKERS COMPENSATION (Source)
Q51A1
At any time during 2017 did (you/anyone in the household) receive any State or
Federal unemployment compensation?
1 Yes
2 No
Q51A1b
Read only if necessary
Who received State or Federal unemployment compensation?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q51A2
At any time during 2017 did (you/anyone in the household) receive any
Supplemental Unemployment Benefits (SUB)?
1 Yes
2 No
Q51A2b
Read only if necessary
Who received Supplemental Unemployment Benefits?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q51A3
At any time during 2017 did (you/anyone in the household) receive any Union
Unemployment or Strike Benefits?
1 Yes
2 No
25

Q51A3b
Read only if necessary
Who received Union Unemployment or Strike Benefits?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q52A
During 2017 did (you/anyone in the household) receive any Worker’s Compensation
payments or other payments as a result of a job related injury or illness?
Exclude sick pay and/or disability retirement.
1 Yes
2 No
Q52Ab
Read only if necessary
Who received Worker’s Compensation or payments as a result of a job related
injury or illness?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Exclude those who received sick pay and/or disability retirement.
Enter persons line number (1-16)
Q52b
What was the source of (your/name’s Fill Q52Ab) payments?
Read Categories if necessary
1 State Worker's Compensation
2 Employer or employer's insurance worker’s compensation
3 Own insurance worker’s compensation
4 Other
Q52Cs1
26

Specify other source from workers compensation/insurance
Enter "Worker’s Compensation" if the answer is "Don't Know"
________________________________________________

4.2 SOCIAL SECURITY (Source)
Q56a
During 2017 did (you/ anyone in this household) receive any Social Security
payments from the U.S. Government?
1 Yes
2 No
Q56b
Read only if necessary
Who received Social Security payments either for themselves or as combined
payments with other family members?
Enter Line Number Of Parent Or Guardian For Payments Made To Children Under
Age 15
Enter all that apply, separate using the space bar or a comma.
Enter persons line number (1-16)
SSR
What were the reasons (name/you) (was/were) getting Social Security in 2017?
Mark all that apply
Probe: Any Other Reason?
1
2
3
4
5
6
7
8

Retired
Disabled
Widowed
Spouse
Surviving child
Dependent child
On behalf of surviving, dependent, or disabled children
Other

SSRs
27

Specify other reason
________________________________________________
SSC
Which children under age 15 were receiving Social Security in 2017?
Probe: Anyone Else?
Enter all that apply, separate by commas.
Enter 0 if none listed
Enter persons line number (1-16)
SSCR
What were the reasons (Child’s name/the children) (was/were) getting Social
Security in 2017?
Mark all that apply
Probe: Any Other Reason?
1
2
3
4

Disabled child
Surviving child
Dependent child
Other

SSDIa1
Did (name/you) receive (your/his/her) first Social Security Disability payment in
2017?
1 Yes
2 No

4.3 SOCIAL SECURITY FOR CHILDREN (Source)
Q56f
Did anyone in this household receive any Social Security income in 2017 that we
have not already counted on behalf of children in this household?
Includes all children under 19 years of age
Social Security Income previously reported will appear here
LN
1

Name

Amount reported in Q56d amount

Yes
28

2

No

Q56g
Read only if necessary
Who received these Social Security payments?
Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SSC-R
Which children under age 19 were receiving Social Security in 2017?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)
SSCR
What were the reasons (Child's name/the children) (was/were) getting Social
Security in 2017?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1 Disabled child/children
2 Surviving child/children
3 Dependent child/children
4 Other

4.4 SUPPLEMENTAL SECURITY INCOME (SSI) (Source)
Q57a
During 2017 did (you/ anyone in this household) receive:
any SSI payments, that is, Supplemental Security Income?
Note: SSI are assistance payments to low-income aged, blind and disabled persons,
and come from state or local welfare offices, the Federal government, or both.
29

1
2

Yes
No

Q57b
Read only if necessary
Who received SSI?
Supplemental Security Income
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
SSIR
What were the reasons (name/you) (was/were) getting Supplemental Security
Income in 2017?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3
4
5

Disabled
Blind
On behalf of a disabled child
On behalf of a blind child
Other ________________

4.5 SUPPLEMENTAL SECURITY INCOME FOR CHILDREN(SSI)
(Source)
Q57d
Did anyone in this household receive any Supplemental Security Income in 2017
that we have not already counted on behalf of children in this household?
Includes all children under 18 years of age
SSI previously reported will appear here

1
2

LN Name
Yes
No

Amount for Q57C amount

Q57e
Read only if necessary
30

Who received these Supplemental Security Income payments?
Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
RSSI
What were the reasons (name/you) (was/were) getting Supplemental Security
Income on behalf of children in 2017?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1
2
3

On behalf of a disabled child/children
On behalf of a blind child/children
Other ________________

CSSI
Which children under age 18 were receiving Supplemental Security Income
in 2017?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

4.6 DISABILITY INCOME (Source)
Q59AR
At any time in 2017 (did you/did anyone in the household) have a disability or health
problem which prevented (you/them) from working, even for a short time, or which
limited the work (you/they) could do?
1
2

Yes
No

Q59b
Read only if necessary
31

Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q60a
(Did you/Is there anyone in this household who) ever (retire or leave/ retired or left)
a job for health reasons?
1
2

Yes
No

Q60b
Read only if necessary
Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q61b
Did (you/name) receive any disability income in 2017 as a result of (your/his/her)
disability or health problem (other than Social Security Disability/other than VA
benefits/ other than Social Security Disability or VA Benefits)?
1
2

Yes
No

Q61C
What was the source of this income?
Asking About: (name) (blank/- -CURRENT RESPONDENT)
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
2 Worker’s compensation
3 Company or union disability
4 Federal Government (CIVIL SERVICE) disability
5 U.S. Military retirement disability
6 State or Local government employee disability
7 U.S. Railroad retirement disability
32

8
9
10
11

Accident or disability insurance
Black Lung miner’s disability
State temporary sickness
Other or don’t know – Specify – Enter last

Q61Cs1
Specify other source from health problem or disability
Enter "Other Health Problem/Disability" if the answer is "Don't Know"
_____________________________________________

4.7 VETERANS PAYMENTS (Source)
Q60A88
At any time during 2017 did (you/anyone in this household) receive:
Any Veterans’ (VA) payments?
Include assistance received by children of veterans
1 Yes
2 No
Q60b_88
Read only if necessary
Who received Veterans’ (VA) payments either for themselves or as combined
payments with other family members?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q60C8
What type of Veterans' payment did (name/you) receive?
Read list only if respondent is having difficulty answering the question.
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Payments?
1
2
3
4

Service-connected disability compensation
Survivor Benefits
Veterans’ Pension
Educational assistance (including assistance received by children of veterans)
33

5

Other Veterans’ payments ________________

Q60D88
(Are/Is) (name/you) required to fill out an annual income questionnaire for the
Department of Veterans' Affairs?
1 Yes
2 No

4.8 SURVIVOR BENEFITS (Source)
Q58a
Did (you/ anyone in this household) receive any survivor benefits in 2017 such as
widow’s pensions, estates, trusts, insurance annuities, or any other survivor benefits
(other than Social Security/ other than VA benefits/ other than Social Security or
VA benefits)?
1 Yes
2 No
Q58b
Read only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q58C
What was the source of this income?
Asking About: (name/name- -CURRENT RESPONDENT)
Read list if respondent is having difficulty answering the question
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Source?
2
3
4
5
6
7
8

Company or union survivor pension (INCLUDE PROFIT SHARING)
Federal Government survivor (CIVIL SERVICE) pension
U.S. Military retirement survivor pension
State or Local government survivor pension
U.S. Railroad retirement survivor pension
Worker's compensation survivor pension
Black Lung survivor pension
34

9
10
11

Regular payments from estates or trusts
Regular payments from annuities or paid-up insurance policies
Other or don't know (SPECIFY) - ENTER LAST

Q58Cs1
Specify other source of income as survivor or widow
Enter "Survivor Benefits" if the answer is "Don't Know"
________________________________________________

4.9 PUBLIC ASSISTANCE (Source)
Q59A88
At any time during 2017, even for one month, did (you/ anyone in this household)
receive any CASH assistance from a state or county welfare program such as
(State Program Name)?
Include cash from:
Welfare or welfare to work
TANF
General Assistance
Diversion payments
Refugee Cash
Gen Assist Indian Affairs

1
2

Don’t include:
Food stamps (SNAP)
AFDC/Aid to Families SSI
Energy assistance
WIC
School meals
Childcare
Education Assistance

Yes
No

Q59A89
Just to be sure, in 2017, did anyone receive CASH assistance from a state or county
welfare program, on behalf of CHILDREN in the household?
1 Yes
2 No
Q59b_88
Who received this CASH assistance?
Enter line number
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
35

Q59C8r
From what type of program did (name/you) receive the CASH assistance? Was it a
welfare or welfare to-work program such as (STATE PROGRAM NAME), General
Assistance, Emergency Assistance, Diversion payments or some other program?
Enter all that apply
Probe: Any Other Program?
1
2
3
4
5
6
7

(State Program Name)/Temporary Assistance to Needy Families (TANF)/
welfare/AFDC
General Assistance
Emergency Assistance/short-term cash assistance
Diversion Payments
Refugee Cash and Medical Assistance program
General Assistance from Bureau of Indian Affairs, or Tribal Administered General
Assistance
Some other program (specify)

(If respondent mentions any of the following categories 7 through 12, note this, but
explain: “Right now we are interested in CASH assistance” and seek answers using
the accepted categories:
Food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits
SSI
Energy assistance
WIC
School meals
Transportation, childcare, rental or education assistance
Q59C8s
What was the name of the other program?
Specify other source of cash assistance
Enter "Cash" if the answer is "Don't Know"
_________________________________________________

4.10 FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE
PROGRAM (SNAP) (Source)
Q87r
At any time during 2017, did (you/ anyone in this household) receive benefits from
SNAP (the Supplemental Nutritional Assistance Program) or the Food Stamp
program, or use a SNAP or food stamp benefit card?
36

Do not include WIC benefits.
1 Yes
2 No
Q87ar
At any time during 2017, even for one month, did (you/ anyone in this household)
receive any food assistance from (State Program name)?
Do not include WIC benefits.
1 Yes
2 No
Q88
Which of the people now living here were covered by that food assistance
during 2017?
List all household members covered by food assistance regardless of age
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Probe: Anyone else?
Enter persons line number (1-16)

4.11 PENSIONS (Source)
Q62Ar
During 2017 did (you/ anyone in this household) receive any pension income from a
previous employer or union, (other than Social Security/ other VA benefits/ other
than Social Security or VA benefits)?
PLEASE DO NOT INCLUDE DISTRIBUTIONS OR WITHDRAWALS FROM
IRAs, 401(k)s, OR SIMILAR ACCOUNTS!
1 Yes
2 No
Q62b
Read only if necessary
Who received pension or retirement income?
37

Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q62Cra
Was (name's/your) pension income from a:
Company or union pension (include profit sharing)?
Enter all that apply, separate using the space bar or a comma.
If “Yes,” probe to identify which source
1 Company Pension
2 Union Pension
3 Neither
Q62Crb
Was (name's/your) pension income from a:
Federal, State or Local Government pension?
Enter all that apply, separate using the space bar or a comma.
If “Yes,” probe to identify which source
1
2
3
4

Federal Government Pension
State Government Pension
Local Government Pension
None of the above

Q62Crc
Was (name's/your) pension income from:
a U.S Military pension?
1 Yes
2 No
Q62Crd
Did (you/name) receive pension income from some other source?
1 Yes
2 No
38

Q62Dr
What was the source of (name's/your) pension income?
Enter all that apply
Probe as needed: Who received this source?
Probe: Any Other pension income?
1 U.S. Railroad Retirement
2 Other sources or don’t know – Specify –
Enter other source of pension income
_____________________________________________
Q62Cs1
Specify other source of pension income
Enter "Other Pension" if the answer is "Don't Know"
_________________________________________________

4.12 ANNUITIES (Source)
Q96Ar
During 2017 did (you/ anyone in this household) receive any income from an
annuity?
1 Yes
2 No
Q96Br
Read only if necessary
Who received annuity income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)

4.13 RETIREMENT ACCOUNTS (Source)
Q97Ar

39

At any time during 2017 did (you/ anyone in this household) have any retirement
accounts such as a 401(k), 403(b), IRA, or other account designed specifically for
retirement savings?
1 Yes
2 No
Q97Br
Read only if necessary
Who had such a retirement account?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q97Cr
What type of retirement account (did you/ NAME) have? Did (you/he/she) have…
READ EACH CATEGORY!
Enter all that apply, separate using the space bar or a comma.
1.
2.
3.
4.

401(k)
403(b)
Roth IRA
Regular IRA

5. KEOGH plan (“KEE-OH”)
6. SEP plan (Simplified Employee Pension)
7. another type of retirement account

Q97Dr
What was the source of (name's/your) retirement income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Probe: Any Other retirement income?
Enter other source of retirement income
_____________________________________________
Q98Ar
Did (you/NAME) withdraw any money or receive a distribution from (your/his/her)
[ACCOUNT TYPE_ FILL IN FROM Q97CR or Q97DR] account in 2017?
(IF AGE 70+ ADD: including distributions you may have been required to take?)
40

1 Yes
2 No

4.14 INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT
(Source)
Q99ArA
IF ANY RETIREMENT ACCOUNTS IN HH, READ TRANSITION:
(Now I will ask about assets that may have paid interest or dividends in 2017 outside
of the retirement account(s).)
At anytime during 2017, did (you/anyone in this household):
Have money in an interest-earning checking account?
1 Yes (
2 No

Probe as needed: Who received this source?)

Q99ArB
At anytime during 2017, did (you/anyone in this household):
Have a savings account?
1 Yes (
2 No

Probe as needed: Who received this source?)

Q99ArC
At anytime during 2017, did (you/anyone in this household):
Have a money-market fund?
1 Yes (
2 No

Probe as needed: Who received this source?)

Q99ArD
At anytime during 2017, did (you/anyone in this household):
Have CDs (certificates of deposit)?
1 Yes (
2 No

Probe as needed: Who received this source?)
41

Q99ArE
At anytime during 2017, did (you/anyone in this household):
Have Savings bonds?
1 Yes (
2 No

Probe as needed: Who received this source?)

Q99ArF
At anytime during 2017, did (you/anyone in this household):
Have shares of stock in corporations or mutual funds?
1 Yes (
2 No

Probe as needed: Who received this source?)

Q99ArG
Any other savings or investments that pay interest or dividends?
1 Yes
2 No
CAPGDIS
Did (you/NAME) receive any capital gains from (your/his/her) shares of stocks or
mutual funds in 2017?
1 Yes
2 No
Q99Br
What was the other source of (name's/your) the savings or investments that pay
interest or dividends?
Enter all that apply
Probe as needed: Who received this source?
Enter other source of retirement income
_____________________________________________

4.15 PROPERTY INCOME (Source)
Q65A1
42

During 2017 did (you/ anyone in this household):
Own any land, business property, apartments, or houses which were rented to
others?
1
2

Yes
No

Q65A2
At anytime during 2017 did (you/ anyone in this household):
Receive income from royalties or from roomers or boarders? (exclude amounts paid
by relatives)
1
2

Yes
No

Q65A3
At anytime during 2017 did (you/ anyone in this household):
Receive income from estates or trusts? (exclude estates or trusts already reported)
1
2

Yes
No

Q65b
Ask only if necessary
Who received this (income/rent) ?
Include each in cases of joint ownership. For self-employed persons, determine if
income was already included
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)

4.16 EDUCATION ASSISTANCE (Source)
Q66a
During 2017 did (you/ anyone in this household) attend school beyond the high school
level including a college, university, or other schools?
(include vocational, business, or trade schools)
1
2

Yes
No
43

Q66b
Did (you/ anyone in this household) receive any educational assistance for tuition,
fees, books, or living expenses during 2017?
Exclude loans, assistance from household members, and VA educational
benefits
1
2

Yes
No

Q66c
Ask only if necessary
Which member received assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q66d
What type of assistance did (name/you) receive?
Exclude assistance from household members
Enter all that apply, separate using the space bar or a comma.
Probe: Any other assistance?
2 Pell Grant
3 Assistance from a welfare or social service office
4 Some other government assistance
5 Scholarships, grants, etc.
6 Other assistance (employers, friends, etc.)

4.17 CHILD SUPPORT (Source)
Q70a
During 2017 did (you/ anyone in this household) receive:
Any child support payments?
1
2

Yes
No

Q70b
44

Read only if necessary
Who received these payments?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)

4.18 REGULAR FINANCIAL ASSISTANCE (Source)
Q72a
Any regular financial assistance from friends
or relatives not living in this household?
Do not include loans
1
2

Yes
No

Q72b
Read only if necessary
Who received this assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)

4.19 OTHER MONEY INCOME (Source)
Q73A1R
During 2017 did (you/ anyone in this household) receive cash income not already
covered such as:
income from foster child care, alimony, jury duty, armed forces reserves, severance
pay, hobbies, or any other source?
1
2

Yes
No

Q73A1b
45

Ask only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Enter persons line number (1-16)
Q73A1Rc1
What was the source of this income?
Asking about: (fill from Q73A1b)
Do not read answer list to respondent
1 Alaska Permanent Fund Dividend
2 Other sources or don’t know – Specify –
Q73A1Rc
Specify other source of income
Asking about: (fill from Q73A1b)
_________________________________________________

5 INCOME AMOUNTS
AMTINTRO
Now I will ask you about the amount of income you and others in this household
received from various sources in 2017.

5.1 UNEMPLOYMENT AND WORKER’S COMPENSATION (Amounts)
Q51A1p
What is the easiest way for you to tell us (name's/your) State or Federal
unemployment compensation; weekly, every other week, twice a month, monthly, or
yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
46

Q51A11
How much did (name/you) receive (weekly/every other week/ twice a
month/monthly/ ) in State or Federal unemployment compensation during 2017?
Enter dollar amount
________________
Q51A11r1
Could you please tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in State or Federal unemployment compensation during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q51A11r2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in State or Federal unemployment compensation during 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q51A1C
Do not read to the respondent.
The annual rate appears out of range. The total State or Federal unemployment
compensation received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q51A12
How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive from State or Federal unemployment compensation during
2017?
47

(1-12/1-24/1-26/1-52)
________________
Q51A13
According to my calculations (name/you) received (total) altogether from State or
Federal unemployment compensation during 2017. Does that sound about right?
1
2

Yes
No

Q51A14
What is your best estimate of the correct total amount (name/you) received from
State or Federal unemployment compensation during 2017?
PREVIOUS ENTRIES: Q51A11: (amount)
Q51A1p: (periodicity)
Q51A12: (number of pay periods)
Enter dollar amount
________________
Q51A2p
What is the easiest way for you to tell us (name's/your) Supplemental
Unemployment Benefits; weekly, every other week, twice a month, monthly, or
yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q51A21
How much did (name/you) receive (weekly/every other week/twice a
month/monthly/ ) in Supplemental Unemployment Benefits during 2017?
Enter dollar amount
_____________
Q51A21r1
Could you tell me if (name/you) received
less than $10,000
48

between $10,000 and $20,000
or over $20,000
in Supplemental Unemployment Benefits during 2017?
1
2
3

Less than $10,000
Between $10,000 and $20,000
Over $20,000

Q51A21r2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in Supplemental Unemployment Benefits during 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q51A2C
Do not read to the respondent.
The annual rate appears out of range. The total Supplemental Unemployment Benefits
received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If
No, press enter and correct entry.
Q51A22
How many (weekly/every other week/twice a month/ monthly) payments did
(name/you) receive from Supplemental Unemployment Benefits during 2017?
(1-12/1-24/1-26/1-52)
________________
Q51A23
According to my calculations (name/you Fill) received (total) altogether from
Supplemental Unemployment Benefits during 2017. Does that sound about right?
1
2

Yes
No

Q51A24
49

What is your best estimate of the correct total amount (name/you) received from
Supplemental Unemployment Benefits during 2017?
PREVIOUS ENTRIES: Q51A21: (amount)
Q51A2p: (periodicity)
Q51A22: (number of pay periods)
Enter dollar amount
________________
Q51A3p
What is the easiest way for you to tell us (name's/your) Union Unemployment or
Strike Benefits; weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q51A31
How much did (name/you) receive (weekly/every other week/ twice a
month/monthly/ ) in Union Unemployment or Strike Benefits during 2017?
Enter dollar amount
________________
Q51A31r1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in Union Unemployment or Strike Benefits during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q51A31r2
Did (name/you) receive
less than $1,000
50

between $1,000 and $5,000
or over $5,000
in Union Unemployment or Strike Benefits during 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

C251A3
Do not read to the respondent.
The annual rate appears out of range. The total Union Unemployment or Strike Benefits
received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If
No, press enter and correct entry.
Q51A32
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive from Union Unemployment or Strike Benefits during 2017?
(1-12/1-24/1-26/1-52)
________________
Q51A33
According to my calculations (name/you) received (total) altogether from Union
Unemployment or Strike Benefits during 2017. Does that sound about right?
1
2

Yes
No

Q51A34
What is your best estimate of the correct total amount (name/you) received from
Union Unemployment or Strike Benefits during 2017?
PREVIOUS ENTRIES: Q51A31: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount
________________
Q52cp
What is the easiest way for you to tell us (your/name’s) (Fill Q52b or Q52Cs1);
weekly, every other week, twice a month, monthly, or yearly?
51

1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q52c1
How much did (name/you) receive (weekly/every other week/twice a
month/monthly) in (Fill Q52b or Q52Cs1) during 2017?
Enter dollar amount
________________
Q52cr1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (Fill Q52b or Q52Cs1) during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q52cr2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (Fill Q52b or Q52Cs1) during 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q52cC2
Do not read to the respondent.
The annual rate appears out of range. The total worker's compensation received in 2017
52

was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q52c2
How many (weekly/every other week/twice a month/monthly) payments did
(name/you) receive from (Fill Q52b or Q52Cs1) during 2017?
(1-12/1-24/1-26/1-52)
________________
Q52c3
Then (name/you) received (total) altogether from (Fill Q52b or Q52Cs1) during
2017. Does that sound about right?
1
2

Yes
No

Q52c4
What is your best estimate of the correct total amount (name/you)
received from (Fill Q52b or Q52Cs1) during 2017?
PREVIOUS ENTRIES: Q52c1: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)
Enter dollar amount
________________

5.2 SOCIAL SECURITY (Amounts)
Q56dp
What is the easiest way for you to tell us (name's/your) Social Security payment;
monthly, quarterly, or yearly?
4
5
7

Monthly
Quarterly
Yearly

Q56d
How much did (name/you) receive (monthly/quarterly) in Social Security payments
in 2017?
Enter dollar amount
53

If already included in amount reported for another household member, press Enter
________________
Q56d_Char
Enter for Already included
________________
Q56drn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in Social Security payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q56drn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in Social Security payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q56d2
For how many (months/quarters) did (name/you) receive Social Security in 2017?
(1-4; 1-12)
________________
Q56d3
Is this $(amount from Q56d/amount from Q56d1) before or after any monthly
Medicare deduction?
54

1
2

After Deduction
Before Deduction

Q56md
If Q56d3 = 1 then ask:
How much were (name’s/your) monthly Medicare deductions?
If Q56d3 = 2 then ask:
How much were all of (name’s/your) monthly payments for Medicare?
Include Medicare Advantage, Part B, and Part D premiums.
________________
Q56dC2
Do not read to the respondent.
The annual rate appears out of range. The total Social Security received in 2017 was
(amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q56d5
According to my calculations (name/you) received $(total) altogether from Social
Security in 2017. Does that sound about right?
1
2

Yes
No

Q56d6
What is your best estimate of the correct amount (name/you) received in Social
Security during 2017?
PREVIOUS ENTRIES:

(amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)

Enter dollar amount
________________

5.3 SOCIAL SECURITY DISABILITY (Amounts)
Q562dp
What is the easiest way for you to tell us (name's/your) Social Security Disability
payment; monthly, quarterly, or yearly?
55

4
5
7

Monthly
Quarterly
Yearly

Q562d
How much did (name/you) receive (monthly/quarterly) in Social Security Disability
payments in 2017?
Enter dollar amount
If already included in amount reported for another household member, press Enter
________________
Q562d_Char
Enter for Already included
________________
Q562d2
For how many (months/quarters) did (name/you) receive Social Security Disability
in 2017?
(1-4; 1-12)
________________
Q562drn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in Social Security Disability payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q562drn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
56

in Social Security Disability payments in 2017?
4
5
6

Less than $1,000
Between $1,000 and $5,000
Over $5,000

Q562d3
Is this $(amount from Q562d/amount from Q562d1) before or after any monthly
Medicare deductions?
1 After Deduction
2 Before Deduction
Q562md
If Q562d3 = 1 then ask:
How much were all of (name’s/your) monthly Medicare deductions?
If Q562d3 = 2 then ask:
How much were all of (name’s/your) monthly payments for Medicare?
Include Medicare Advantage, Part B, and part D premiums.
Q562dC2
Do not read to the respondent.
The annual rate appears out of range. The total Social Security received in 2017 was
(amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
BACKPAY1
During 2017, did (name/you) receive an initial Social Security Disability payment
that was larger than the usual payment that we haven’t accounted for yet?
(This is sometimes done to make up for a delay in the start of payments)
1
2

Yes
No

BACKPAY2
How much was that initial disability payment?
Enter dollar amount
57

______________
Q562d5
According to my calculations (name/you) received $(total) altogether from Social
Security Disability in 2017. Does that sound about right?
1
2

Yes
No

Q562d6
What is your best estimate of the correct amount (name/you) received in Social
Security Disability during 2017?
PREVIOUS ENTRIES:

(amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)

Enter dollar amount
________________

5.4 SOCIAL SECURITY FOR CHILDREN (Amounts)
Q56r
Now we’re going to ask you to report the amount of Social Security received on
behalf of children in the household.
Q56ip
What is the easiest way for you to tell us (name's/your) Social Security payment for
children in this household; monthly, quarterly, or yearly?
4 Monthly
5 Quarterly
7 Yearly
Q56i
How much did (name/you) receive (monthly/quarterly/ ) in Social Security payments
for children in this household in 2017?
Enter dollar amount
If already included in amount reported for another household member, press Enter
________________
58

Q56i_Char
Enter A for Already included
________________
Q56irn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in Social Security payments for children in this household in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q56irn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in Social Security payments for children in this household in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q56i2
For how many (months/quarters) did (name/you) receive Social Security in 2017?
(1-4; 1-12)
________________
Q56iC2
Do not read to the respondent.
The annual rate appears out of range. The total Social Security received for children in
2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press
enter and correct entry.
59

Q56i4
According to my calculations (name/you) received $(total) altogether for children in
this household from Social Security in 2017. Does that sound about right?
1
2

Yes
No

Q56i5
What is your best estimate of the correct amount (name/you) received in Social
Security for children in this household during 2017?
Previous entries:

(amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)

Enter dollar amount
________________

5.5 SUPPLEMENTAL SECURITY INCOME (SSI) (Amounts)
Q57cp
What is the easiest way for you to tell us (name's/your fill) Supplemental Security
Income payment; monthly, quarterly, or yearly?
4 Monthly
5 Quarterly
7 Yearly
Q57c
How much did (name/you) receive (monthly/quarterly) in Supplemental Security
Income payments in 2017?
Enter dollar amount
________________
Q57crn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
60

in Supplemental Security Income payments in 2017?
1
2
3

Less than $10,000
Between $10,000 and $20,000
Over $20,000

Q57crn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in Supplemental Security Income payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q57c2
For how many (months/quarters) did (name/you) receive Supplemental Security
Income in 2017?
(1-4; 1-12)
________________
Q57cC2
Do not read to the respondent.
The annual rate appears out of range. The total Supplemental Security Income received
in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press
enter and correct entry.
Q57c4
According to my calculations (name/you) received $(total) altogether from
Supplemental Security Income in 2017. Does that sound about right?
1
2

Yes
No

Q57c5
What is your best estimate of the correct amount (name/you) received in
Supplemental Security Income during 2017?
61

Previous entries: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
Q57c3: (amount subtracted per month)
Enter Dollar Amount
________________

5.6 SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (Amounts)
Q57R
Now we’re going to ask you to report the amount of Supplemental Security Income
received on behalf of children in the household. What would be the easiest way for you to
report the amount (name/you) received for [fill in from Q57d] – Is it easiest to report for
them combined, or separately?
1
2

Separately
Combined

Q57ip
What is the easiest way for you to tell us the Supplemental Security
Income (name/you) received on behalf of children?
4
5
7

Monthly
Quarterly
Yearly

Q57i
How much did (name/you) receive (monthly/quarterly) in Supplemental Security
Income on behalf of children in 2017?
Enter dollar amount
________________
Q57irn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in Supplemental Security Income on behalf of children in 2017?
62

1
2
3

Less than $10,000
Between $10,000 and $20,000
Over $20,000

Q57irn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in Supplemental Security Income on behalf of children in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q57i2
For how many (months/quarters) did (name/you) receive Supplemental Security
Income on behalf of children in 2017?
(1-4; 1-12)
________________
Q57iC2
Do not read to the respondent.
The annual rate appears out of range. The total Supplemental Security Income received
on behalf of children in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q57i4
According to my calculations (name/you) received $(total) altogether from
Supplemental Security Income on behalf of children in 2017.
Does that sound about right?
1
2

Yes
No

Q57i5
What is your best estimate of the correct amount (name/you) received in
Supplemental Security Income on behalf of children during 2017?
PREVIOUS ENTRIES: (amount)
63

Q57ip: (periodicity)
Q57i2: (number of pay periods)
Q57i3: (amount subtracted per month)
Enter dollar amount
________________

5.7 DISABILITY INCOME (Amounts)
Q61E1P
What is the easiest way for you to tell us (name's/your) (fill first answer from Q61C
or Q61Cs1) payments; weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q61E1
How much did (name/you) receive (weekly/ every other week/ twice a month/
monthly) before deductions in (fill first answer from Q61C or Q61Cs1) payments in
2017?
Enter dollar amount
_______________
Q61e1rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
for the TOTAL amount (name/you) received in (fill first answer from Q61Cr or
Q61Cs1) during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q61e1rn2
Did (name/you) receive
64

less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill first answer from Q61C or Q61Cs1) during 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

Q61E12
How many (weekly/ every other week/ twice a month/ monthly) payments did
(name/you) receive in (fill first answer from Q61C or Q61Cs1) payments in 2017?
Disability income source #1 (1-12; 1-52)
______________
Q61E1C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q61c or
Q61cs1) payments received in 2017 was (amount). Is this a correct entry? If Yes, enter
"S" to Suppress. If No, press enter and correct entry.
Q61E13
According to my calculations (name/you) received $(total) altogether from
(fill first answer from Q61C or Q61Cs1) payments in 2017. Does that sound about
right?
1
2

Yes
No

Q61E14
What is your best estimate of the correct amount (name/you) received from (fill first
answer from Q61C or Q61Cs1) payments during 2017?
PREVIOUS ENTRIES: Q61E1: (amount)
Q61E1P: (periodicity)
Q61E12: (number of pay periods)
Enter dollar amount
_______________
Q61E2P
What is the easiest way for you to tell us (name's/your) (fill second answer from
65

Q61C or Q61Cs1) payments; weekly, every other week, twice a month, monthly, or
yearly?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q61E2
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly) before deductions in (fill second answer from Q61C or Q61Cs1)
payments in 2017?
Enter dollar amount
_______________
Q61e2rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
for the TOTAL amount (name/you) received in (fill SECOND answer from Q61C or
Q61Cs1) during 2017?
1
2
3

Less than $10,000 (proceed to next question)
Between $10,000 and $20,000
Over $20,000

Q61e2rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill SECOND answer from Q61C or Q61Cs1) during 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q61E22
66

How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (fill second answer from Q61C or Q61Cs1) payments in 2017?
Disability income payment source #2 (1-12; 1-52)
_______________
Q61E2C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q61c or
Q61cs1) payments received in 2017 was (amount). Is this a correct entry? If Yes, enter
"S" to Suppress. If No, press enter and correct entry.
Q61E23
According to my calculations (name/you) received $(total) altogether
from (fill second answer from Q61C or Q61Cs1) payments in 2017. Does that
sound about right?
1
2

Yes
No

Q61E24
What is your best estimate of the correct amount (name/you) received from (fill
second answer from Q61C or Q61Cs1) payments during 2017?
PREVIOUS ENTRIES:

Q61E2: (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)

Enter dollar amount
_______________

5.8 VETERANS PAYMENTS (Amounts)
Q60V1P
What is the easiest way for you to tell us (name's/your) (fill from first answer in
Q60c8); weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
67

Q60V1
How much did (name/you) receive (weekly/every other week/ twice a
month/monthly) before deductions in (fill from first answer in Q60c8) in 2017?
Enter dollar amount
_______________
Q60v1rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (fill from first answer in Q60c8) payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q60v1rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from first answer in Q60c8) payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q60V12
How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive in (fill from first answer in Q60c8) in 2017?
(1-52)
________________
Q60V1C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q60c8) received
68

in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press
enter and correct entry.
Q60V13
According to my calculations (name/you fill) received $(total) altogether from (fill
from first answer in Q60c8) in 2017. Does that sound about right?
1
2

Yes
No

Q60V14
What is your best estimate of the correct amount (name/you) received in Veteran's
benefits during 2017?
PREVIOUS ENTRIES:

Q60V1: (amount)
Q60V1P: (periodicity)
Q60V12: (number of pay periods)

Enter dollar amount
________________
Q60V2P
What is the easiest way for you to tell us (name's/your) (fill from second answer in
Q60c8); weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q60V2
How much did (name/you) receive (weekly/every other week/ twice a
month/monthly) before deductions in (fill from second answer in Q60c8) in 2017?
Enter dollar amount
_______________
Q60v2rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
69

in (fill from second answer in Q60c8) payments in 2017?
1
2
3

Less than $10,000
Between $10,000 and $20,000
Over $20,000

Q60v2rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from second answer in Q60c8) payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q60V22
How many (weekly/every other week/ twice a month/monthly) payments did
(name/you) receive in (fill from second answer in Q60c8) in 2017?
(1-52)
________________
Q60V2C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q60c8)
received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If
No, press enter and correct entry.
Q60V23
According to my calculations (name/you) received $(total) altogether from
(fill from second answer in Q60c8) in 2017. Does that sound about right?
1
2

Yes
No

Q60V24
What is your best estimate of the correct amount (name/you) received in
(fill from second answer in Q60c8) during 2017?
70

PREVIOUS ENTRIES:

Q60V2: (amount)
Q60V2P: (periodicity)
Q60V22: (number of pay periods)

Enter dollar amount
________________

5.9 SURVIVOR BENEFITS – Amounts
Q58E1P
What is the easiest way for you to tell us (name's/your) (fill from first answer
in Q58C or Q58Cs1); weekly, every other week, twice a month, monthly,
or yearly?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q58E1
How much did (name/you) receive (weekly/every other week/twice a month/
monthly) in (fill from first answer in Q58C or Q58Cs1) in 2017?
Enter dollar amount
_______________
Q58e1rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (fill from first answer in Q58C or Q58Cs1) payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q58e1rn2
Did (name/you) receive
71

less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from first answer in Q58C or Q58Cs1) payments in 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

Q58E12
How many (weekly/every other week/twice a month/monthly) payments did
(name/you) receive in (fill from first answer in Q58C or Q58Cs1) in 2017?
(1-52)
________________
Q58E1C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q58C or
Q58Cs1) received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q58E13
According to my calculations (name/you) received (total) altogether from
(fill from first answer in Q58C or Q58Cs1) in 2017. Does that sound about right?
1
2

Yes
No

Q58E14
What is your best estimate of the correct amount (name/you) received from (fill
from first answer in Q58C or Q58Cs1) during 2017?
PREVIOUS ENTRIES:

Q58E1: (amount)
Q58E1P: (periodicity)
Q58E12: (number of pay periods)

Enter dollar amount
________________
Q58E2P
What is the easiest way for you to tell us (name's/your) (fill from second answer in
72

Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q58E2
How much did (name/you) receive (weekly/every other week/twice a month/
monthly/ ) in (fill from second answer in Q58C or Q58Cs1) in 2017?
Enter dollar amount
________________
Q58e2rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (fill from second answer in Q58C or Q58Cs1) payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q58e2rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from second answer in Q58C or Q58Cs1) payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q58E22
How many (weekly/every other week/twice a month/monthly) payments did
(name/you) receive in (fill from second answer in Q58C or Q58Cs1) in 2017?
73

(1-52)
________________
Q58E2C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from second answer in Q58C or
Q58Cs1) received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q58E23
According to my calculations (name/you) received (total) altogether from
(fill from second answer in Q58C or Q58Cs1) in 2017.
Does that sound about right?
1
2

Yes
No

Q58E24
What is your best estimate of the correct amount (name/you) received from (fill
from second answer in Q58C or Q58Cs1) during 2017?
PREVIOUS ENTRIES:

Q58E2: (amount)
Q58E2P: (periodicity)
Q58E22: (number of pay periods)

Enter dollar amount
________________
Q58E3P
What is the easiest way for you to tell us (name's/your) (fill from third answer in
Q58C or Q58Cs1); weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q58E3
How much did (name/you) receive (weekly/every other week/twice a month/
monthly) in (fill from third answer in Q58C or Q58Cs1) in 2017?
74

Enter dollar amount
________________
Q58e3rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (fill from third answer in Q58C or Q58Cs1) payments in 2017?
1
2
3

Less than $10,000 (proceed to Q58e3rn2)
Between $10,000 and $20,000
Over $20,000

Q58e3rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (fill from third answer in Q58C-R or Q58D-R) payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q58E32
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (fill from third answer in Q58C or Q58Cs1) in 2017?
(1-52)
________________
Q58E3C
Do not read to the respondent.
The annual rate appears out of range. The total (fill from third answer in Q58C or
Q58Cs1) received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to
Suppress. If No, press enter and correct entry.
Q58E33
75

According to my calculations (name/you) received (total) altogether from (fill from
third answer in Q58C or Q58Cs1) in 2017. Does that sound about right?
1
2

Yes
No

Q58E34
What is your best estimate of the correct amount (name/you) received from (fill
from third answer in Q58C or Q58Cs1) during 2017?
PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)
Enter dollar amount
_______________

5.10 PUBLIC ASSISTANCE (Amounts)
Q59ep
What is the easiest way for you to tell us [name's/your fill from Q59b88] CASH
assistance payments from [fill from Q59C8-R]; weekly, every other week, twice a
month, monthly, or yearly?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q59e
During 2017, how much CASH assistance did [name's/your] receive (per week/every
other week/twice a month/monthly)?
Enter dollar amount
___________
Q59ern1
Could you tell me if (name's/your fill) received
less than $1,000
between $1,000 and $3,000
76

or over $3,000
in TOTAL CASH assistance payments in 2017?
1
2
3

Less than $1,000
Between $1,000 and $3,000
Over $3000

Q59ern2
Did (name's/your) receive
less than $100
between $100 and $500
or over $500
in TOTAL CASH assistance payments in 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q59e2
How many (weekly/every other week/ twice a month/ monthly) cash assistance
payments did (name's/your) receive in 2017?
(1-12/1-24/1-26/1-52)
________________
Q59eC2
Do not read to the respondent.
The annual rate appears out of range. The total cash assistance received in 2017 was
(amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and
correct entry.
Q59e3
According to my calculations (name's/your) received $(total) altogether in cash
assistance from a state or county program in 2017. Does that sound about right?
1
2

Yes
No

Q59e4
What is your best estimate of the correct amount of cash assistance
77

(name's/your) received during 2017?
PREVIOUS ENTRIES:

Q59e: (amount)
Q59ep: (periodicity)
Q59e2: (number of pay periods)

Enter dollar amount
________________
Q59f
Was the cash assistance for adults AND children, or JUST children?
1 Both adults AND children
2 Children only
3 Adults only
Q59g
(Who/Which children) in your household was the cash assistance for?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
Enter persons line number (1-16)

5.11 FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE
PROGRAM (SNAP) (Amounts)
Q90p
What is the easiest way for you to tell us the value of the food assistance:
monthly or yearly?
1 Monthly
2 Yearly
3 Already included with TANF/AFDC payment
Q90
What is the (monthly) value of the food assistance received in 2017?
Enter dollar amount
________________
Q90rn1
78

Could you tell me if the value of food assistance received in 2017 was
less than $1,000
between $1,000 and $3,000
or over $3,000
in food assistance in 2017?
1
2
3

Less than $1,000
Between $1,000 and $3,000
Over $3000

Q90rn2
Did (name/you) receive
less than $100
between $100 and $500
or over $500
in food assistance in 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q902
How many months was food assistance received in 2017?
(1-12)
________________
Q90C2
Do not read to the respondent.
The annual rate appears out of range. The total food assistance payments received in
2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press
enter and correct entry.
Q903
According to my calculations (total) was received altogether from food assistance
in 2017. Does that sound about right?
1
2

Yes
No
79

Q904
What is your best estimate of the correct amount of food assistance received
during 2017?
PREVIOUS ENTRIES:

Q90: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)

Enter dollar amount
________________

5.12 PENSIONS (Amounts)
Q62E1PR
What is the easiest way for you to tell us (name's/your) (first answer FILL IN
FROM Q62C-R or Q62DR); weekly, every other week, twice a month, monthly, or
yearly?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

Q62E1R
How much did (name's/your) receive (weekly/every other week/ twice a month/
monthly/ ) in (first answer FILL IN FROM Q62C-R or Q62DR) in 2017?
Enter dollar amount
______________
Q62E1rn1
Could you tell me if (you/name) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (first answer FILL IN FROM Q62CR or Q62DR) payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
80

Q62E1rn2
Did (you/name) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (first answer FILL IN FROM Q62CR or Q62DR) payments in 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

Q62E12R
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (first answer FILL IN FROM Q62CR or Q62DR) in 2017?
Pension/Retirement #1 (1-12; 1-52)
_______________
Q62E1CR
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q62c or
Q62cs1) payments received in 2017 was (amount). Is this a correct entry? If Yes, enter
"S" to Suppress. If No, press enter and correct entry.
Q62E13R
According to my calculations (name/you) received (total) dollars altogether from
(first answer FILL IN FROM Q62CR or Q62DR) in 2017. Does that sound about
right?
1
2

Yes
No

Q62E14R
What is your best estimate of the correct amount (name/you) received in (first
answer FILL IN FROM Q62CR or Q62DR) during 2017?
PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
81

_______________
Q62E2PR
What is the easiest way for you to tell us (name's/your) (second answer FILL IN
FROM Q62CR or Q62DR); weekly, every other week, twice a month, monthly, or
yearly?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
7 Yearly
Q62E2R
How much did (name's/your) receive (weekly/every other week/ twice a month/
monthly) in (second answer FILL IN FROM Q62CR or Q62DR) in 2017?
Enter dollar amount
_______________
Q62E2rn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in (second answer FILL IN FROM Q62CR or Q62DR) payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q62E2rn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in (second answer FILL IN FROM Q62CR or Q62DR) payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
82

3

Over $5,000

Q62E22R
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (second answer FILL IN FROM Q62CR or Q62DR) in 2017?
Pension/Retirement #1 (1-12; 1-52)
_______________
Q62E2CR
Do not read to the respondent.
The annual rate appears out of range. The total (fill from first answer in Q62c or
Q62cs1) payments received in 2017 was (amount). Is this a correct entry? If Yes, enter
"S" to Suppress. If No, press enter and correct entry.
Q62E23R
According to my calculations (name/you) received $(total) altogether from (second
answer FILL IN FROM Q62CR or Q62DR) in 2017. Does that sound about right?
1
2

Yes
No

Q62E24R
What is your best estimate of the correct amount (name/you) received in (second
answer FILL IN FROM Q62CR or Q62DR) during 2017?
PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
Q62E12: (number of pay periods)
Enter dollar amount
_______________

5.13 ANNUITIES (Amounts)
ANNNEW1
What is the easiest way for you to tell us (name/your) annuity income; weekly, every
other week, twice a month, monthly, or yearly?
1
2
3
4

Weekly
Every other week
Twice a month
Monthly
83

7

Yearly

ANNNEW2
How much did (name/you) receive (weekly/every other week/twice a month/
monthly) in annuities in 2017?
Enter dollar amount
_______________
ANNNEWrn1
Could you tell me if (name/you) received
less than $10,000
between $10,000 and $20,000
or over $20,000
in annuity payments in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
ANNNEWrn2
Did (name/you) receive
less than $1,000
between $1,000 and $5,000
or over $5,000
in annuity payments in 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
ANNNEW3
How many (weekly/every other week/ twice a month/monthly) annuity payments did
(name/you) receive in 2017?
(1-12; 1-52)
_______________
ANNNEW4
According to my calculations (name/you) received $(total) altogether from annuities
84

in 2017. Does that sound about right?
PREVIOUS ENTRIES: ANNNEW2: (amount)
ANNNEW3: (periodicity)
1
2

Yes
No

ANNNEW5
What is your best estimate of the correct amount (name/you) received in annuities
in 2017?
Enter dollar amount
_______________

5.14 WITHDRAWALS/DISTRIBUTIONS FROM RETIREMENT PLAN
(Amounts)
DISTNEW1
What is the easiest way for you to tell us the amount of money withdrawn or
distributed from (name’s/your) [(ACCOUNT TYPE) FILL FROM Q97CR or
Q97DR)] in 2017: monthly, quarterly, every 6 months, or yearly?
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly
DISTNEW2
How much was (name's/your) withdrawal or distribution (weekly/every other week/
twice a month/ monthly/ ) from [(ACCOUNT TYPE) FILL FROM Q97CR or
Q97DR)] in 2017?
Enter dollar amount
_______________
DISTNEW3
How many (monthly/quarterly) withdrawals did (name/you) make or distributions
did (name/you) receive in 2017 from the [(ACCOUNT TYPE) FILL FROM Q97CR
or Q97DR)]?
Valid entries are 1-12 if monthly; 1-4 if quarterly; 1-2 if every six months
85

DISTNEWrn1
Could you tell me if (name’s/your) withdrawal or distribution was
less than $10,000
between $10,000 and $20,000
or over $20,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
DISTNEWrn2
Was (name’s/your) withdrawal or distribution
less than $1,000
between $1,000 and $5,000
or over $5,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

DISTNEW4
According to my calculations (name/you) withdrew or received a distribution of
$(total) altogether from the [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)]
in 2017. Does that sound about right?
1
2

Yes
No

DISTNEW5
What is your best estimate of the correct amount (name/you) withdrew or the
distribution received from the [(ACCOUNT TYPE) FILL FROM Q97CR or
Q97DR)] during 2017?
Enter dollar amount
_______________
ROLLA
86

Did [you/name] re-invest or "roll over" any of the money into an IRA or some other
kind of retirement plan?
1 Yes
2 No
ROLLAMTA
How much did (you/name) re-invest or “roll over” into an IRA or some other kind
of retirement plan in 2017?
Enter dollar amount
_______________
ROLLB
Do/Does (you/name) plan to re-invest or roll over any of the money?
1
2

Yes
No

ROLLAMTB
How much do/does (you/name) plan to re-invest or “roll over” into an IRA or some
other kind of retirement plan?
Enter dollar amount
_______________
DISTNEW6
What is the easiest way for you to tell us the amount of money withdrawn or
distributed from (name’s/your) [(SECOND ACCOUNT TYPE) FILL FROM Q97CR
or Q97DR)] in 2017: monthly, quarterly, every 6 months, or yearly?
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly
DISTNEW7
How much was (name's/your) withdrawal or distribution (weekly/every other week/
twice a month/ monthly) from [(SECOND ACCOUNT TYPE) FILL FROM Q97CR
or Q97DR)] in 2017?
87

Enter dollar amount
_______________
DISTNEW8
How many (monthly/quarterly) withdrawals did (name/you) make or distributions
did (name/you) receive in 2017 from the [(SECOND ACCOUNT TYPE) FILL
FROM Q97CR or Q97DR)]?
Enter dollar amount
_______________
DISTNEWrn3
Could you tell me if (name’s/your) withdrawal or distribution was
less than $10,000
between $10,000 and $20,000
or over $20,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
DISTNEWrn4
Was (name’s/your) withdrawal or distribution
less than $1,000
between $1,000 and $5,000
or over $5,000
from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR)] in 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

DISTNEW9
According to my calculations (name/you) withdrew or received a distribution of
$(total) altogether from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR or
Q97DR)] in 2017. Does that sound about right?
1
2

Yes
No
88

DISTNEW10
What is your best estimate of the correct amount (name/you) withdrew or the
distribution received from the [(SECOND ACCOUNT TYPE) FILL FROM Q97CR
or Q97DR)] during 2017?
Enter dollar amount
_______________
ROLLC
Did [you/NAME] re-invest or "roll over" any of the money into an IRA or some
other kind of retirement plan?
1
2

Yes
No

ROLLAMTC
How much did (you/name) re-invest or “roll over” into an IRA or some other kind
of retirement plan in 2017?
Enter dollar amount
_______________
ROLLD
Do/Does (you/name) plan to re-invest or roll over any of the money?
1 Yes (If ‘yes,’ go to ROLLAMTD)
2 No
ROLLAMTD
How much do/does (you/name) plan to re-invest or “roll over” into an IRA or some
other kind of retirement plan?
Enter dollar amount
_______________

5.15 INTEREST/DIVIDENDS ON RETIREMENT ACCOUNTS(Amounts)
RETIRENEW1
89

Within [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR] account, how much
did (name/you) earn in interest or dividends during 2017? Please include small
amounts reinvested or credited to the account.
Enter dollar amount
_____________
RETIRENEWrn1
Could you tell me if (name/you) earned
less than $1,000
between $1,000 and $3,000
or over $3,000
in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR]
during 2017?
1
2
3

Less than $1,000
Between $1,000 and $3,000
Over $3,000

RETIRENEWrn2
Did (name/you) earn
less than $100
between $100 and $500
or over $500
in interest or dividends from [(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR]
during 2017?
1 Less than $100
2 Between $100 and $500
3 Over $500
RETIRENEW2
The Census Bureau can estimate the amount earned in this account based on the
size of the account. So can you tell me how much money was in (name’s/your)
[(ACCOUNT TYPE) FILL FROM Q97CR or Q97DR] at the end of 2017?
Enter dollar amount
_____________

90

5.16 INTEREST/DIVIDENDS ON NON- RETIREMENT ACCOUNTS
(Amounts)
NONRETIRENEW(1-7)1
How much did (you/name) receive in (interest/dividends) from [FILL IN Q99AR or
Q99BR] during 2017, including even small amounts reinvested or credited to
accounts?
If a joint account please split interest income in half for each person.
Enter dollar amount
_____________
NONRETIRENEW(1-7)rn1
Could you tell me if (you/name) received:
less than $1,000
between $1,000 and $3,000
or over $3,000
in interest or dividends from [FILL IN Q99AR or Q99BR] during 2017?
1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000
NONRETIRENEW(1-7)rn2
Did (you/name) receive:
less than $100
between $100 and $500
or over $500
in interest or dividends from [FILL IN Q99AR or Q99BR] during 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

NONRETIRENEW(1-7)2
The Census Bureau can estimate the amount earned in this account based on the
size of the account. How much money did (you/name) have in [FILL IN Q99AR or
Q99BR] at the end of 2017?
91

Enter dollar amount
_____________
Q63cp
Read if necessary
Is this a weekly, every other week, twice a month, monthly, quarterly, every 6
months, or yearly amount?
1 Weekly
2 Every other week
3 Twice a month
4 Monthly
5 Quarterly
6 Every 6 months
7 Yearly
Q63c2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6
months) payments did (you/name) receive in interest/dividend income in 2017 from
[FILL IN Q99AR or Q99BR]?
_______________
Q63c3
According to my calculations (you/name) received $(total) from interest/dividend
income from [FILL IN Q99AR or Q99BR] in 2017. Does that sound about right?
1
2

Yes
No

Q63c4
What is your best estimate of the correct amount (you/NAME) received from
interest payments during 2017?
PREVIOUS ENTRIES: Q63c: (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
_______________
CAPGDAMT
How much did (you/name) receive in capital gains in 2017?
92

Enter dollar amount
_______________
CAPGDAMTrn1
Could you tell me if (name/you) received:
less than $10,000
between $10,000 and $20,000
or over $20,000
for the TOTAL yearly amount in capital gains during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
CAPGDAMTrn2
Did (name/you) receive:
less than $1,000
between $1,000 and $5,000
or over $5,000
in capital gains during 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

5.17 PROPERTY INCOME (Amounts)
Q65c
How much did (name/you) receive in income from rent (roomers or boarders,
estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or trusts fill
from Q65A1-3) AFTER EXPENSES during 2017?
Separate amounts for joint ownership if response is "Broke Even" then enter 1.
Enter dollar amount
If already included in amount reported for another household member,
or if response is "None",
or if response is "Lost Money"
press key
_______________
93

Q65c_Char
Enter "A" for Already included
Enter "L" for Lost Money
Enter "X" for None
______________
Q65cL
Enter amount of money lost in 2017.
_______________
Q65crn1
Could you tell me if (name/you) received:
less than $10,000
between $10,000 and $20,000
or over $20,000
in income from rent (roomers or boarders, estates, trusts, or royalties/, roomers or
boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES
during 2017?
1 Less than $10,000
2 Between $10,000 and $20,000
3 Over $20,000
Q65crn2
Did (name/you)receive:
less than $1,000
between $1,000 and $5,000
or over $5,000
in income from rent (roomers or boarders, estates, trusts, or royalties/, roomers or
boarders, or royalties/, estates or trusts fill from Q65A1-3) AFTER EXPENSES
during 2017?
1 Less than $1,000
2 Between $1,000 and $5,000
3 Over $5,000
Q65cp
Is this a weekly, every other week, twice a month, monthly, quarterly, or yearly
amount?
94

1
2
3
4
5
7

Weekly
Every other week
Twice a month
Monthly
Quarterly
Yearly

Q65c2
What is your best estimate of (name's/your) ANNUAL net income from rent
(roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or
royalties/, estates or trusts) AFTER EXPENSES in 2017?
PREVIOUS ENTRIES:

Q65c: (amount)
Q65cp: (periodicity)

Enter dollar amount
_______________
Q65cC2
Do not read to the respondent.
The annual rate appears out of range. The total income received from rent (roomers or
boarders, estates, trusts, or royalties) was (amount) in 2017. Is this a correct entry? If
Yes, enter "S" to Suppress. If No, press enter and correct entry.
Q65c2L
What is your best estimate of (name/you) ANNUAL LOSS from rent (roomers or
boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, estates or
trusts fill from Q65A1-3) AFTER EXPENSES in 2017?
PREVIOUS ENTRIES:

Q65cL: (amount)
Q65cp: (periodicity)

Enter dollar amount
_______________

5.18 EDUCATIONAL ASSISTANCE (Amounts)
Q69F88
How much did (name/you) receive in Pell Grants during 2017?
Enter annual amount only
________________
95

Q69Frn1
Could you tell me if (name/you) received:
less than $1,000
between $1,000 and $3,000
or over $3,000
in Pell Grants during 2017?
1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000
Q69Frn2
Did (name/you) receive:
less than $100
between $100 and $500
or over $500
in Pell Grants during 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q66HP
What is the easiest way for you to tell us (name's/your) (other/blank) educational
assistance during 2017; weekly, every other week, twice a month, monthly, or
yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q66H
How much did (name/you) receive (weekly/every other week/ twice a month/
monthly/ ) in educational assistance during 2017?
Enter dollar amount
________________
96

Q66H2
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you fill Q66c) receive in educational assistance in 2017?
(1-12/1-24/1-26/1-52)
________________
Q66Hrn1
Could you tell me if (name/you) received:
less than $1,000
between $1,000 and $3,000
or over $3,000
in educational assistance during 2017?
1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000
Q66Hrn2
Did (name/you) receive:
less than $100
between $100 and $500
or over $500
in educational assistance during 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q66HC2
Do not read to the respondent.
The annual rate appears out of range. The total educational assistance received in 2017
was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter
and correct entry.
Q66H3
According to my calculations (name/you) received (total) altogether from
educational assistance in 2017. Does that sound about right?
97

1
2

Yes
No

Q66H4
What is your best estimate of the correct amount (name/you) received from
educational assistance during 2017?
Previous entries:

Q66h: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)

Enter dollar amount
________________

5.19 CHILD SUPPORT (Amounts)
Q70cp
What is the easiest way for you to tell us (name's/your) child support payments;
weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q70c
How much did (name/you) receive (weekly/ every other week/ twice a month/
monthly) in child support payments in 2017?
Enter dollar amount
________________
Q70c2
How many (weekly/every other week/ twice a month/ monthly) child support
payments did (name/you) receive in 2017?
(1-12/1-24/1-26/1-52)
________________
Q70c1rn1
98

Could you tell me if (name/you fill Q70b) received:
less than $10,000
between $10,000 and $20,000
or over $20,000
in child support payments in 2017?
1
2
3

Less than $10,000
Between $10,000 and $20,000
Over $20,000

Q70c1rn2
Did (name/you) receive:
less than $1,000
between $1,000 and $5,000
or over $5,000
in child support payments in 2017?
1
2
3

Less than $1,000
Between $1,000 and $5,000
Over $5,000

Q70cC2
Do not read to the respondent.
The annual rate appears out of range. The total child support payments received in
2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press
enter and correct entry.
Q70c3
According to my calculations (name/you) received (total) altogether from child
support payments in 2017. Does that sound about right?
1
2

Yes
No

Q70c4
What is your best estimate of the correct amount (name/you) received from child
support payments during 2017?
PREVIOUS ENTRIES:

Q70c: (amount)
Q70cp: (periodicity)
99

Q70c2: (number of pay periods)
Enter dollar amount
________________

5.20 REGULAR FINANCIAL ASSISTANCE (Amounts)
Q72cp
What is the easiest way for you to tell us (name's/your) regular financial assistance;
weekly, every other week, twice a month, monthly, or yearly?
1 Weekly
2 Every other week (bi-weekly)
3 Twice a month
4 Monthly
7 Yearly
Q72c
How much did (name/you) receive (weekly/every other week/twice a month/
monthly) in regular financial assistance in 2017?
Enter dollar amount
________________
Q72c2
How many (weekly/every other week/twice a month/monthly) payments did
(name/you) receive in regular financial assistance in 2017?
(1-12/1-24/1-26/1-52)
_______________
Q72crn1
Could you tell me if (name/you) received:
less than $1,000
between $1,000 and $3,000
or over $3,000
in regular financial assistance in 2017?
1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000
100

Q72crn2
Did (name/you) receive
less than $100
between $100 and $500
or over $500
in regular financial assistance in 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

Q72cC2
Do not read to the respondent.
The annual rate appears out of range. The total regular financial assistance payments
received in 2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress.
If No, press enter and correct entry.
Q72c3
According to my calculations (name/you) received (total) altogether from regular
financial assistance in 2017. Does that sound about right?
1
2

Yes
No

Q72c4
What is your best estimate of the correct amount (name/you fill) received from
regular financial assistance during 2017?
PREVIOUS ENTRIES:

Q72c: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)

________________

5.21 OTHER MONEY INCOME (Amounts)
Q731P
What is the easiest way for you to tell us (name's/your) income from (fill from
Q73A1Rc);
101

weekly, every other week, twice a month, monthly, or yearly?
1
2
3
4
7

Weekly
Every other week (bi-weekly)
Twice a month
Monthly
Yearly

Q731
How much did (name/you) receive (weekly/every other week/twice a month/
monthly) in income from (fill from Q73A1Rc) during 2017?
Enter dollar amount
________________
Q7312
How many (weekly/every other week/twice a month/monthly) payments did
(name/you) receive in income from (fill from Q73A1Rc) during 2017?
(1-12/1-24/1-26/1-52)
________________
Q73rn1
Could you please tell me if (name/you) received:
less than $1,000
between $1,000 and $3,000
or over $3,000
in income not already covered?
1 Less than $1,000
2 Between $1,000 and $3,000
3 Over $3,000
Q73rn2
Did (name/you) receive:
less than $100
between $100 and $500
or over $500
in income not already covered?
102

1
2
3

Less than $100
Between $100 and $500
Over $500

Q731C2
Do not read to the respondent.
The annual rate appears out of range. The total income from (fill from Q73A1Rc) in
2017 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press
enter and correct entry.
Q7313
According to my calculations (name/you) received (total) altogether from (fill from
Q73A1Rc) in 2017.
Does that sound about right?
1
2

Yes
No

Q7314
What is your best estimate of the correct amount (name/you) received in income
from (fill from Q73A1Rc) in 2017?
PREVIOUS ENTRIES:

Q731: (amount)
Q731P: (periodicity)
Q7312: (number of pay periods)

Enter dollar amount
________________

5.22 CONTRIBUTIONS TO RETIREMENT ACCOUNTS (Amounts)
CONTRIB1
Earlier we recorded that (you/name) (have/has) a retirement account, such as a
401(k), 403(b), IRA, or other account designed specifically for retirement savings.
Did (you/he/she) contribute any money to (your/his/her) plan(s), for example,
through payroll deductions?
(Do not include amounts reinvested or “rolled over” from other retirement
accounts.)
1
2

Yes
No
103

CONTRIB2
How much did (you/he/she) contribute to (your/his/her) account(s) in 2017?
Total contributions to all accounts.
________________

6 HEALTH INSURANCE
6.1 INTRODUCTION TO HEALTH INSURANCE SECTION
HINTRO
These next questions are about health coverage between January 1, 2017 and now.
Press 1 to Continue
1

Enter 1 to Continue

PINTRO
First I'm going to ask about (name's/your) health coverage.
Press 1 to Continue
1

Enter 1 to Continue

FHINTRO
Next, I'm going to ask about (name's/your) health coverage.
Press 1 to Continue

6.2 CURRENT COVERAGE
MCARE1
?[F1]
Medicare is health insurance for people 65 years and older and people under 65
with disabilities. (Is/Are) (name/you) NOW covered by Medicare?
Code Medicare Parts A, B, and C and Medicare Advantage as "Yes"
1
2

Yes
No
104

ANYCOV
(Does/Do) (name/you) NOW have any type of health plan or health coverage?
1
2

Yes
No

MEDI
?[F1]
(Are/Is/Was/Were) (name/you) covered by Medicaid, Medical Assistance, or
(CHIP/or Medicare)?
1
2

Yes
No

OTHGOVT
(Is/Are) (name/you) NOW covered by a state or government assistance program
that helps pay for healthcare, such as: State Medicaid, CHIP, Exchange/Portal, or
other State Health program?
Stop reading list if respondent says "YES"
1
2

Yes
No

VET
(Is/Are) (name/you) NOW covered by Veteran's Administration (VA) care?
1
2

Yes
No

VERIFY
I recorded that (name/you) (is/are) not currently covered by a health plan. Is that
correct?
1
2

Yes, is NOT covered
No, is covered

6.3 TYPE OF COVERAGE
105

SRCEGEN
?[F1]
ASK OR VERIFY
For the coverage (name/you) (has/have/had) NOW, (do/does/did) (he/she/you) get it
through a job, the government or state, or some other way?
2. GOVERNMENT OR
STATE
Medical Assistance
Medicaid
Medicare (Parts A+B; Part C)
Medicare Advantage
State-provided health coverage
VA Care/CHAMPVA/other
military

1. JOB
Former job/Retiree
Union
Spouse/parent's job
Job with the government
COBRA
TRICARE/TRICARE For Life

3. OTHER WAY
Privately purchased
Parent or spouse
Medicare Supplements
Exchange plan/Marketplace
Group or association
School

IF RESPONDENT CHOOSES MORE THAN ONE: Let's talk about one plan at a
time. Which would you like to tell me about first?
[

If respondent is not covered, go back to VERIFY and select "Yes"]

1
2
3

Job (current or former)
Government or State
Some other way

SRCEDEPDIR
ASK OR VERIFY
(Does/Do/Did) (name/you) get that coverage through a parent or spouse,
(does/do/did) (he/she/you) buy it (himself/herself/yourself), or (does/did/do)
(he/she/you) get it some other way?

1. PARENT OR SPOUSE
Parent
Spouse

1
2
3

2. BUY IT DIRECTLY
Buy it
Parent or spouse buys it
Medicare Supplement

Parent or spouse
Buy it
Some other way

SRCEOTH
106

3. SOME OTHER WAY
Former employer
Group or association
Indian Health Service
School

ASK OR VERIFY
(Does/Do/Did) (name/you) get it through a former employer, a union, a group or
association, the Indian Health Service, a school, or some other way?
1
2
3
4
5
6

Former employer
Union
Group or association
Indian Health Service
School
Some other way

JOBCOV
(Is/Was) that coverage related to a JOB with the government or state?
READ IF NECESSARY: Include coverage through FORMER employers and unions,
and COBRA plans.
1
2

Yes
No

MILPLAN
ASK OR VERIFY
(Is/Was) that plan related to military service in any way?
Examples of military plans include:
- VA Care
- TRICARE
- TRICARE for Life
- CHAMPVA
- Other military care
1
2

Yes
No

GOVTYPE
?[F1]
ASK OR VERIFY
(Is/Was) that coverage Medicaid, CHIP, Medicare, a plan through the military, or
some other program?
107

Code Medicare Parts A, B, and C and Medicare Advantage as "Medicare"
IF RESPONDENT CHOOSES MORE THAN ONE: Let's talk about one plan at a
time. Which would you like to tell me about first?
1
2
3
4
5

Medicaid or Medical Assistance
CHIP
Medicare
Military
Other

MILTYPE
ASK OR VERIFY
(Is/Was) that plan through TRICARE, TRICARE for Life, CHAMPVA, VA Care,
military health care, or something else?
1
2
3
4
5
6

TRICARE
TRICARE for Life
CHAMPVA
Veterans Administration (VA) care
Military health care
Other

POLHOLDER
ASK OR VERIFY
Whose name (is/was) the policy in? (Who (is/was) the policyholder?)
1-16
17

Name on roster
Someone living outside the household

Enter persons line number (1-16), or 17 for person not in the household
SRCEPTSP
ASK OR VERIFY
(Do/Did) they get that coverage through their job, (do/did) they buy it themselves, or
(do/did) they get it some other way?
1
2
3

Job (current or former)
Buy it
Some other way

GOVPLAN
108

ASK OR VERIFY
What do you call the program?
IF RESPONDENT ANSWERS WITH INSURANCE COMPANY NAME: OK, so
that would be the plan name. What do you call the program? Some examples of
programs in (state) are [read full list below].
1
2
3
4-12
13-15
16
17
18

Medicaid
Medical Assistance
Indian Health Service (IHS)
State Medicaid Programs Names
State Exchange Programs Names
Plan through State Exchange Portal
Other government plan
Other (please specify)

MISCSPEC
Please Specify
Write in plan name
_______________
PORTAL
ASK OR VERIFY
(Is/Was) that coverage through (State Exchange Portal Name), which may also be
known as (State Exchange Program Name 1, Name 2, Name 3)?
1
2

Yes
No

EXCHTYPE
ASK OR VERIFY
What do you call it – State Exchange Program (Portal, Name 1, Name 2, Name 3)?
1-4

State Exchange Programs Names

HIPAID
(Does/Did) (your/policyholder name's/the policyholder’s) employer or union pay for
all, part, or none of the health insurance premium?
109

Report here employer's contribution to employee's health insurance premiums, not the
employee's medical bills.
1
2
3

All
Part
None

SHOP
Small businesses can offer health coverage to their employees through (State
Exchange SHOP Portal Name). (Is/Was) the coverage at all related to (State
Exchange SHOP Portal Name), (such as State SHOP Name 1, Name 2, Name 3)?
1
2

Yes
No

POLHOLDER2
ASK OR VERIFY
Whose name (is/was) the policy in? (Who [is/was] the policyholder?)
1-16
17

Name on roster
Someone living outside the household

Enter persons line number (1-16), or 17 for person not in the household
PREMYN
Is there a monthly premium for this plan?
A monthly premium is a fixed amount of money people pay each month to have
health coverage. It does not include copays or other expenses such as prescription
costs.
1
2

Yes
No

PREMSUBS
Is the cost of the premium subsidized based on (your/family) income?
A monthly premium is a fixed amount of money people pay each month to have
health coverage. It does not include copays or other expenses such as prescription
costs.
Subsidized health coverage is insurance with a reduced premium. Low and middle
income families are eligible to receive tax credits that allow them to pay lower
110

premiums for insurance bought through healthcare exchanges or marketplaces.
1
2

Yes
No

6.4 MONTHS OF COVERAGE
BEFORAFT
Did (name's/your) coverage from (plan type) start before January 1, 2017?
READ IF NECESSARY: Your best estimate is fine.
(READ IF NECESSARY: If (policyholder) switched employers or plans through
(your/their) employer, consider it the same plan.)
(READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)
(buy/buys), consider it the same plan.)
1
2

Yes
No

MNTHBEG1/2
In which month did (that/this) coverage start?
READ IF NECESSARY: Your best estimate is fine.
(READ IF NECESSARY: If (policyholder) switched employers or plans through
(your/their) employer, consider it the same plan.)
(READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)
(buy/buys), consider it the same plan.)
This question refers to (plan type).
1
2
3
4
5
6
7
8
9
10
11
12

January
February
March
April
May
June
July
August
September
October
November
December
111

YEARBEG
ASK OR VERIFY
Which year was that?
(READ IF NECESSARY: If (policyholder) switched employers or plans through
(your/their) employer, consider it the same plan.)
(READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)
(buy/buys), consider it the same plan.)
This question refers to (plan type).
1
2

2017
2018

CNTCOV
Has it been continuous since (beginning month)?
(READ IF NECESSARY: If (policyholder) switched employers or plans through
(your/their) employer, consider it the same plan.)
(READ IF NECESSARY: If (policyholder) switched plans that (you/he/she)
(buy/buys), consider it the same plan.)
READ IF NECESSARY: If the gap in coverage was less than 3 weeks, consider the
coverage "continuous."
This question refers to (plan type).
1
2

Yes
No

SPELLADD
I have recorded that (name/you) (was/were) covered by (plan type) in (months of
coverage). Were there any OTHER months between January 2017 and now that
(name/you) (was/were) also covered by (plan type)?
1
2

Yes
No

ANYTHIS
Which months (was/were) (name/you) covered by (plan type) THIS year -- in 2018?
112

1
2
3
4
20
21

January 2018
February 2018
March 2018
April 2018
All months of 2018
No months of 2018

ANYLAST
Which months (was/were) (name/you) covered by (plan type) LAST year -- in 2017?
1
2
3
4
5
6
7
8
9
10
11
12
20
21

January
February
March
April
May
June
July
August
September
October
November
December
All months from January 2017 until December 2017
No months from January 2017 until December 2017

WMNTHS
Which months between January 2017 and now (was/were) (name/you) covered by
(plan type)?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

January 2017
February 2017
March 2017
April 2017
May 2017
June 2017
July 2017
August 2017
September 2017
October 2017
November 2017
December 2017
January 2018
February 2018
March 2018
April 2018
113

20
21

All months from January 2017 until now
No months from January 2017 until now

6.5 OTHER HOUSEHOLD MEMBERS
OTHMEMB
Between January 1, 2017 and now, was anyone in the household other than
(name/you) ALSO covered by (plan type)?
1
2

Yes
No

COVWHO
Who else was covered? Who else was covered by (plan type)?
PROBE: Anyone else?
0
1-16
96

No one listed
Person 1 through 16’s name
All persons listed

SAMEMNTHS
(Was/Were) (name/names) also covered from January 2017 until now?
This question refers to (plan type)
1
2

All also covered from January 2017 until now
None covered from January 2017 until now

MNTHS_P(1-16)M
Which months between January 2017 and now was (NAME) covered? [How about
(NAME)?]
This question refers to (plan type)
1
2
3
4
5
6
7
8
9

January 2017
February 2017
March 2017
April 2017
May 2017
June 2017
July 2017
August 2017
September 2017
114

10
11
12
13
14
15
16
20
21

October 2017
November 2017
December 2017
January 2018
February 2018
March 2018
April 2018
All months from January 2017 until now
No months from January 2017 until now

OTHOUT
Does that plan cover anyone living outside this household?
1
2

Yes
No

OTHWHO
How old are they -- under 19, 19-25, or older than 25?
Mark all that apply
1
2
3

Under 19
19-25 years old
Older than 25

6.6 ADDITIONAL PLANS
ADDGAP
So far, I have recorded that (name/you) (was/were) NOT covered in (months of no
coverage). (Was/Were) (name/you) covered by any type of health plan or health
coverage in (those months/that month)?
READ IF NECESSARY: Do not include plans that cover only one type of care, such
as dental or vision plans.
1
2

Yes
No

ADDOTH
Other than (plan type[s]), (was/were) (name/you) covered by any other type of health
plan or health coverage AT ANY TIME between January 1, 2017 and now?
READ IF NECESSARY: Do not include plans that cover only one type of care, such
115

as dental or vision plans.
1
2

Yes
No

6.7 EMPLOYER-SPONSORED INSURANCE OFFERS AND TAKEUP
ESIINTRO
Earlier I recorded that (name/you) (is/are) employed but (does/do) not have health
coverage through (his/her/your) job.
1

Enter 1 to continue

OFFER
Does (employer name) offer a health insurance plan to any of its employees?
1
2

Yes
No

COULD
Could (name/you) be in this plan if (he/she/you) wanted to?
1
2

Yes
No

WNTAKE
Why (aren't/isn't) (you/he/she) in this plan?
Choose all that apply
1
2
3
4
5
6
7
8

Covered by another plan
Traded health insurance for higher pay
Too expensive
Don't need health insurance
Have a pre-existing condition
Haven't yet worked for this employer long enough to be covered
Contract or temporary employees not allowed in plan
Other/specify

WNTAKESPEC
Please specify other reason why not in the plan
WNELIG
116

Why not? Why can't (name/you) be in this plan if (he/she/you) wanted to?
Choose all that apply
1
2
3
4
5
6

Don't work enough hours per week or weeks per year
Contract or temporary employees not allowed in plan
Haven't yet worked for this employer long enough to be covered
Have a pre-existing condition
Too expensive
Other/specify

WNELIGSPEC
Please specify other reason why not eligible.
________________

6.8 HEALTH STATUS
HealthStatus_Intro
An important factor in evaluating a person's or family's health insurance situation
is their current health status and/or the current health status of other family
members.
Enter 1 to Continue
HealthStatus
Would you say (name's/your) health in general is excellent, very good, good, fair, or
poor?
1
2
3
4
5

Excellent
Very good
Good
Fair
Poor

6.9 MEDICAL EXPENDITURES
MedExp_Intro
Next I would like to ask about out-of-pocket medical expenses during 2017.
Press 1 to Continue
117

1

Enter 1 to continue

HIPREM
[Earlier I recorded that (your/name’s) employer or union did not pay for
(your/his/her) entire health insurance premium.] Last year, how much did
(you/name) pay out-of-pocket for ALL health insurance premiums [covering
(yourself/himself/herself) or others in the household]? Include both comprehensive
and supplemental plans (such as vision and dental insurance).
[What about (you/name)?]
[DO NOT include the $(amount reported) per month from Medicare deductions
from (Social Security/ Social Security Disability/ Social Security and Social Security
Disability) payments mentioned earlier.]
Enter dollar amount
________________
MEDAMT
?[F1]
Last year, how much was paid out-of-pocket for (your/name’s) OWN medical care,
such as copays for doctor and dentist visits, diagnostic tests, prescription medicine,
glasses and contacts, and medical supplies?
[What about (you/name)? Last year, how much was paid out-of-pocket for
(your/name’s) OWN medical care, such as copays for doctor and dentist visits,
diagnostic tests, prescription medicine, glasses and contacts, and medical supplies?]
Include any amount paid out-of-pocket on (your/his/her) behalf by anyone in this
household.
Enter dollar amount
________________
OTCMEDAMT
Last year, how much was paid out-of-pocket for (your/name’s) non-prescription
healthcare products such as vitamins, allergy and cold medicine, pain relievers, quit
smoking aids, AND anything else not yet reported?
[What about (you/name)? Last year, how much was paid out-of-pocket for
(your/name’s) non-prescription healthcare products such as vitamins, allergy and
cold medicine, pain relievers, quit smoking aids, AND anything else not yet
reported?]
118

Include any amount paid out-of-pocket on (your/his/her) behalf by anyone in this
household.
Enter dollar amount
If unsure of the amount, a best guess is acceptable.
________________

7 EMPLOYER’S PENSION PLAN
Q74a
Other than Social Security did (ANY) employer or union that (name/you) worked
for in 2017 have a pension or other type of retirement plan for any of its employees?
1
2

Yes
No

Q74b
(Were/Was) (name/you) included in that plan?
1
2

Yes
No

8 LOW INCOME ITEMS
8.1 SCHOOL LUNCHES
Q80
During 2017 which of the children ages 5 to 18 in this household usually ate a
complete lunch offered at school?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Enter persons line number (1-16)
Q83
During 2017 which of the children in this household received free or reduced priced
lunches because they qualified for the Federal School Lunch Program?
119

Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Enter persons line number (1-16)

8.2 PUBLIC HOUSING
Q85
Is this public housing, that is, is it owned by a local housing authority or other
public agency?
1
2

Yes
No

Q86
Are you paying lower rent because the Federal, State, or local government is paying
part of the cost?
1
2

Yes
No

SPHS8
Is this through Section 8 or through some other government program?
1
2
3

Section 8
Some other government program
Not sure

8.3 WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM
(WIC)
SWRWIC
At any time during 2017, (was/were) (you/ anyone in this household) on WIC, the
Women, Infants, and Children Nutrition Program?
1
2

Yes
No

SWRW
Who received WIC for themselves or on behalf of a child?
120

Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter persons line number (1-16)

8.4 ENERGY ASSISTANCE
Q93
The government has an energy assistance program which helps pay heating and
cooling costs. This assistance can be received directly by the household or it can be
paid directly to the electric company, gas company, or fuel dealer.
In 2017, (have you/has this household) received assistance of this type from the
federal, state, or local government?
1
2

Yes
No

Q93pr1
Do you remember receiving an additional or unexpected check that was sent during
the year to help pay heating or cooling costs?
1
2

Yes
No

Q93pr2
Was it used to pay heating or cooling costs?
1
2

Yes
No

Q94
Altogether, how much energy assistance has been received in 2017?
Enter annual amount only
________________
Q94rn1
Could you tell me if (name/you) received:
less than $1,000
between $1,000 and $3,000
121

or over $3,000
in energy assistance during 2017?
1
2
3

Less than $1,000
Between $1,000 and $3,000
Over $3000

Q94rn2
Did (name/you) receive:
less than $100
between $100 and $500
or over $500
in energy assistance during 2017?
1
2
3

Less than $100
Between $100 and $500
Over $500

9 MIGRATION
9.1 1- Year Migration
MIGSAM
(Were/Was) (reference person's name/you) living in this house (or apartment) one
year ago?
1
2
3

Yes, this house (apt)
No, different house in U.S.
No, outside the U.S.

MIGPLC
Where did (reference person's name/you) live one year ago?
Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME
_______________
MIGSTA
?[F1]
122

Where did (reference person's name/you) live one year ago?
Name of State
Current: (state)
Enter W for person living on a ship at sea
Enter correct State or press ENTER for SAME
_______________
MIGZIP
Where did (reference person's name/you) live one year ago?
Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME
_______________
MIGCLM
Did (reference person's name/you) live inside the city limits of (place name)?
1
2

Yes, inside city limits
No, outside city limits or post office name only

MIGCOU
What (county/parish) is (place name) in?
Enter "IND CITY" if an independent city, not a county
_____________________________________________
S_MIGCN1
What country did (reference person's name/you) live in one year ago?
MI1RES
What was [your/name’s] main reason for moving to this house (apartment)?
The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-14
OTHER REASONS 15-19
1
2
3
4

change in marital status
to establish own household
other family reason (specify)
new job or job transfer
123

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

to look for work or lost job
to be closer to work/easier commute
retired
other job-related reason (specify)
wanted to own home, not rent
wanted new or better house/ apartment
wanted better neighborhood/less crime
wanted cheaper housing
foreclosure/eviction
other housing reason (specify)
to attend or leave college
change of climate
health reasons
natural disaster (hurricane, tornado, etc.)
other reason (specify)

MI1s
What was the reason for moving?
_____________________________________________
MIGALL
(There are (number) other persons in this household ages 1 year or over/ )
Did (all of these persons/this person) live with (reference person's name/you) (in this
house/in City, State/outside the U.S.) one year ago?

1
2

Yes, all lived with (reference person's name/you)
No, some or all did not live with (reference person's name/you)

MIGM
Which of the other members of this household did NOT live with (reference
person's name/you) one year ago?
PROBE: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter persons line number (1-16)
NXTSAM
Did (name/you) live in this house (apartment) one year ago?
1
2
3

Yes , this house
No, different house in U.S.
No, outside the U.S.
124

NXTPLC
Where did (name/you) live one year ago?
Name of city/town/post office
Current: (city) Enter correct city/town/post office or
Press ENTER for SAME
_____________________________________________
NXTSTA
?[F1]
Where did (name/you) live one year ago?
Name of State
Current: (state)
Enter correct State or press ENTER for SAME
_____________________________________________
NXTZIP
Where did (name/you) live one year ago?
Zip Code Current: (zip)
Enter correct zip code or
Press ENTER for SAME
_______________
NXTCLM
Did (name/you) live inside the city limits of (place name)?
1
2

Yes, inside city limits
No, outside city limits or post office name only

NXTCOU
What (county/parish) is (place name) in?
Enter "IND CITY" if an independent city, not a county
_____________________________________________
S_NXTCN1
What country did (name/you) live in one year ago?
125

NX1RES
What was (name’s/your) main reason for moving to this house (apartment)?
The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-14
OTHER REASONS 15-19
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

change in marital status
to establish own household
other family reason (specify)
new job or job transfer
to look for work or lost job
to be closer to work/easier commute
retired
other job-related reason (specify)
wanted to own home, not rent
wanted new or better house/ apartment
wanted better neighborhood/less crime
wanted cheaper housing
foreclosure/eviction
other housing reason (specify)
to attend or leave college
change of climate
health reasons
natural disaster (hurricane, tornado, etc.)
other reason (specify)

NX1OTH
What was the reason for moving?
_____________________________________________
SUNITS
Ask if necessary
How many housing units are in your building?
1
2
3
4
5

Only one
Two
Three or four
Five to nine
Ten or more

126

10 SUPPLEMENTAL POVERTY MEASURE
10.1 PROPERTY VALUE/PRESENCE OF MORTGAGE
VALPROP
About how much do you think this (house and lot/apartment/mobile home)
would sell for if it were for sale?
Enter dollar amount
________________
VALPROPR
Could you tell me if (name/you) think this (house and lot/apartment/mobile home)
would sell for:
less than $100,000
between $100,000 and $250,000
between $250,000 and $500,000
or $500,000 or more?
1
2
3
4

Less than $100,000
Between $100,000 and $250,000
Between $250,000 and $500,000
$500,000 or more

MORTYN
Not counting home equity loans, do you or any other member of this household have
a mortgage, deed of trust, contract to purchase, or similar debt on THIS property?
1
2

Yes
No

SMORTYN
Do you or any member of this household have a second mortgage or a home equity
loan on THIS property?
1
2
3
4

Yes, home equity loan.
Yes, second mortgage.
Yes, second mortgage and home equity loan.
No

10.2 CHILD CARE
127

Q95
Now we want to ask about some of your expenses for children.
Did (you/ anyone in this household) PAY for the care of (your/their) (child/children)
while (you/they) worked in 2017?
Include: All child care expenses including preschool and nursery school expenses,
before and after school care, and summer care.
Do not include: cost of kindergarten or grade/elementary school.
1
2

Yes
No

Q95A
Which children needed care while their parents worked?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter 96 for All persons
Enter persons line number (1-16)
CCFREQ
What is the easiest way for you to tell us how much (you/you and others in this
household) paid for child care while (you/they) worked in 2017: weekly, every other
week, twice a month, monthly, or yearly?
1
2
3
4
7

Weekly
Every other week
Twice a month
Monthly
Yearly

CCAMT
How much did (you/they) pay for child care?
Include child care payments made for all children in the household.
For example, if there are two adults in the household with childcare
expenses use the total paid by both adults. Do not try to separate
the payments. Record one total for the entire household.
________________
CCNUMPAY
128

How many (weekly/every other week/twice a month/monthly) payments did
(you/they) make during 2017?
________________
CCTOT
Then (you/they) paid (total dollar amount) altogether in child care while (you/they)
worked during 2017. Does that sound about right?
1
2

Yes
No

CCEST
What is your best estimate of the correct amount (you/they) paid for child care
while (you/they) worked in 2017?
________________
10.3 CHILD SUPPORT PAID
CSPCHILD
Does anyone in this household have any children who lived elsewhere with their
other parent or guardian at anytime during 2017?
1
2

Yes
No

CSPWHO
Who had children who lived elsewhere? Anyone else?
Enter line number
Enter all that apply, separate using the space bar or a comma.
________________
CSPREQ
In 2017, (were/was) (name/you) required to pay child support?
1
2

Yes
No

CSPAMT
How much child support did (name/you) pay in 2017?
129

Enter dollar amount
COUNT ALL FORMS OF CHILD SUPPORTS PAYMENTS, INCLUDING:
PAYMENTS MADE DIRECTLY TO THE OTHER PARENT/GUARDIAN;
PAYMENTS MADE THROUGH A COURT OR AGENCY; AND
PAYMENTS WITHHELD FROM THIS PERSON'S PAYCHECK

130

Attachment A. Income Range Follow-up Questions
The three levels of income range follow-up questions are:
1) High-range income follow-up brackets:
•

Less than $45,000

•

Between $45,000 and $60,000

•

$60,000 or more

If the respondent selects the lowest bracket (Less than $45,000), then the
following ranges will be presented to the respondent:
•
Less than $15,000
•

Between $15,000 and $30,000

•

$30,000 or more

2) Mid-range income follow-up questions:
•

Less than $10,000

•

Between $10,000 and $20,000

•

$20,000 or more

If the respondent selects the lowest bracket (Less than $10,000), then the
following ranges will be presented to the respondent:
•
Less than $1,000
•

Between $1,000 and $5,000

•

$5,000 or more

3) Low-range income follow-up questions:
•

Less than $1,000

•

Between $1,000 and $3,000

•

$3,000 or more

If the respondent selects the lowest bracket (Less than $1,000), then the following
ranges will be presented to the respondent:
131

•

Less than $100

•

Between $100 and $500

•

$500 or more

132

Attachment B. Income Source and Follow-Up Question Range Level
The following table displays the income source and range level used in the follow-up range
questions.
Source
Screen

Range
Level

Income Source

Range Screen

Earnings from Longest Job
Longest Job: tips, bonuses, etc.
Earnings from Business/ Farm
Business/ Farm: tips, bonuses, etc.
Earnings from All Other Employers
All Other Employers: tips, bonuses, etc.
Earnings from Any Other Business
Earnings from Any Other Farm
State or Federal Unemployment Compensation
Supplemental Unemployment Benefits
Union Unemployment or Strike Benefits
Worker's Compensation
Social Security
Social Security for Children
Supplemental Security Income (SSI)
SSI for Children
Disability Income (source 1)
Disability Income (source 2)
Veteran's Payments (source 1)
Veteran's Payments (source 2)
Survivor Benefits (source 1)
Survivor Benefits (source 2)
Survivor Benefits (source 3)

PUQ48AARN1
PUQ48AADRN1
PUQ48BRN1
PUQ48BADRN1
PUQ49B1DRN1
PUQ49B1ARN1
PUQ49B2RN1
PUQ49B4RN1
PUQ51A11R1
PUQ51A21R1
PUQ51A31R1
PUQ52CR1
PUQ656DRN1
PUQ56IRN1
PUQ57CRN1
PUQ57IRN1C
PUQ61E1RN1
PUQ61E2RN1
PUQ60V1RN1
PUQ60V2RN1
PUQ58E1RN1
PUQ58E2RN1
PUQ58E3RN1

High
Low
High
Low
Mid
Low
Mid
Mid
Mid
Mid
Mid
Mid
Mid
Mid
Mid
Mid

Public Assistance/ TANF

PUQ59ERN1

Low

Food Assistance/ SNAP

HUQ90RN1

Low

Q99ARa

Pensions (source 1)
Pensions (source 2)
Annuities
Retirement Withdrawals/Distributions (source 1)
Retirement Withdrawals/Distributions (source 2)
Retirement Interest (source 1)
Retirement Interest (source 2)
Checking Account Interest

PUQ62E1RN1
PUQ62E2RN1
PUANNEWRN1
PUDSTNEWR1
PUDSTNEWR3
PURETNEWRN1
PURETNEWRN3
PUQ63C1B

Low

Q99ARb

Savings Account Interest

PUQ63D1B

Low

Q99ARc

Money Market Account Interest

PUQ63e1B

Low

Q99ARd

CD Interest

PUQ63f1B

Low

Q99ARe

Saving Bonds Interest

PUQ63g1b

Low

Q99ARe

Stock Dividends

PUQ63h1b

Low

Q99ARg

Any Other Interest

PUQ63i1b

Low

CAPGDIS
Q65A1,
Q65A2,

Nonretirement Interest

PUCAPGDAMTRN1

Mid

Property Income

PUQ65CRN1

Mid

Q48AA
Q48AAD
Q48B
Q48BAD
Q49B1D
Q49B1A
Q49B2
Q49B4
Q51A1
Q51A2
Q51A3
Q52A
Q56A
Q56F
Q57A
Q57D
Q59AR
Q60A88
Q58A
Q59A88,
Q59A89
Q87R,
Q87AR
Q62AR
Q96AR
Q98Ar
Q97Cr

133

Mid
Mid
Mid

Mid
Mid
Mid
Low

Source
Screen

Range
Level

Income Source

Range Screen

Q70A

Pell Grant
Other Education Assistance
Child Support

PUQ69FRN1
PUQ66HRN1
PUQ70C1RN1

Q72A

Regular Financial Assistance

PUQ72CRN1

Low

Q73A1

Other Money Income

PUQ73RN1

Low

Q93

Energy Assistance

HUQ94RN1

Low

Q65A3
Q66B

134

Low
Mid

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135