Form Items Booklet Items Booklet 2022 Annual Social and Economic Survey

Annual Social and Economic Supplement to the Current Population Survey

2022 ASEC Items Booklet

Annual Social and Economic Supplement to the Current Population Survey

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2022 Annual Social and Economic Supplement

Items Booklet - Feb/March/April 2022















2022 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 MOVER ITEMS 3

1.2 FAMILY INCOME 3

1.3 INCDKR 3

2 INTRODUCTION and WORK EXPERIENCE 4

3 EARNED INCOME 11

4 INCOME SOURCES 24

4.1 UNEMPLOYMENT AND WORKERS COMPENSATION (Source) 26

4.2 SOCIAL SECURITY (Source) 28

4.3 SOCIAL SECURITY FOR CHILDREN (Source) 29

4.4 SUPPLEMENTAL SECURITY INCOME (SSI) (Source) 30

4.5 SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (SSI) (Source) 31

4.6 DISABILITY INCOME (Source) 32

4.7 VETERANS PAYMENTS (Source) 34

4.8 SURVIVOR BENEFITS (Source) 35

4.9 PUBLIC ASSISTANCE (Source) 36

4.10 FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (Source) 38

4.11 PENSIONS (Source) 38

4.12 ANNUITIES (Source) 40

4.13 RETIREMENT ACCOUNTS (Source) 40

4.14 INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT (Source) 41

4.15 PROPERTY INCOME (Source) 45

4.16 EDUCATION ASSISTANCE (Source) 45

4.17 CHILD SUPPORT (Source) 46

4.18 REGULAR FINANCIAL ASSISTANCE (Source) 47

4.19 OTHER MONEY INCOME (Source) 47

5 INCOME AMOUNTS 48

5.1 UNEMPLOYMENT AND WORKER’S COMPENSATION (Amounts) 48

5.2 SOCIAL SECURITY (Amounts) 56

5.3 SOCIAL SECURITY DISABILITY (Amounts) 58

5.4 SOCIAL SECURITY FOR CHILDREN (Amounts) 61

5.5 SUPPLEMENTAL SECURITY INCOME (SSI) (Amounts) 63

5.6 SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (Amounts) 65

5.7 DISABILITY INCOME (Amounts) 66

5.8 VETERANS PAYMENTS (Amounts) 70

5.9 SURVIVOR BENEFITS – Amounts 74

5.10 PUBLIC ASSISTANCE (Amounts) 80

5.11 FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (Amounts) 82

5.12 PENSIONS (Amounts) 84

5.13 ANNUITIES (Amounts) 87

5.14 WITHDRAWALS/DISTRIBUTIONS FROM RETIREMENT PLAN (Amounts) 89

5.15 INTEREST/DIVIDENDS ON RETIREMENT ACCOUNTS (Amounts) 94

5.16 INTEREST/DIVIDENDS ON NON-RETIREMENT ACCOUNTS (Amounts) 96

5.17 PROPERTY INCOME (Amounts) 98

5.18 EDUCATIONAL ASSISTANCE (Amounts) 101

5.19 CHILD SUPPORT (Amounts) 103

5.20 REGULAR FINANCIAL ASSISTANCE (Amounts) 105

5.21 OTHER MONEY INCOME (Amounts) 107

5.22 CONTRIBUTIONS TO RETIREMENT ACCOUNTS (Amounts) 109

6 HEALTH INSURANCE 110

6.1 INTRODUCTION TO HEALTH INSURANCE SECTION 110

6.2 CURRENT COVERAGE 110

6.3 TYPE OF COVERAGE 111

6.4 MONTHS OF COVERAGE 117

6.5 OTHER HOUSEHOLD MEMBERS 120

6.6 ADDITIONAL PLANS 121

6.7 EMPLOYER-SPONSORED INSURANCE OFFERS AND TAKEUP 122

6.8 HEALTH STATUS 123

6.9 MEDICAL EXPENDITURES 124

7 EMPLOYER’S PENSION PLAN 125

8 LOW INCOME ITEMS 126

8.1 SCHOOL LUNCHES 126

8.2 PUBLIC HOUSING 126

8.3 WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC) 127

8.4 ENERGY ASSISTANCE 127

9 MIGRATION 129

9.1 1-YEAR MIGRATION 129

10 SUPPLEMENTAL POVERTY MEASURE 134

10.1 PROPERTY VALUE/PRESENCE OF MORTGAGE 134

10.2 CHILD CARE 135

10.3 CHILD SUPPORT PAID 136

10.4 STIMULUS/ADVANCE CHILD TAX CREDIT PAYMENTS 138

10.5 EMERGENCY BROADBAND DISCOUNT PROGRAM 138























  1. BASIC CPS ITEMS


    1. MOVER ITEMS


HH32b


Did (you/name of reference person) live at this address during the week of November 19, 2021?


1 Yes

2 No


HH32d


Did any of the following household members live here during the week of

November 19, 2021?


  1. Yes

  2. No


    1. 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 Less than $5,000 9 30,000 to 34,999

2 5,000 to 7,499 10 35,000 to 39,999

3 7,500 to 9,999 11 40,000 to 49,999

4 10,000 to 12,499 12 50,000 to 59,999

5 12,500 to 14,999 13 60,000 to 74,999

6 15,000 to 19,999 14 75,000 to 99,999

7 20,000 to 24,999 15 100,000 to 149,000

8 25,000 to 29,999 16 150,000 to more


    1. INCDKR


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


  1. Above

  2. Below


  1. 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 2021?


  1. Yes

  2. No


Q29b


Did (you/he/she) do any temporary, part-time, or seasonal work even

for a few days during 2021?


Include any Military Reserves or National Guard work.


  1. Yes

  2. No


Q30


Even though (name/you) did not work in 2021, did (you/he/she) spend any time trying to find a job or on layoff?


  1. Yes

  2. No


Q31


How many different weeks (was/were) (name/you) looking for work or on layoff from a job?


 (01-52) Number of weeks

________________


Q32


What was the main reason (you/he/she) did not work in 2021?


Read categories if necessary


  1. Ill, or disabled and unable to work

  2. Retired

  3. Taking care of home or family

  4. Going to school

  5. Could not find work

  6. Doing something else


Q33


During 2021 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. Yes

              1. 2 No – back to Q33 and obtain estimate


Q35


Did (name/you) lose any full weeks of work in 2021 because (you/he/she)

(were/was) on layoff from a job or lost a job?

Number of weeks worked in 2021: (number)


  1. Yes

                  1. 2 No

                1. 7 Mistake made in number of weeks worked last year - Specify in Q35SP


Q35SP


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. Yes – one stretch

  2. No – two stretches

  3. 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 2021?


Read list only if respondent is having difficulty answering the question

  1. Ill, or disabled and unable to work

  2. Taking care of home or family

  3. Going to school

  4. Retired

  5. No work available

  6. Other   (Specify - Q38sp)


Q38sp


 Enter verbatim response

_________________________________________________


Q39

For how many employers did (name/you) work in 2021?
If more than one at the same time, only count it as one employer.

  1. One

  2. Two

  3. Three or more


Q41


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 2021, 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. Yes

  2. No


Q44


In the weeks that (name/you) worked, how many weeks did (name/you) work less than 35 hours in 2021?


 Number of weeks worked in 2021: (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. Could not find a full time job

  2. Wanted to work part time or only able to work part time

  3. Slack work or material shortage

  4. Other reason


Q46


What was (name's/your) longest job during 2021?


Was it:

(IO1NAM:) (name of employer)

(IO1IND:) (kind of business or industry)

(IO1OCC:) (occupation)

(IO1DT:) (duties)

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


  1. Same as listed

  2. Different job


Q47a


For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job during 2021?))

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 2021)

_________________________________________________


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. Manufacturing

  2. Retail trade

  3. Wholesale trade

  4. 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. Government

  2. Private for profit company

  3. Non profit organization including tax exempt and charitable organizations

  4. Self employed

  5. Working in family business


Q47E1a


Would that be the federal, state, or local government?


  1. Federal

  2. State

  3. Local (county, city, township)


Q47E1b


Was this business incorporated?


  1. Yes

  2. No


Q47E1c

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


  1. Yes

  2. 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. under 10

  2. 10-49

  3. 50-99

  4. 100-499

  5. 500-999

  6. 1,000+


  1. EARNED INCOME


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. 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 2021?


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 2021?


  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 2021?

  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?

  1. Weekly

  2. Every other week

  3. Twice a month

  4. Monthly

7 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 2021?


(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 2021 before deductions. Does that sound about right?


  1. Yes

  2. No

Q48a2


What is your best estimate of (name's/your) correct total amount of earnings from this employer during 2021 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 2021?


  1. Yes

  2. No


Q48aad


How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from this employer in 2021?


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 2021?


  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 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q48b


What were (name's/your) net earnings from this business/farm after expenses during 2021?


If response is "Broke Even" then enter 1

If response is “none” or if respondent does not own a business or farm, then enter "0"

If response is "Lost Money" press Enter

Enter dollar amount

________________


Q48b_char


Enter “L” for Lost Money

________________


Q48BL


  Enter amount of money lost in 2021

  Enter annual amount only

________________


Q48brn1 Ask only if the respondent “Doesn’t know” or “Refused” Q48b.


Could you please 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 2021?


  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 2021?

  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. Weekly

  2. Every other week

  3. Twice a month

  4. Monthly

  5. Quarterly

  1. Yearly


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 2021?


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 2021?

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 2021?


If response is "Broke Even" then enter 1

Enter "0" for None

If response is “Lost Money” press enter

Enter dollar amount

________________


Q48b3_char


Enter "L" for Lost Money

________________


Q48B3L


Enter amount of money lost in the first quarter of 2021.

________________


Q48b4


What were (name's/your) net earnings from this business/farm during the SECOND quarter of 2021?


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 2021.

________________


Q48b5


What were (name's/your) net earnings from this business/farm during the THIRD quarter of 2021?


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 2021.

________________


Q48b6


What were (name's/your) net earnings from this business/farm during the FOURTH quarter of 2021?


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 2021.

________________


Q48b7


Does this amount include all tips, bonuses, overtime pay, or commissions (name/you) may have received from this business in 2021?


  1. Yes

  2. No


Q48bad


How much did (name/you) earn in tips, bonuses, overtime pay, or commissions

in 2021?


 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 2021?


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. 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 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q49a


Did (name/you) earn money from any other work (you/he/she) did during 2021?

  1. Yes

  2. No


Q49b1d


How much did (name/you) earn from all other employers before taxes and other deductions during 2021?


 Enter dollar amount

 Enter “0” for None

________________


Q49b1drn1 Ask only if the respondent “Doesn’t know” or “Refused” Q48b1d.


Could you please 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 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. Over $20,000


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 2021?

  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. Weekly

  2. Every other week

  3. Twice a month

  4. Monthly

7 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 2021?


(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 2021.  Does that sound about right?


  1. Yes

  2. No


Q49B12


What is your best estimate of (name's/your) correct total amount of earnings from all other employers during 2021?


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 2021?



  1. Yes

  2. No


Q49B1A


How much did (name/you) earn in tips, bonuses, overtime pay, or commissions from all other employers in 2021?


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 2021?


  1. Less than $1,000 (proceed to Q49B1ARN2)

  2. Between $1,000 and $3,000

  3. Over $3,000


Q49B1ARN2


Did (name/you) earn


less than $100

between $100 and $500

or over $500


in tips, bonuses, overtime pay, or commissions from all other employers in 2021?

  1. Less than $100

  2. Between $100 and $500

  3. 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. Less than $10,000 (proceed to Q49b2rn2)

  2. Between $10,000 and $20,000

  3. 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

  2. Between $1,000 and $5,000

  3. 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. Less than $10,000 (proceed to Q49b4rn2)

  2. Between $10,000 and $20,000

  3. Over $20,000


Q49b4rn2


Did (name/you) receive


less than $1,000

between $1,000 and $5,000

or over $5,000


from (your/his/her) farm after expenses?


  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000




Q49b4_char


Enter "L" for Lost Money

________________


Q49b5


Enter annual amount lost only

________________



  1. 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.

Default

Low Income

Householder or Spouse

62 Years +

Earnings- Person Level

Earnings- Person Level

Earnings- Person Level

1

Unemployment/Workers Compensation

1

Unemployment/Workers Compensation

1

Unemployment/Workers Compensation

2

Social Security/SS for Children

7

Public Assistance / TANF

2

Social Security/SS for Children

3

Supplemental Security Income (SSI)/SSI Children

8

Food Stamps (SNAP)

3

Supplemental Security Income (SSI)/SSI Children

4

Disability

2

Social Security/SS for Children

4

Disability

5

Veterans

3

Supplemental Security Income (SSI)/SSI Children

5

Veterans

6

Survivor Benefits

4

Disability

6

Survivor Benefits

7

Public Assistance / TANF

5

Veterans

9

Pensions

8

Food Stamps (SNAP)

6

Survivor Benefits

10

Annuities

9

Pensions

9

Pensions

11

Retirement Accounts (within) –Withdrawals or distributions

10

Annuities

10

Annuities

12

Other Income Earning Assets (outside of retirement)

11

Retirement Accounts (within) – Withdrawals or distributions

11

Retirement Accounts (within) – Withdrawals or distributions

13

Property Income

12

Other Income Earning Assets (outside of retirement)

12

Other Income Earning Assets (outside of retirement)

7

Public Assistance / TANF

13

Property Income

13

Property Income

8

Food Stamps (SNAP)

14

Education Assistance

14

Education Assistance

14

Education Assistance

15

Child Support

15

Child Support

15

Child Support

16

Financial Assistance from friends or relatives

16

Financial Assistance from friends or relatives

16

Financial Assistance from friends or relatives

17

Other Income

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


    1. UNEMPLOYMENT AND WORKERS COMPENSATION (Source)


Q51A1


At any time during 2021 did (you/anyone in the household) receive any State or Federal unemployment compensation?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


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?


Q51A2


At any time during 2021 did (you/anyone in the household) receive any Supplemental Unemployment Benefits (SUB)?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


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?


Q51A3


At any time during 2021 did (you/anyone in the household) receive any Union Unemployment or Strike Benefits?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


1 Yes

2 No


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?


Q52A


During 2021 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.

  • Do NOT include federal stimulus payments due to the Coronavirus pandemic.


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.


Q52b


What was the source of (your/name’s) payments?


1 State Worker's Compensation

2 Employer or employer's insurance worker’s compensation

3 Own insurance worker’s compensation

4 Other


Q52Cs1


  • Specify other source from workers compensation/insurance

  • Enter "Worker’s Compensation" if the answer is "Don't Know"

________________________________________________


    1. SOCIAL SECURITY (Source)


Q56a


During 2021 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.


Probe: Anyone else?


SSR


What were the reasons (name/you) (was/were) getting Social Security in 2021?


Mark all that apply, separate using the space bar or a comma.


Probe: Any Other Reason?


  1. Retired

  2. Disabled

  3. Widowed

  4. Spouse

  5. Surviving child

  6. Dependent child

  7. On behalf of surviving, dependent, or disabled children

  8. Other


SSRs


 Specify other reason

________________________________________________


SSC


Which children under age 19 were receiving Social Security in 2021?


Probe: Anyone Else?

Enter all that apply, separate by commas.

  Enter 96 for All People   Enter 0 for None


SSCR


What were the reasons (Child’s name/the children) (was/were) getting Social Security in 2021?


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

SSDIa1


Did (name/you) receive (your/his/her) first Social Security Disability payment in 2021?


  1. Yes

  2. No


    1. SOCIAL SECURITY FOR CHILDREN (Source)


Q56f


Did anyone in this household receive any Social Security income in 2021 that we have not already counted on behalf of children in this household?


 Includes all children under 19 years of age


1 Yes

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?


CSS


Which children under age 19 were receiving Social Security in 2021?


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


CRSS


What were the reasons (Child's name/the children) (was/were) getting Social Security in 2021?


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


    1. SUPPLEMENTAL SECURITY INCOME (SSI) (Source)


Q57a


During 2021 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.


1 Yes

2 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?


SSIR


What were the reasons (name/you) (was/were) getting Supplemental Security Income in 2021?

Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?


  1. Disabled

  2. Blind

  3. On behalf of a disabled child

  4. On behalf of a blind child

  5. Other ________________



    1. SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (SSI) (Source)


Q57d


Did anyone in this household receive any Supplemental Security Income in 2021 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


LN  Name  Amount for Q57C amount


1 Yes

2 No


Q57e

Read only if necessary


 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?


RSSI


What were the reasons (name/you) (was/were) getting Supplemental Security Income on behalf of children in 2021?


 Enter all that apply, separate using the space bar or a comma.

Probe: Any Other Reason?


  1. On behalf of a disabled child/children

  2. On behalf of a blind child/children

  3. Other ________________


CSSI


Which children under age 18 were receiving Supplemental Security Income

in 2021?


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

4.6 DISABILITY INCOME (Source)



Q59AR


At any time in 2021 (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. Yes

  2. No


Q59b

 Read only if necessary


Who is that?


 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?


Q60a


(Did you/Is there anyone in this household who) ever (retire or leave/ retired or left) a job for health reasons?


  1. Yes

  2. No


Q60b

 Read only if necessary


Who is that?


 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?


Q61b


Did (you/name) receive any income in 2021 as a result of (your/his/her) health problem (other than Social Security Disability/other than VA benefits/ other than Social Security Disability or VA Benefits)?


(  If amount was reported previously as compensation from a job related injury or illness, then enter <2>. Amount previously reported in Q52CT was (amount).)

Do not include Veterans’ payments.


  1. Yes

  2. 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 income related to this health condition or disability?


  1. Worker’s compensation

  2. Company or union disability

  3. Federal Government (CIVIL SERVICE) disability

  4. U.S. Military retirement disability

  5. State or Local government employee disability

  6. U.S. Railroad retirement disability

  7. Accident or disability insurance

  8. Black Lung miner’s disability

  9. State temporary sickness

  10. 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"

_____________________________________________


    1. VETERANS PAYMENTS (Source)


Q60A88


At any time during 2021 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?


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. Service-connected disability compensation

  2. Survivor Benefits

  3. Veterans’ Pension

  4. Educational assistance (including assistance received by children of veterans)

  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


    1. SURVIVOR BENEFITS (Source)


Q58a


Did (you/ anyone in this household) receive any survivor benefits in 2021 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?


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 Company or union survivor pension (INCLUDE PROFIT SHARING)

  1. Federal Government survivor (CIVIL SERVICE) pension

  2. U.S. Military retirement survivor pension

  3. State or Local government survivor pension

  4. U.S. Railroad retirement survivor pension

  5. Worker's compensation survivor pension

  6. Black Lung survivor pension

  7. Regular payments from estates or trusts

  8. Regular payments from annuities or paid-up insurance policies

11 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"


________________________________________________


    1. PUBLIC ASSISTANCE (Source)


Q59A88


At any time during 2021, 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)?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


Include cash from: Don’t include:

Welfare or welfare to work Food stamps (SNAP)

TANF SSI

AFDC/Aid to Families Energy assistance

General Assistance WIC

Diversion payments School meals

Refugee Cash Childcare

Gen Assist Indian Affairs Education Assistance


  1. Yes

  2. No


Q59A89


Just to be sure, in 2021, did anyone receive CASH assistance from a state or county welfare program, on behalf of CHILDREN in the household?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


  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?


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, separate using the space bar or a comma.

  • Probe: Any Other Program?

  • If respondent mentions any of the following categories:

Food Stamps

SSI

Energy Assistance

School Meals

Transportation

Child Care

Rental

Educational Assistance


Note this, but explain: “Right now we are interested in CASH assistance”. Seek answers using the accepted categories


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


  1. (State Program Name)/Temporary Assistance to Needy Families (TANF)/ welfare/AFDC

  2. General Assistance

  3. Emergency Assistance/short-term cash assistance

  4. Diversion Payments

  5. Refugee Cash and Medical Assistance program

  6. General Assistance from Bureau of Indian Affairs, or Tribal Administered General Assistance

  7. Some other program (specify)


Q59C8s


What was the name of the other program?

Specify other source of cash assistance

Enter "Cash" if the answer is "Don't Know"

_________________________________________________


    1. FOOD STAMPS/SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (Source)


Q87r


At any time during 2021, 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?


  • Do not include WIC benefits.


1 Yes

2 No


Q87ar


At any time during 2021, even for one month, did (you/ anyone in this household) receive any food assistance from (State Program name)?


Do not include WIC benefits.

Include SNAP (Supplemental Nutrition Assistance Program)


1 Yes

2 No


Q88


Which of the people now living here were covered by that food assistance

during 2021?


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?




    1. PENSIONS (Source)


Q62Ar


During 2021 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 income?


 Enter all that apply, separate using the space bar or a comma.

 Probe: Anyone Else?


Enter persons line number (1-16)


Q62Cr


What was the source of (your/ NAME’s) pension income? Did (you/he/she) have a pension from a:


READ EACH CATEGORY.

Enter all that apply, separate using the space bar or a comma.


  1. Company

  2. Union

  3. Federal Government

  4. State Government

  5. Local Government

  6. U.S. Military

  7. Some other source


Q62DR


What was the source of (name's/your) other pension income?


Enter all that apply

Probe as needed: Who received this source?

Probe: Any Other pension income?


  1. U.S. Railroad Retirement pension

  2. Other source (specify) or “don’t know”


Q62Cs1


Specify other source of pension income

Enter "Other Pension" if the answer is "Don't Know"


    1. ANNUITIES (Source)


Q96Ar


During 2021 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?


    1. RETIREMENT ACCOUNTS (Source)


Q97Ar


At any time during 2021 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?


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. 401(k)

5. KEOGH plan (“KEE-OH”)

  1. 403(b)

6. SEP plan (Simplified Employee Pension)

  1. Roth IRA

7. another type of retirement account

  1. Regular IRA



Q97Dr


What was the source of (name's/your) retirement income?


 Enter other source of retirement income

Enter “Other Retirement” if the answer is “Don’t Know”



Q98Ar(1-7)


Did (you/NAME) withdraw any money or receive a distribution from (your/his/her) [ACCOUNT TYPE_ FILL IN FROM Q97CR or Q97DR] in 2021 (, including any distributions (you/he/she) may have been required to take)?


1 Yes

2 No


    1. INCOME-EARNING ACCOUNTS OUTSIDE OF RETIREMENT (Source)


Q99ARa


Now I will ask about assets that may have paid interest or dividends in 2021 outside of the retirement accounts.


At any time during 2021, did (you/anyone in this household):


Have money in an interest-earning checking account?


1 Yes

2 No


Q99Ba


  • Ask only if necessary


Which members of this household ages 15 and over had an interest-earning checking account?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


Q99ARb


At any time during 2021, did (you/anyone in this household):


Have money in a savings account?


1 Yes

2 No


Q99Bb


  • Ask only if necessary


Which members of this household ages 15 and over had savings accounts?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


Q99ARc


At any time during 2021, did (you/anyone in this household):

Have money in a money market fund?


1 Yes

2 No


Q99Bc


  • Ask only if necessary


Which members of this household ages 15 and over had a money market fund?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


Q99ARd


At any time during 2021, did (you/anyone in this household):


Have money in CDs (certificates of deposit)?


1 Yes

2 No


Q99Bd


  • Ask only if necessary


Which members of this household ages 15 and over had CDs (certificates of deposit)?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


Q99ARe


At any time during 2021, did (you/anyone in this household):

Have money in savings bonds?


1 Yes

2 No


Q99Be


  • Ask only if necessary


Which members of this household ages 15 and over had savings bonds?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


Q99ARf


At any time during 2021, did (you/anyone in this household):


Have money in shares of stock in corporations or mutual funds?


1 Yes

2 No


Q99Bf


  • Ask only if necessary


Which members of this household ages 15 and over had shares of stock in corporations or mutual funds?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


Q99ARg


At any time during 2021, did (you/anyone in this household):


Have money in any other savings or investments that pay interest or dividends?


1 Yes

2 No


Q99Bg


  • Ask only if necessary


Which members of this household ages 15 and over had any other savings or investments that paid interest or dividends?


  • Include each person in cases of joint accounts or ownership

  • Enter all that apply, separate using the space bar or a comma

  • Probe: Anyone else?


CAPGDIS



Did (you/NAME) receive any capital gains from (your/his/her) shares of stocks or mutual funds in 2021?



1 Yes

2 No


Q99BR


What was the source of (name's/your) savings or investments that pay interest or dividends?


  • Enter other source of interest or dividend income



    1. PROPERTY INCOME (Source)


Q65A1


During 2021 did (you/ anyone in this household):


Own any land, business property, apartments, or houses which were rented to others?

  1. Yes

  2. No


Q65A2


At any time during 2021 did (you/ anyone in this household):

Receive income from royalties or from roomers or boarders?

(exclude amounts paid by relatives)


  1. Yes

  2. No


Q65A3


At any time during 2021 did (you/ anyone in this household):


Receive income from estates or trusts?

(exclude estates or trusts already reported)


  1. Yes

  2. No


Q65b

Ask only if necessary


Who received this (income/rent) ?


  • (Amount previously reported in Q48b was (amount))

  • 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?


    1. EDUCATION ASSISTANCE (Source)


Q66a


During 2021 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. Yes

  2. No


Q66b


Did (you/ anyone in this household) receive any educational assistance for tuition, fees, books, or living expenses during 2021?


 Exclude loans, assistance from household members, and VA educational benefits


  1. Yes

  2. 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? 


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?


  1. Pell Grant

  2. Assistance from a welfare or social service office

  3. Some other government assistance

  4. Scholarships, grants, etc.

  5. Other assistance (employers, friends, etc.)


    1. CHILD SUPPORT (Source)


Q70a


During 2021 did (you/anyone in this household) receive:

Any child support payments?


  1. Yes

  2. No


Q70b


  • Read only if necessary


Who received these payments?


Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else? 


    1. REGULAR FINANCIAL ASSISTANCE (Source)


Q72a


(Any other/Any) regular financial assistance from friends or relatives not living in this household?


Do not include loans


  1. Yes

  2. 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?


    1. OTHER MONEY INCOME (Source)

Q73A1R


During 2021 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?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


  1. Yes

  2. No


Q73A1b


Ask only if necessary


Who received this income?


Enter all that apply, separate using the space bar or a comma.

Probe: Anyone Else?


Q73A1Rc1


What was the source of this income?

  • Asking about: (name/you – Current respondent)

  • 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: (name/you – Current respondent)



  1. INCOME AMOUNTS


AMTINTRO


Now I will ask you about the amount of income you (and others in this household) received from various sources in 2021.


    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


Q51A11


How much did (name/you) receive (weekly/every other week/ twice a

month/monthly) in State or Federal unemployment compensation during 2021?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


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 2021?


  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 2021?

  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 2021 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 2021?


(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 2021. Does that sound about right?


1 Yes

2 No


Q51A14


What is your best estimate of the correct total amount (name/you) received from State or Federal unemployment compensation during 2021?


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 2021?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


Enter dollar amount

_____________


Q51A21r1


Could you please tell me if (name/you) received


less than $10,000

between $10,000 and $20,000

or over $20,000


in Supplemental Unemployment Benefits during 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. 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 2021?

  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 2021 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 2021?


(1-12/1-24/1-26/1-52)

________________


Q51A23


According to my calculations (name/you) received (total) altogether from Supplemental Unemployment Benefits during 2021. Does that sound about right?


1 Yes

2 No


Q51A24


What is your best estimate of the correct total amount (name/you) received from Supplemental Unemployment Benefits during 2021?


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 2021?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


Enter dollar amount

________________


Q51A31r1


Could you please 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 2021?


  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

between $1,000 and $5,000

or over $5,000


in Union Unemployment or Strike Benefits during 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. 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 2021 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 2021?


(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 2021. Does that sound about right?


1 Yes

2 No


Q51A34


What is your best estimate of the correct total amount (name/you) received from Union Unemployment or Strike Benefits during 2021?


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) Worker’s Compensation: weekly, every other week, twice a month, monthly, or yearly?



1 Weekly

2 Every other week

3 Twice a month

4 Monthly

7 Yearly


Q52c1


How much did (name/you) receive (weekly/every other week/twice a month/monthly) in Worker’s Compensation during 2021?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


Enter dollar amount

________________


Q52cr1


Could you please tell me if (name/you) received


less than $10,000

between $10,000 and $20,000

or over $20,000


in Worker’s Compensation during 2021?


  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 Worker’s Compensation during 2021?

  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 2021

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 Worker’s Compensation during 2021?


(1-12/1-24/1-26/1-52)

________________


Q52c3


Then (name/you) received (total) altogether from Worker’s Compensation during 2021. Does that sound about right?


1 Yes

2 No


Q52c4


What is your best estimate of the correct total amount (name/you)

received from Worker’s Compensation during 2021?


PREVIOUS ENTRIES: Q52c1: (amount)

Q52cp: (periodicity)

Q52c2: (number of pay periods)


Enter dollar amount

________________

    1. 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 Monthly

5 Quarterly

7 Yearly


Q56d


How much did (name/you) receive (monthly/quarterly) in Social Security payments in 2021?


  • Enter dollar amount 

Shape3  

  • (If already included in amount reported for another household member, press Enter)

________________


Q56d_Char


Shape4 Enter <A> for Already included

________________


Q56drn1


Could you please tell me if (name/you) received


less than $10,000

between $10,000 and $20,000

or over $20,000


for the TOTAL amount (you/name) received in Social Security payments in 2021?


  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 2021?

  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 2021?

Shape5 (1-4; 1-12)

________________


Q56d3


Is this $(amount from Q56d/amount from Q56d1) before or after any monthly Medicare deduction?

1 After Deduction 

2 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 (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 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q56d6


What is your best estimate of the correct amount (name/you) received in Social Security during 2021?

PREVIOUS ENTRIES:  Q56d: (amount)
Q56dp: (periodicity)
  Q56d2: (number of pay periods)

Enter dollar amount 

________________


    1. 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?


4 Monthly

5 Quarterly

7 Yearly


Q562d


How much did (name/you) receive (monthly/quarterly) in Social Security Disability payments in 2021?


 Enter dollar amount 


 (If already included in amount reported for another household member, press Enter)

________________


Q562d_Char


Enter <A> for Already included

________________


Q562d2


For how many (months/quarters) did (name/you) receive Social Security Disability in 2021?

Shape6 (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 2021?


  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


in Social Security Disability payments in 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000


Q562d3


Is this $(amount from Q562d) 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 (name’s/your) monthly payments for Medicare?


Include Medicare Advantage, Part B, and part D premiums.


 Q562dC2


Shape7 Do not read to the respondent.


Shape8 The annual rate appears out of range. The total Social Security received in 2021 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.


BACKPAY1


During 2021, did (name/you) receive an initial Social Security Disability payment that was larger than the usual payment that we haven’t accounted for yet?


Sometimes the initial payment from Social Security Disability is larger than the usual monthly payments to make up for the delay in receiving the first payment.


  1. Yes

  2. No


BACKPAY2


How much was that initial disability payment?


Q562d5


According to my calculations (name/you) received $(total) altogether from Social Security Disability in 2021. Does that sound about right?


1 Yes

2 No


Q562d6


What is your best estimate of the correct amount (name/you) received in Social Security Disability during 2021?

PREVIOUS ENTRIES: Q562d: (amount)
Q562dp: (periodicity)
Q562d2: (number of pay periods)
BACKPAY2: (amount)

Enter dollar amount 

________________


    1. SOCIAL SECURITY FOR CHILDREN (Amounts)



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 2021?


Enter dollar amount 


(If already included in amount reported for another household member, press Enter)

________________


Q56i_Char


Enter A for Already included

________________


Q56irn1


Could you please 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 Social Security payments for children in this household in 2021?


  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 2021?

  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 2021?


 (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 2021 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.


Q56i4


According to my calculations (name/you) received $(total) altogether for children in this household from Social Security in 2021. Does that sound about right?


1 Yes

2 No



Q56i5


What is your best estimate of the correct amount (name/you) received in Social Security for children in this household during 2021?

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

 Enter dollar amount

________________



    1. SUPPLEMENTAL SECURITY INCOME (SSI) (Amounts)


Q57cp


What is the easiest way for you to tell us (name's/your) 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 2021?


Enter dollar amount 

________________


Q57crn1


Could you please 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 Supplemental Security Income payments in 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. 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 2021?

  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 2021?


(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 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q57c5


What is your best estimate of the correct amount (name/you) received in Supplemental Security Income during 2021?


Previous entries: (amount)

Q57cp: (periodicity)
 Q57c2: (number of pay periods)

Enter Dollar Amount

________________


    1. SUPPLEMENTAL SECURITY INCOME FOR CHILDREN (Amounts)


Q57ip


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

4 Monthly

5 Quarterly

7 Yearly


Q57i


How much did (name/you) receive (monthly/quarterly) in Supplemental Security Income on behalf of children in 2021?

Enter dollar amount

________________


Q57irn1


Could you please 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 Supplemental Security Income payments in 2021?

  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. 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 in 2021?

  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 2021?


(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 2021 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 2021.

Does that sound about right?


1 Yes

2 No


Q57i5


What is your best estimate of the correct amount (name/you) received in Supplemental Security Income on behalf of children during 2021?


PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)

 Enter dollar amount 

________________


    1. 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 2021?


  • Enter dollar amount


  • Do not include Veterans’ payments.

_______________


Q61e1rn1


Could you please 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 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. Over $20,000


Q61e1rn2


Did (name/you) receive


less than $1,000

between $1,000 and $5,000

or over $5,000


in (fill first answer from Q61C or Q61Cs1) during 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. 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 2021?

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 2021 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 2021. Does that sound about right?


1 Yes

2 No




Q61E14


What is your best estimate of the correct amount (name/you) received from (fill first answer from Q61C or Q61Cs1) payments during 2021?


PREVIOUS ENTRIES:  (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 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


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 2021?

Enter dollar amount

_______________


Q61e2rn1


Could you please 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 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. 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 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000


Q61E22


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 2021?


 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 2021 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 2021. Does that

sound about right?


1 Yes

2 No


Q61E24


What is your best estimate of the correct amount (name/you) received from (fill second answer from Q61C or Q61Cs1) payments during 2021?


PREVIOUS ENTRIES:  (amount)
Q61E2P: (periodicity)
Q61E22: (number of pay periods)


 Enter dollar amount

_______________


    1. 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

  3. Twice a month

  4. Monthly

7 Yearly


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 2021?


Enter dollar amount

_______________


Q60v1rn1


Could you please 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 from first answer in Q60c8) during 2021?


  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 during 2021?

  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 2021?


(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 in 2021 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) received $(total) altogether from (fill from first answer in Q60c8) in 2021. Does that sound about right?


1 Yes

2 No


Q60V14


What is your best estimate of the correct amount (name/you) received in Veteran's benefits during 2021?


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 2021?


Enter dollar amount

_______________


Q60v2rn1


Could you please 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 from second answer in Q60c8) payments during 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. 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 during 2021?

  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 2021?


(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 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q60V24


What is your best estimate of the correct amount (name/you) received in

(fill from second answer in Q60c8) during 2021?


PREVIOUS ENTRIES:  Q60V2:  (amount)

Q60V2P: (periodicity)

Q60V22: (number of pay periods)


Enter dollar amount
________________


    1. 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) 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


Q58E1


How much did (name/you) receive (weekly/every other week/twice a month/

monthly) from (your/his/her) (fill from first answer in Q58C or Q58Cs1) in 2021?


Enter dollar amount

_______________


Q58e1rn1


Could you please 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 from (your/his/her) (fill from first answer in Q58C or Q58Cs1) payments during 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. Over $20,000


Q58e1rn2


Did (name/you) receive


less than $1,000

between $1,000 and $5,000

or over $5,000


from (you/his/her) (fill from first answer in Q58C or Q58Cs1) payments during 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. 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 2021?


 (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 2021 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 2021. Does that sound about right?

1 Yes

2 No


Q58E14


What is your best estimate of the correct amount (name/you) received from (your/his/her) (fill from first answer in Q58C or Q58Cs1) payments during 2021?


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 Q58C or Q58Cs1) 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


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 2021?


Enter dollar amount

________________


Q58e2rn1


Could you please 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 from (your/his/her) (fill from second answer in Q58C or Q58Cs1) payments during 2021?


  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


from (your/his/her) (fill from second answer in Q58C or Q58Cs1) payments during 2021?

  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 from (your/his/her) (fill from second answer in Q58C or Q58Cs1) in 2021?


 (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 2021 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 (your/his/her) (fill from second answer in Q58C or Q58Cs1) payments in 2021.


Does that sound about right?


1 Yes

2 No


Q58E24


What is your best estimate of the correct amount (name/you) received from (your/his/her) (fill from second answer in Q58C or Q58Cs1) payments during 2021?


 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 2021?


 Enter dollar amount

________________


Q58e3rn1


Could you please 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 from (your/his/her) (fill from third answer in Q58C or Q58Cs1) payments during 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. Over $20,000

Q58e3rn2


Did (name/you) receive


less than $1,000

between $1,000 and $5,000

or over $5,000


from (your/his/her) (fill from third answer in Q58C or Q58Cs1) payments during 2021?

  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 from (your/his/her) (fill from third answer in Q58C or Q58Cs1) in 2021?


 (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 2021 was (amount). Is this a correct entry? If Yes, enter "S" to Suppress. If No, press enter and correct entry.


Q58E33


According to my calculations (name/you) received (total) altogether from (your/his/her) (fill from third answer in Q58C or Q58Cs1) payments in 2021. Does that sound about right?


1 Yes

2 No


Q58E34


What is your best estimate of the correct amount (name/you) received from (your/his/her) (fill from third answer in Q58C or Q58Cs1) payments during 2021?


PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: (periodicity)
Q58E32: (number of pay periods)

Enter dollar amount
_______________


    1. PUBLIC ASSISTANCE (Amounts)


Q59ep


What is the easiest way for you to tell us (name's/your) TOTAL CASH assistance payments from (fill from Q59C8r); Is it 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 2021, how much TOTAL CASH assistance did (name/you) receive (per week/every other week/twice a month/monthly): (fill from Q59C8r)?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


 Enter dollar amount

___________


Q59ern1


Could you tell me if (name/you) received


less than $1,000

between $1,000 and $3,000

or over $3,000


in TOTAL CASH assistance payments in 2021?


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. Over $3000


Q59ern2


Did (name/you) receive


less than $100

between $100 and $500

or over $500


in TOTAL CASH assistance payments in 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q59e2


How many (weekly/every other week/ twice a month/ monthly) cash assistance payments did (name/you) receive in 2021?


(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 2021 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/you) received $(total) altogether in cash assistance from a state or county program in 2021. Does that sound about right?


1 Yes

2 No


Q59e4


What is your best estimate of the correct amount of cash assistance
(name/you) received during 2021?

PREVIOUS ENTRIES:  Q59e: (amount)

Q59ep: (periodicity)

Q59e2: (number of pay periods)

Enter dollar amount 

________________


Q59f


Was the cash assistance for adults AND children in the household, 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


    1. 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 2021?

Enter dollar amount

________________


Q90rn1


Could you tell me if the value of food assistance received in 2021 was


less than $1,000

between $1,000 and $3,000

or over $3,000


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. Over $3000


Q90rn2


Was the value


less than $100

between $100 and $500

or over $500


in food assistance in 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q902


How many months was food assistance received in 2021?


 (1-12)

________________


Q90C2


Do not read to the respondent.

The annual rate appears out of range. The total food assistance payments received in 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q904


What is your best estimate of the correct amount of food assistance received

during 2021?


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

Enter dollar amount 
 ________________



    1. PENSIONS (Amounts)


Q62E1PR


What is the easiest way for you to tell us (name's/your) (first answer fill-in from Q62CR/Q62cS1); weekly, every other week, twice a month, monthly, or yearly?


  1. Weekly

  2. Every other week

  3. Twice a month

  4. Monthly

7 Yearly


Q62E1R


How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) in (first answer fill-in from Q62CR/Q62cS1) in 2021?


 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/Q62cS1) in 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. Over $20,000

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/Q62cS1) in 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. 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/Q62cS1) in 2021?


 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 Q62CR/Q62cS1) payments received in 2021 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/Q62cS1) in 2021. Does that sound about right?


1 Yes

2 No


Q62E14R


What is your best estimate of the correct amount (name/you) received in (first answer fill-in from Q62CR/Q62cS1) during 2021?


PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
  Q62E12: (number of pay periods)
 Enter dollar amount

_______________


Q62E2PR


What is the easiest way for you to tell us (name's/your) (second answer fill-in from Q62CR/Q62cS1); 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/you) receive (weekly/every other week/ twice a month/ monthly) in (second answer fill-in from Q62CR/Q62cS1) in 2021?


 Enter dollar amount

_______________


Q62E2rn1


Could you please 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/Q62cS1) payments in 2021?


  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/Q62cS1) in 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  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/Q62cS1) in 2021?


 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 second answer in Q62CR/Q62cS1) payments received in 2021 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) dollars altogether from (second answer fill-in from Q62CR/Q62cS1) in 2021. Does that sound about right?


1 Yes

2 No


Q62E24R


What is your best estimate of the correct amount (name/you) received in (second answer fill-in from Q62CR/Q62cS1) during 2021?


PREVIOUS ENTRIES: Q62E1: (amount)
Q62E1P: (periodicity)
  Q62E12: (number of pay periods)

Enter dollar amount

_______________


    1. 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. Weekly

  2. Every other week

  3. Twice a month

  4. Monthly

7 Yearly


ANNNEW2


How much did (name/you) receive (weekly/every other week/twice a month/ monthly) in annuities in 2021?


 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 2021?


  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 2021?

  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) payments did (name/you) receive in 2021?


  (1-12; 1-52)

_______________


ANNNEW4


According to my calculations (name/you) received $(total) dollars altogether from annuities in 2021. Does that sound about right?

1 Yes

2 No


ANNNEW5


What is your best estimate of the correct amount (name/you) received in annuities in 2021?


Enter dollar amount

_______________


    1. 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) (1st account type fill-in from Q97CR or Q97DR) in 2021: 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 (1st account type fill-in from Q97CR or Q97DR) in 2021?


 Enter dollar amount

_______________


DISTNEW3


How many (monthly/quarterly) withdrawals did (name/you) make or distributions did (name/you) receive in 2021 from the (1st account type fill-in from Q97CR or Q97DR)?


 Valid entries are 1-12 if monthly; 1-4 if quarterly; 1-2 if every six months

DISTNEWrn1


Could you please 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 (your/his/her) (1st account type fill-in from Q97CR or Q97DR) in 2021?


  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 (your/his/her) (1st account type fill-in from Q97CR or Q97DR) in 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000


DISTNEW4


According to my calculations (name/you) withdrew or received a distribution of $(total) altogether from the (1st account type fill-in from Q97CR or Q97DR) in 2021. Does that sound about right?


1 Yes

2 No


DISTNEW5


What is your best estimate of the correct amount (name/you) withdrew or the distribution received from the (1st account type fill-in from Q97CR or Q97DR) during 2021?


 Enter dollar amount

_______________



ROLLA



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 2021?

  • Enter dollar amount

  • Dollar amount should not exceed amount of withdrawals reported.

  • Amount of withdrawals reported: $(amount)

_______________



ROLLB



(Do/Does) (you/name) plan to re-invest or roll over any of the money?



  1. Yes

  2. 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

  • Dollar amount should not exceed amount of withdrawals reported.

  • Amount of withdrawals reported: $(amount)

_______________


DISTNEW6


What is the easiest way for you to tell us the amount of money withdrawn or distributed from (name’s/your) (2nd account type fill-in from Q97CR or Q97DR) in 2021: 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 (your/his/her) (2nd account type fill-in from Q97CR or Q97DR) in 2021?


 Enter dollar amount

_______________


DISTNEW8


How many (monthly/quarterly) withdrawals did (name/you) make or distributions did (name/you) receive in 2021 from the (2nd account type fill-in from Q97CR or Q97DR)?


(1-12), (1-4), (1-2)

DISTNEWrn3


Could you please 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 (your/his/her) (2nd account type fill-in from Q97CR or Q97DR) in 2021?


  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 (your/his/her) (2nd account type fill-in from Q97CR or Q97DR) in 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000


DISTNEW9


According to my calculations (name/you) withdrew or received a distribution of $(total) altogether from the (2nd account type fill-in from Q97CR or Q97DR) in 22021. Does that sound about right?


1 Yes

2 No


DISTNEW10


What is your best estimate of the correct amount (name/you) withdrew or the distribution received from the (2nd account type fill-in from Q97CR or Q97DR) during 2021?


 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 Yes

2 No



ROLLAMTC



How much did (you/name) re-invest or “roll over” into an IRA or some other kind of retirement plan in 2021?

  • Enter dollar amount

  • Dollar amount should not exceed amount of withdrawals reported.

  • Amount of withdrawals reported: $(amount)

_______________



ROLLD



(Do/Does) (you/name) plan to re-invest or roll over any of the money?



1 Yes

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

  • Dollar amount should not exceed amount of withdrawals reported.

  • Amount of withdrawals reported: $(amount)

_______________


    1. INTEREST/DIVIDENDS ON RETIREMENT ACCOUNTS (Amounts)


RETIRENEW1


Within the (1st account type fill-in from Q97CR/Q97DR) account, how much did (name/you) earn in interest or dividends during 2021? 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 (your/his/her) (1st account type fill-in from Q97CR/Q97DR) during 2021?


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. Over $3,000


RETIRENEWrn2


Did (name/you) earn


less than $100

between $100 and $500

or over $500


in interest or dividends from (your/his/her) (1st account type fill-in from Q97CR/Q97DR) during 2021?

  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) (1st account type fill-in from Q97CR/Q97DR) account at the end of 2021?


 Enter dollar amount

_____________


RETIRENEW3


Within the (2nd account type fill-in from Q97CR/Q97DR) account, how much did (name/you) earn in interest or dividends during 2021? Please include small amounts reinvested or credited to the account.


 Enter dollar amount

_____________


RETIRENEWrn3


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 (your/his/her) (2nd account type fill-in from Q97CR/Q97DR) during 2021?


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. Over $3,000


RETIRENEWrn4


Did (name/you) earn


less than $100

between $100 and $500

or over $500


in interest or dividends from (your/his/her) (2nd account type fill-in from Q97CR/Q97DR) during 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500



    1. INTEREST/DIVIDENDS ON NON-RETIREMENT ACCOUNTS (Amounts)


NONRETIRENEW(1-7)1


How much did (you/name) receive in (interest/dividends) from [fill-in from Q99AR or Q99BR] during 2021, 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/dividends) from [fill-in from Q99AR or Q99BR] during 2021?


  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/dividends) from [fill-in from Q99AR or Q99BR] during 2021?

  1. Less than $100

  2. Between $100 and $500

  3. 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 from Q99AR or Q99BR] at the end of 2021?


 Enter dollar amount

_____________


Q63(c-i)p


 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


Q63(c-i)2


How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months) payments did (you/name) receive in interest/dividend income in 2021 from [fill-in from Q99AR or Q99BR]?

_______________


Q63(c-i)3


According to my calculations (you/name) received $(total) from interest/dividend income from [fill-in from Q99AR or Q99BR] in 2021. Does that sound about right?


1 Yes

2 No


Q63(c-i)4


What is your best estimate of the correct amount (you/NAME) received from interest payments during 2021?


PREVIOUS ENTRIES: Q63(c-i): (amount)
Q63(c-i)p: (periodicity)
Q63(c-i)2: (number of pay periods)

 Enter dollar amount

_______________



CAPGDAMT



How much did (you/name) receive in capital gains in 2021?

 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


in capital gains during 2021?


  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 distributions during 2021?

  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000


    1. 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 2021?


  • 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, press Enter

  • If response is "None" or "Lost Money" press <Enter> key

_______________


Q65c_Char


Enter "A" for Already included 

Enter "L" for Lost Money

Enter "X" for None

______________


Q65cL


 Enter amount of money lost in 2021.

_______________


Q65crn1


Could you please 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 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 2021?


  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 2021?

  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?


  1. Weekly

  2. Every other week

  3. Twice a month

  4. Monthly

  5. Quarterly

7 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 2021?


 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 2021. 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’s/your) 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 2021?


 PREVIOUS ENTRIES:  Q65cL: (amount)
  Q65cp: (periodicity)

Enter dollar amount 

_______________


    1. EDUCATIONAL ASSISTANCE (Amounts)


Q69F88


How much did (name/you) receive in Pell Grants during 2021?


Enter annual amount only

________________


Q69Frn1

Could you please tell me if (name/you) received:


less than $1,000

between $1,000 and $3,000

or over $3,000


for the TOTAL amount (name/you) received in Pell Grants during 2021?


  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 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q66HP


What is the easiest way for you to tell us (name's/your) (other/blank) educational assistance during 2021; 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


(Aside from the Pell Grant assistance, how/How) much did (name/you) receive (weekly/every other week/ twice a month/ monthly) in educational assistance during 2021? 


Enter dollar amount

________________


Q66H2


How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive in educational assistance in 2021?


(1-12/1-24/1-26/1-52)

________________


Q66Hrn1


Could you please tell me if (name/you) received:


less than $1,000

between $1,000 and $3,000

or over $3,000


for the TOTAL amount (name/you) received in educational assistance during 2021?


  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 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q66HC2


Do not read to the respondent.

The annual rate appears out of range. The total educational assistance received in 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q66H4


What is your best estimate of the correct amount (name/you) received from educational assistance during 2021?


 Previous entries: Q66h: (amount)

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

Enter dollar amount

________________


    1. 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 2021?


Enter dollar amount 

________________


Q70c2


How many (weekly/every other week/ twice a month/ monthly) child support payments did (name/you) receive in 2021?


 (1-12/1-24/1-26/1-52)

________________


Q70c1rn1


Could you please 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 child support payments in 2021?


  1. Less than $10,000

  2. Between $10,000 and $20,000

  3. 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 2021?


  1. Less than $1,000

  2. Between $1,000 and $5,000

  3. Over $5,000


Q70cC2


Do not read to the respondent.

The annual rate appears out of range. The total child support payments received in 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q70c4


What is your best estimate of the correct amount (name/you) received from child support payments during 2021?


PREVIOUS ENTRIES: Q70c: (amount)
  Q70cp: (periodicity)
  Q70c2: (number of pay periods)

Enter dollar amount
________________


    1. 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 2021?


 Enter dollar amount

________________


Q72c2


How many (weekly/every other week/twice a month/monthly) payments did (name/you) receive in regular financial assistance in 2021?


(1-12/1-24/1-26/1-52)

_______________


Q72crn1


Could you please 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 2021?


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. Over $3,000




Q72crn2


Did (name/you) receive


less than $100

between $100 and $500

or over $500


in regular financial assistance in 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q72cC2


Do not read to the respondent.

The annual rate appears out of range. The total regular financial assistance payments received in 2021 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 2021. Does that sound about right?


1 Yes

2 No


Q72c4


What is your best estimate of the correct amount (name/you) received from regular financial assistance during 2021?


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

________________


    1. OTHER MONEY INCOME (Amounts)


Q731P


What is the easiest way for you to tell us (name's/your) income from (fill from Q73A1Rc);


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


Q731


How much did (name/you) receive (weekly/every other week/twice a month/ monthly) in income from (fill from Q73A1Rc) during 2021?


 Do NOT include federal stimulus payments due to the Coronavirus pandemic.


 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 2021?


 (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 from (Alaska Permanent Fund Dividend/fill-in from Q73a1Rc)?


  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 from (Alaska Permanent Fund Dividend/fill-in from Q73a1Rc)?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


Q731C2


Do not read to the respondent.

The annual rate appears out of range. The total income from (fill from Q73A1Rc) in 2021 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 (Alaska Permanent Fund Dividend/fill-in from Q73a1Rc) in 2021.


Does that sound about right?


1 Yes

2 No


Q7314


What is your best estimate of the correct amount (name/you) received in income from (Alaska Permanent Fund Dividend/fill-in from Q73a1Rc) in 2021?


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

Enter dollar amount 
________________


    1. 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 Yes

2 No


CONTRIB2


How much did (you/he/she) contribute to (your/his/her) account(s) in 2021?


Total contributions to all accounts.

________________


  1. HEALTH INSURANCE

    1. INTRODUCTION TO HEALTH INSURANCE SECTION


HINTRO

These next questions are about health coverage between January 1, 2021 and now.


Press 1 to Continue


1 Enter 1 to Continue


PINTRO


(First/Next) 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


    1. 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 Yes

2 No


ANYCOV


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


1 Yes

2 No


MEDI


?[F1]


(Are/Is/Was/Were) (name/you) covered by Medicaid, Medical Assistance, or (CHIP/or Medicare)?


1 Yes

2 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 Yes

2 No


VET


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


1 Yes

2 No


VERIFY


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


1 Yes, is NOT covered

2 No, is covered



    1. TYPE OF COVERAGE


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?


1. JOB

2. GOVERNMENT OR STATE

3. OTHER WAY

Former job/Retiree

Medical Assistance

Privately purchased

Union

Medicaid

Parent or spouse

Spouse/parent's job

Medicare (Parts A+B; Part C)

Medicare Supplements

Job with the government

Medicare Advantage

Exchange plan/Marketplace

COBRA

State-provided health coverage

Group or association

TRICARE/TRICARE For Life

VA Care/CHAMPVA/other military

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 Job (current or former)

2 Government or State

3 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

2. BUY IT DIRECTLY

3. SOME OTHER WAY

Parent

Buy it

Former employer

Spouse

Parent or spouse buys it

Group or association


Medicare Supplement

Indian Health Service



School


1 Parent or spouse

2 Buy it

3 Some other way


SRCEOTH


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 Former employer

2 Union

3 Group or association

4 Indian Health Service

5 School

6 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 Yes

2 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 Yes

2 No


GOVTYPE


?[F1]


ASK OR VERIFY


(Is/Was) that coverage Medicaid, CHIP, Medicare, a plan through the military, or some other program?


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 Medicaid or Medical Assistance

2 CHIP

3 Medicare

4 Military

5 Other


MILTYPE


ASK OR VERIFY

(Is/Was) that plan through TRICARE, TRICARE for Life, CHAMPVA, VA Care, military health care, or something else?


1 TRICARE

2 TRICARE for Life

3 CHAMPVA

4 Veterans Administration (VA) care

5 Military health care

6 Other


POLHOLDER


ASK OR VERIFY


Whose name (is/was) the policy in? (Who (is/was) the policyholder?)

1-16 Name on roster

17 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 Job (current or former)

2 Buy it

3 Some other way


GOVPLAN


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 Medicaid

2 Medical Assistance

3 Indian Health Service (IHS)

4-12 State Medicaid Programs Names

13-15 State Exchange Programs Names

16 Plan through State Exchange Portal

17 Other government plan

18 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 Yes

2 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?


Report here employer's contribution to employee's health insurance premiums, not the

employee's medical bills.

1 All

2 Part

3 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 Yes

2 No


POLHOLDER2


ASK OR VERIFY


Whose name (is/was) the policy in? (Who [is/was] the policyholder?)

1-16 Name on roster

17 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 Yes

2 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

premiums for insurance bought through healthcare exchanges or marketplaces.

1 Yes

2 No


    1. MONTHS OF COVERAGE


BEFORAFT


Did (name's/your) coverage from (plan type) start before January 1, 2021?


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 Yes

2 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 January

2 February

3 March

4 April

5 May

6 June

7 July

8 August

9 September

10 October

11 November

12 December


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 2021

2 2022


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 Yes

2 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 2021 and now that (name/you) (was/were) also covered by (plan type)?

1 Yes

2 No


ANYTHIS


Which months (was/were) (name/you) covered by (plan type) THIS year -- in 2022?


1 January 2022

2 February 2022

3 March 2022

4 April 2022

20 All months of 2022

21 No months of 2022


ANYLAST


Which months (was/were) (name/you) covered by (plan type) LAST year -- in 2021?


1 January

2 February

3 March

4 April

5 May

6 June

7 July

8 August

9 September

10 October

11 November

12 December

20 All months from January 2021 until December 2021

21 No months from January 2021 until December 2021


WMNTHS


Which months between January 2021 and now (was/were) (name/you) covered by (plan type)?


1 January 2021

2 February 2021

3 March 2021

4 April 2021

5 May 2021

6 June 2021

7 July 2021

8 August 2021

9 September 2021

10 October 2021

11 November 2021

12 December 2021

13 January 2022

14 February 2022

15 March 2022

16 April 2022

20 All months from January 2021 until now

21 No months from January 2021 until now


    1. OTHER HOUSEHOLD MEMBERS


OTHMEMB


Between January 1, 2021 and now, was anyone in the household other than (name/you) ALSO covered by (plan type)?


1 Yes

2 No


COVWHO


Who else was covered? Who else was covered by (plan type)?


PROBE: Anyone else?

0 No one listed

1-16 Person 1 through 16’s name

96 All persons listed


SAMEMNTHS


(Was/Were) (name/names) also covered from January 2021 until now?


This question refers to (plan type)


1 All also covered from January 2021 until now

2 None covered from January 2021 until now

MNTHS_P(1-16)M


Which months between January 2021 and now was (NAME) covered? [How about (NAME)?]


This question refers to (plan type)


1 January 2021

2 February 2021

3 March 2021

4 April 2021

5 May 2021

6 June 2021

7 July 2021

8 August 2021

9 September 2021

10 October 2021

11 November 2021

12 December 2021

13 January 2022

14 February 2022

15 March 2022

16 April 2022

20 All months from January 2021 until now

21 No months from January 2021 until now


OTHOUT


Does that plan cover anyone living outside this household?


This question refers to (plan type)


1 Yes

2 No

OTHWHO


How old are they -- under 19, 19-25, or older than 25?


Mark all that apply


1 Under 19

2 19-25 years old

3 Older than 25



    1. 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 Yes

2 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, 2021 and now?


READ IF NECESSARY: Do not include plans that cover only one type of care, such

as dental or vision plans.

1 Yes

2 No


    1. 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 Yes

2 No


COULD


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

1 Yes

2 No

WNTAKE


Why (aren't/isn't) (you/he/she) in this plan?


Choose all that apply


1 Covered by another plan

2 Traded health insurance for higher pay

3 Too expensive

4 Don't need health insurance

5 Have a pre-existing condition

6 Haven't yet worked for this employer long enough to be covered

7 Contract or temporary employees not allowed in plan

8 Other/specify


WNTAKESPEC


Please specify other reason why not in the plan

WNELIG


Why not? Why can't (name/you) be in this plan if (he/she/you) wanted to?


Choose all that apply


1 Don't work enough hours per week or weeks per year

2 Contract or temporary employees not allowed in plan

3 Haven't yet worked for this employer long enough to be covered

4 Have a pre-existing condition

5 Too expensive

6 Other/specify

WNELIGSPEC


Please specify other reason why not eligible.

________________



    1. 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 Excellent

2 Very good

3 Good

4 Fair

5 Poor



    1. MEDICAL EXPENDITURES


MedExp_Intro


Next I would like to ask about out-of-pocket medical expenses during 2021.


Press 1 to Continue


  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?]


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.

________________


  1. EMPLOYER’S PENSION PLAN

Q74a


Other than Social Security did (the/any) employer or union that (name/you) worked for in 2021 have a pension or other type of retirement plan for any of its employees?


  1. Yes

  2. No


Q74b


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

  1. Yes

  2. No


  1. LOW INCOME ITEMS


    1. SCHOOL LUNCHES


Q80


During 2021 which of the children ages 5 to 18 in this household usually ate a complete lunch offered at school?

“Usually” refers to days where school was being held in person, such as during the pre-pandemic period or in areas where schools remained open.

Probe: Anyone else?

Enter all that apply, separate using the space bar or a comma.

Enter 96 for All

Enter 0 for None


Q83


During 2021 which of the children in this household received free or reduced priced lunches because they qualified for the Federal School Lunch Program or their school provided free lunches to all students?


  Probe: Anyone else?

  Enter all that apply, separate using the space bar or a comma.

  Enter 96 for All

  Enter 0 for None

 

ECVDPEBT


During 2021, did you or anyone in this household receive a school meal debit, pandemic EBT, or P-EBT card?


  1. Yes

  2. No


    1. PUBLIC HOUSING


Q85


Is this public housing, that is, is it owned by a local housing authority or other public agency?


  1. Yes

  2. No


Q86


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


  1. Yes

  2. No



    1. WOMEN, INFANTS, AND CHILDREN NUTRITION PROGRAM (WIC)


SWRWIC


At any time during 2021, (was/were) (you/ anyone in this household) on WIC, the Women, Infants, and Children Nutrition Program?


  1. Yes

  2. No



SWRW


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


 Enter all that apply, separate using the space bar or a comma.

Probe: Anyone else?



    1. 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 2021, (did you/did this household) receive assistance of this type from the federal, state, or local government?


  1. Yes

  2. 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. Yes

  2. No


Q93pr2


Was it used to pay heating costs?


  1. Yes

  2. No


Q94


Altogether, how much energy assistance has been received in 2021?


Enter annual amount only

________________


Q94rn1


Could you tell me if you received:


less than $1,000

between $1,000 and $3,000

or over $3,000


in energy assistance during 2021?


  1. Less than $1,000

  2. Between $1,000 and $3,000

  3. Over $3000


Q94rn2


Did you receive:


less than $100

between $100 and $500

or over $500


in energy assistance during 2021?

  1. Less than $100

  2. Between $100 and $500

  3. Over $500


  1. MIGRATION


    1. 1-YEAR MIGRATION


MIGSAM


(Were/Was) (you/reference person's name) living in this house (or apartment) one year ago?


1 Yes, this house (apt)

2 No, different house in U.S.

3 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


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. Yes, inside city limits

  2. 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 5-9

HOUSING-RELATED REASONS 10-15

OTHER REASONS 4, 16-20


*Family-related reasons only include family as defined by the Census Bureau. Family consists of people who are related by birth, marriage, or adoption.



  1. change in marital status

  2. to establish own household

  3. other family reason (specify)

  4. relationship with unmarried partner (boy/girlfriend, fiancé, etc.)

  5. new job or job transfer

  6. to look for work or lost job

  7. to be closer to work/easier commute

  8. retired

  9. other job-related reason (specify)

  10. wanted to own home, not rent

  11. wanted newer/better/larger house or apartment

  12. wanted better neighborhood/less crime

  13. cheaper housing

  14. foreclosure/eviction

  15. other housing reason (specify)

  16. to attend or leave college

  17. change of climate

  18. health reasons

  19. natural disaster (hurricane, tornado, etc.)

  20. 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. Yes, all lived with (reference person's name/you)

  2. 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 Line Number(s)



NXTSAM


Did (name/you) live in this house (apartment) one year ago?


  1. Yes , this house

  2. No, different house in U.S.

  3. No, outside the U.S.


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


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. Yes, inside city limits

  2. 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?


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 5-9

HOUSING-RELATED REASONS 10-15

OTHER REASONS 4, 16-20


*Family-related reasons only include family as defined by the Census Bureau. Family are people who are related by birth, marriage, or adoption.



  1. change in marital status

  2. to establish own household

  3. other family reason (specify)

  4. relationship with unmarried partner (boy/girlfriend, fiancé, etc.)

  5. new job or job transfer

  6. to look for work or lost job

  7. to be closer to work/easier commute

  8. retired

  9. other job-related reason (specify)

  10. wanted to own home, not rent

  11. wanted newer/better/larger house or apartment

  12. wanted better neighborhood/less crime

  13. cheaper housing

  14. foreclosure/eviction

  15. other housing reason (specify)

  16. to attend or leave college

  17. change of climate

  18. health reasons

  19. natural disaster (hurricane, tornado, etc.)

  20. other reason (specify)



NX1OTH


What was the reason for moving?

_____________________________________________


SUNITS


Ask if necessary


How many housing units are in your building?


  1. Only one

  2. Two

  3. Three or four

  4. Five to nine

  5. Ten or more




  1. SUPPLEMENTAL POVERTY MEASURE


    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 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. Less than $100,000

  2. Between $100,000 and $250,000

  3. Between $250,000 and $500,000

  4. $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 Yes

2 No


SMORTYN

Do you or any member of this household have a second mortgage or a home equity loan on THIS property?

1 Yes, home equity loan.

2 Yes, second mortgage.

3 Yes, second mortgage and home equity loan.

4 No


    1. CHILD CARE


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 2021?


  • 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. Yes

  2. 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 0 if none



CCFREQ

What is the easiest way for you to tell us how much was paid for child care while (you/they) worked in 2021: weekly, every other week, twice a month, monthly, or yearly?

1 Weekly

2 Every other week

3 Twice a month

4 Monthly

7 Yearly

CCAMT

How much was paid (weekly/every other week/twice a month/monthly) 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

How many (weekly/every other week/twice a month/monthly) payments did (you/they) make during 2021?


(1-52), (1-26), (1-24), (1-12)

________________


CCTOT

Then (you/they) paid $(amount) altogether in child care while (you/they) worked during 2021.  Does that sound about right?

1 Yes

2 No

CCEST

What is your best estimate of the correct amount (you/they) paid for child care while (you/they) worked in 2021?

________________


    1. CHILD SUPPORT PAID


CSPCHILD

(Do you/Does anyone in this household) have any children who lived elsewhere with their other parent or guardian at anytime during 2021?

1 Yes

2 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 2021, did (name/you) pay any child support for children living elsewhere with their other parent or guardian? 

1 Yes

2 No

CSPAMT

How much child support did (name/you) pay in 2021?

  • 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



    1. STIMULUS/ADVANCE CHILD TAX CREDIT PAYMENTS


ECVD_EIP

During 2021, have you or anyone in your household received a “stimulus payment,” that is the coronavirus (COVID-19) related Economic Impact Payment from the Federal Government?


  • Do not include refunds on annual income taxes, unemployment compensation, or payments from an employer


1 Yes

2 No

ECTC


In the spring of 2021, as part of the American Rescue Plan, the child tax credit was expanded and the IRS was instructed to pay out the benefit to parents, monthly, starting in July 2021. Since July, have you or anyone in your household received an Advance Child Tax Credit payment from the Federal Government?


1 Yes

2 No


  • Please report “yes” if you received the payment as a paper check or as a direct deposit.


    1. EMERGENCY BROADBAND DISCOUNT PROGRAM


EBDP


At any time during 2021, did you or anyone in this household receive benefits from the Emergency Broadband Discount Program or any other program that provided reduced price WIFI, broadband, or other home internet services?


1 Yes

2 No


EBDP_MNTH


How many months did (you/anyone in this household) receive these benefits in 2021?


 (1-12)




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


  1. 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


  1. 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:


      • Less than $100

      • Between $100 and $500

      • $500 or more



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

Income Source

Range Screen

Range Level

Q48AA

Earnings from Longest Job

PUQ48AARN1

High

Q48AAD

Longest Job: tips, bonuses, etc.

PUQ48AADRN1

Low

Q48B

Earnings from Business/ Farm

PUQ48BRN1

High

Q48BAD

Business/ Farm: tips, bonuses, etc.

PUQ48BADRN1

Low

Q49B1D

Earnings from All Other Employers

PUQ49B1DRN1

Mid

Q49B1A

All Other Employers: tips, bonuses, etc.

PUQ49B1ARN1

Low

Q49B2

Earnings from Any Other Business

PUQ49B2RN1

Mid

Q49B4

Earnings from Any Other Farm

PUQ49B4RN1

Mid

Q51A1

State or Federal Unemployment Compensation

PUQ51A11R1

Mid

Q51A2

Supplemental Unemployment Benefits

PUQ51A21R1

Mid

Q51A3

Union Unemployment or Strike Benefits

PUQ51A31R1

Mid

Q52A

Worker's Compensation

PUQ52CR1

Mid

Q56A

Social Security

PUQ656DRN1

Mid

Q56F

Social Security for Children

PUQ56IRN1

Mid

Q57A

Supplemental Security Income (SSI)

PUQ57CRN1

Mid

Q57D

SSI for Children

PUQ57IRN1C

Mid

Q59AR

Disability Income (source 1)

Disability Income (source 2)

PUQ61E1RN1

PUQ61E2RN1

Mid

Q60A88

Veteran's Payments (source 1)

Veteran's Payments (source 2)

PUQ60V1RN1

PUQ60V2RN1

Mid

Q58A

Survivor Benefits (source 1)

Survivor Benefits (source 2)

Survivor Benefits (source 3)

PUQ58E1RN1

PUQ58E2RN1

PUQ58E3RN1

Mid

Q59A88, Q59A89

Public Assistance/ TANF

PUQ59ERN1

Low

Q87R, Q87AR

Food Assistance/ SNAP

HUQ90RN1

Low

Q62AR

Pensions (source 1)

Pensions (source 2)

PUQ62E1RN1

PUQ62E2RN1

Mid

Q96AR

Annuities

PUANNEWRN1

Mid

Q98Ar

Retirement Withdrawals/Distributions (source 1)

Retirement Withdrawals/Distributions (source 2)

PUDSTNEWR1

PUDSTNEWR3

Mid

Q97Cr

Retirement Interest (source 1)

Retirement Interest (source 2)

PURETNEWRN1

PURETNEWRN3

Low

Q99ARa

Checking Account Interest

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

Nonretirement Interest

PUCAPGDAMTRN1

Mid

Q65A1, Q65A2, Q65A3

Property Income

PUQ65CRN1

Mid

Q66B

Pell Grant

Other Education Assistance

PUQ69FRN1

PUQ66HRN1

Low

Q70A

Child Support

PUQ70C1RN1

Mid

Q72A

Regular Financial Assistance

PUQ72CRN1

Low

Q73A1

Other Money Income

PUQ73RN1

Low

Q93

Energy Assistance

HUQ94RN1

Low






File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title2016 ASEC Items Booklet
AuthorLisa Paska
File Modified0000-00-00
File Created2021-11-09
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