Proposed NAWS Questionnaire_Cycle 102_2.25.2022

ENGLISH
CYCLE 102, Spring 2022
OMB Nº. 1205-0453

1

EXPIRATION DATE: 01/31/2023

0 2

COUNTY FIPS

[Revised Feb. 8, 2022]

FARM WORKER ID
[FOR OFFICE USE ONLY]

NATIONAL AGRICULTURAL WORKERS SURVEY - 2022
CS2

DATE:

/

(“NAWS”)

/
[FOR OFFICE USE ONLY]

CROP CODE
CS5

CROP:

CS6 TASK:

TASK CODE

LANGUAGE DURING INTERVIEW: __________________

GN:

ID:
IF GN REFERRED TO CONTRACTOR, GROWER OR OTHER,
WRITE INFORMATION)
NAME :
_______________________________________
ADDRESS:
_______________________________________
TELEPHONE:
(_________)___________-________________

GN REFERRED TO:
9 “CONTRACTOR”?:
9 OTHER GROWER?
9 OTHER?:_______

WORKER IS ACTUALLY EMPLOYED BY?:
9 1 GROWER
9 2 CONTRACTOR
TYPE OF WORK?: 91 FIELD WORK
92 NURSERY
93 PACKING HOUSE
97 OTHER:________

FARM WORKER’S NAME:
TELEPHONE:

INTERVIEWER’S
NAME:
CP5 TIME BEGAN:

CS9 INTERVIEWER’S ID:
:

9 AM
9 PM

CP6

TIME ENDED:

:

9 AM
9 PM

Notwithstanding any other provision of law, no person is required to respond to nor shall a person be subject to a
penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction
Act unless that collection of information displays a currently valid Office of Management and Budget control
number. Public reporting burden for this collection of information, which is voluntary, is estimated to average 45
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate to the Office of Policy Development, Evaluation and Research, ETA, Department of
Labor, Room N5641, 200 Constitution Avenue, N.W., Washington, D.C. 20210.

HOUSEHOLD GRID
A1

NAME

A. (FARMWORKER)

*A2
R
E
L
A
T
I
O
N

A3

S
E
X

M
F

B.

A5
M
A
R
I
T
A
L
S
T
A
T
U
S

S
M
O

A6
B
I
R
T
H
D
A
Y
MM
/
YY

**A7
C
O
U
N
T
R
Y

A9
**A10
HIGHEST
C
GRADE
O
LEVEL
U
[FOR
N
MINORS
T
INCLUDE
R
PREY
SCHOOL
(“PS”) AND
S
B KINDER (“K”)
C
I
[ASK
H
R
ONLY
O
T
WORKER
O
H
FOR
L
[COD HIGHEST
[COD
E]
DEGREE
E]
OBTAINED. ]

A8
MONTH
AND
YEAR
FIRST
E
N
T
E
R
E
D

Y

Y

Y

N

N

N

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

/
HD: _______

S
/

NF

/

F
O
D.

NW

S

FW

M
M

/

/

F

Y

Y

Y

Y

N

N

N

N

NF

O
E.

NW

S
M
M

/

Y

Y

Y

N

N

N

N

NW

Y

Y

Y

Y

FW

N

N

N

N

NF

O

M
F

S
M

/

/

O

*CODES FOR A2 (RELATIONSHIP):
1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS, UNCLES, ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
7= OTHER::__________________

** CODES FOR A7 AND A10 (COUNTRIES AND REGIONS):
1= U.S.A.
8= PACIFIC ISLANDS (THE
2= PUERTO RICO
PHILIPPINES, GUAM, FIJI, ETC.)
3= MEXICO
9= ASIA (CHINA, JAPAN, KOREA,
4= CENTRAL AMERICA
ETC.)
5= SOUTH AMERICA
95= DK (DON’T KNOW)
6= CARIBBEAN
96= RF (REFUSE)
7= SOUTH EAST ASIA (INDONESIA, CAMBODIA,
97=OTHER:________
VIETNAM, LAOS, THAILAND)
2

FW

Y
/

F
F.

NW
FW

M
M

FW
NF

/

/

O
C.

A4
***A31
A32-33
A34-35
A11
A36
[ASK ALL
IF
LAST 12
PRIOR 12
ANY
ANY
IN A1]:
NOT
MONTHS,
MONTHS
U.S.
U.S.
DOES
HERE, TRAVELED TO (A32-33), SCHOOL WORK
S/HE LIVE WITH YOU NOW?
WHY TO DO FW TRAVELED LAST
LAST
IF NOT, WHERE? [STATE and NOT? (OR DONE TO DO FW
12
12
COUNTRY]
_
FW IN
(OR DONE MONTHS MONTHS
C
OTHER
FW IN
?
?
O
CITY)?
OTHER
D
IF YES,
CITY)?
E
[NAME]
IF YES,
TRAVELED
[NAME]
OR JOINED TRAVELED
WITH YOU? OR JOINED
WITH YOU?

HG: _______
/

S
M

102 ___ ___ ___ __
Farmworker ID

U.S.?

M
F

___ ___ ___ ___ ___
County

NF
NW

***CODES FOR A31
1 = NO CHILD CARE IN THIS LOCATION
2 = NO HOUSING IN THIS LOCATION
3 = CHILD IN SCHOOL, AFFECTED IF
MOVED
95= DK (DON’T KNOW)
96= RF (REFUSE)
7= OTHER: _______

HOUSEHOLD GRID
A1

NAME

*A2

R
E
L
A
T
I
O
N

A3

S
E
X

G.

A5

A6

**A7

A9

**A10

A8

M
A
R
I
T
A
L

B
I
R
T
H
D
A
Y

C
O
U
N
T
R
Y

HIGHEST
GRADE
LEVEL
[FOR
MINORS
INCLUDE
PRESCHOOL
(“PS”) AND
KINDER
(“K”)

C
O
U
N
T
R
Y

MONTH
AND
YEAR

S
T
A
T
U
S

MM
/
YY

B
I
R
T
H

[CODE]

S
C
H
O
O
L

[ASK
ONLY
WORKER
FOR HIGHEST
DEGREE
OBTAINED. ] [COD
E]

FIRST
E
N
T
E
R
E
D
U.S.?

M

S
/

M

***A31

A34-35

A11

A36

LAST 12
MONTHS,
TRAVELED
TO DO FW
(OR DONE
FW IN
OTHER
CITY)?
IF YES,
[NAME]
TRAVELED
OR JOINED
WITH YOU?

PRIOR 12
MONTHS TO
(A32-33),
TRAVELED
TO DO FW
(OR DONE
FW IN
OTHER
CITY)?
IF YES,
[NAME]
TRAVELED
OR JOINED
WITH YOU?

ANY
U.S.
S
C
H
O
O
L
LAST
12
M
O
N
T
H
S?

ANY
U.S.
WORK

Y

Y

Y

Y

N

N

N

N

[ASK ALL
IF
IN A1]:
NOT
DOES
S/HE LIVE WITH YOU NOW?
H
IF NOT, WHERE? [STATE
E
and
R
COUNTRY]
E,
WHY
NOT
?
_
C
O
D
E

A32-33

102___ ___ ___ __
Farmworker ID

/

/

O
H.

A4

County

LAST
12
M
O
N
T
H
S?

FW

S
M
F

___ ___ ___ ___ ___

M

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

Y

N

N

N

N

Y

Y

Y

N

N

N

/

F
O

NF
NW
FW
NF
NW

I.
S
M
M
F
O
J.

M

S

F

M

NF

/
/

/

/

FW

Y

NW
FW
NF

N
O
S

K.

NW
FW

M

Y
M

1 = SPOUSE/COMMON LAW SPOUSE
2 = OWN CHILD, DEPENDENT OR ADOPTED
3 = SIBLING
4 = PARENT
5 = GRANDCHILD
6 = OTHER RELATIVE (COUSINS, UNCLES, ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
7 = OTHER:__________________

Y

Y

N

N

N

NF

F
*CODES FOR A2 (RELATIONSHIP):

Y

/
/

O
** CODES FOR A7 AND A10 (COUNTRIES AND REGIONS):
1= U.S.A.
2= PUERTO RICO
3= MEXICO
4= CENTRAL AMERICA
5= SOUTH AMERICA
6= CARIBBEAN

N

7= SOUTHEAST ASIA (INDONESIA, CAMBODIA,
VIETNAM, LAOS, THAILAND)
8= PACIFIC ISLANDS (THE PHILIPPINES, GUAM,
FIJI, ETC.)
9= ASIA (CHINA, JAPAN, KOREA, ETC.)
95= DK (DON’T KNOW)
96= RF (REFUSE)
97=OTHER: ________
3

NW
***CODES FOR A31
1 = NO CHILD CARE IN THIS LOCATION
2 = NO HOUSING IN THIS LOCATION
3 = CHILD IN SCHOOL, AFFECTED IF MOVED
95= DK (DON’T KNOW)
96= RF (REFUSE)
7 = OTHER:: _______

[THESE QUESTIONS REFER TO OTHER INDIVIDUALS WHO LIVE WITH THE WORKER AND WERE NOT MENTIONED IN THE
“HOUSEHOLD GRID”!]: A15 Other than those you have already mentioned, how many people live with you now?:

... TOTAL:
A20 ...your

Out of those (TOTAL IN “A15” ), ...how many are: ...
a.

...ADULTS? (18 YEARS OR OLDER)?

b.

...CHILDREN? (17 YEARS OR YOUNGER)?

c.

relatives?

A16

...doing FW?

...DO NOT KNOW AGE?

INSURANCE QUESTIONS ABOUT RESPONDENT AND HIS/HER FAMILY
(INDIVIDUALS IN THE “HOUSEHOLD GRID”) [DESCRIBE/EXPLAIN “HEALTH INSURANCE”]
A21

A23

In the U.S.A.,... Who has Health (Medical) Insurance in your family? ...
How about...
a. ...you
(farmworker)?
b. ...your
spouse?
[CHILDREN UNDER
AND OVER 18 YRS.
OLD. MATCH TOTAL
WITH FAMILY GRID]

C. ...your
children?

9 0 NO
9 1 YES
9 95 DON’T KNOW
9 0 NO
9 1 YES
9 95 DON’T KNOW

Who pays for it?
[USE CODES. MARK ALL
THAT APPLY]
91 92 93 94 95
97

9 6:

91

92

93

94

92

93

94

9 6:

A21c2

A24

9 0 NO

(a) How many under 18 yrs?:

9 1 YES, ALL HAVE IT [ASK A23]

(b) How many over 18 yrs?:

9 2 YES, ONLY SOME HAVE IT

91
9 6:

9 95 DON’T KNOW
CODES FOR “A23” (WHO PAYS?):
1= I PAY
2= MY SPOUSE

3= MY EMPLOYER
4= MY SPOUSE’S EMPLOYER

5= GOVERNMENT
7 = PARENT’(S’) INSURANCE

D36a [FOR PARENTS OF CHILDREN 12 YEARS OLD OR
YOUNGER]: ...in all the places you’ve lived in the USA
in the past 12 MONTHS, where have all your children
12 years old or younger stayed while you are working
(FW in the USA)? [CHECK ALL THAT APPLY]
91
9 13
9 14
9 15
9 16
9 17
9 11
9 12

95

They've stayed home alone, at least sometimes
With my spouse, other family
With a neighbor or babysitter
Migrant head start, Head start
School or pre-school
Other migrant education
With me in the fields
OTHER: _____________________________

4

6 = OTHER:

95

D65 Do you live in a labor camp or Migrant Center? [IF
YES, PROBE: WHO OWNS OR RUNS IT?]
90
91
92
93

D35b

NO
YES, labor camp run by a grower or labor
contractor
YES, labor camp run by migrant center or public
agency
YES, labor camp run by another person/group
Specify: __________________

Where are your living quarters located?
[READ CHOICES. MARK ONLY ONE]: ...

91
9
9

9

9

...OFF FARM IN PROPERTY NOT OWNED OR
ADMINISTERED BY YOUR PRESENT EMPLOYER?
2 ...OFF FARM IN PROPERTY OWNED OR ADMINISTERED
BY YOUR PRESENT EMPLOYER?
5 ...ON FARM OR NEXT TO OR ADJACENT TO A FARM
OWNED BY THE GROWER YOU CURRENTLY WORK
FOR?
6 ...ON A FARM OR NEXT TO OR ADJACENT TO A FARM
NOT OWNED BY THE GROWER YOU CURRENTLY WORK
FOR?
97 ...OTHER?:

D34b

D33a

9 10 I (OR I AND MY FAMILY) RECEIVE FREE HOUSING FROM
MY EMPLOYER. [SKIP TO D66]
9 3 I PAY FOR HOUSING PROVIDED BY MY EMPLOYER. (I
PAY DIRECTLY OR THROUGH WAGE DEDUCTION).
9 5 I PAY FOR HOUSING PROVIDED BY THE GOVERNMENT,
A CHARITY, OR OTHER NON-WORK RELATED
INSTITUTION.
9 11 DO NOT PAY RENT. (I OR FAMILY MEMBER OWN THE
HOUSE OR LIVE FOR FREE WITH FRIENDS OR
RELATIVES) [SKIP TO G6. ASK IF BUYING OTHERS]
9 12 I RENT FROM NON-EMPLOYER (RELATIVE OR NONRELATIVE)
9 97 OTHER:

91
per week ___________________________________
per month___________________________________
per day___________________________

...MOBILE HOME?
...SINGLE-FAMILY HOME (DETACHED)?
...APARTMENTS (TWO OR MORE IN A BUILDING,
SHARED PARKING SPACES)?
9 97 ...OTHER:

9 b.

...Bathrooms?:

9 c.

...Kitchens?:

9 f.

...Other rooms?:

DON'T KNOW, TAKEN OUT OF MY PAYCHECK
DON'T KNOW/DON'T REMEMBER, BUT NOT TAKEN OUT
OF MY PAYCHECK

9

OTHER:

7

OPTIONS and MARK RESPONSES]:
9 a. individual rooms
9 b. single beds (no bunk beds)
9 c. information about COVID/infectious disease prevention
9 d. a separate place to isolate sick workers

How many of the following do you have in your
current living quarters (dwelling)...
...Bedrooms?:

9 2
9 3

D66 [If in employer-provided housing]: Over the past 12
months, what safety practices have been in place to prevent
COVID (or spread of infectious disease) in the housing? (READ

91
92
94

9 a.

At this location how much do you pay for housing
(including housing for your family if they live with you)?

D50

In what type of living quarters do you live
now (housing structure at this location)? [READ
CHOICES. MARK ONLY ONE]: ...Is it a (an)...

D54

While you are working for this grower/ contractor, what
type of payment arrangement do you have for your
living quarters? [IF PAYMENT IS ONLY FOR UTILITIES,
CONSIDER IT FREE. DO NOT READ. MARK ONE]:

9 none

9 other: _________________________

NV1. In the last 12 months, how many days did you miss
work(stay home) because you were ill, or because
there was a possibility you had an illness?
9 0 NONE (skip to G6) 9 _____ days

95 DK

9 96 RF

NV2a. Among the days you missed, how many days have you
D52

MISSED WORK (FW) because you were ill with COVID or because
you were exposed to COVID?

How many people total sleep in these rooms?
[VERIFY RESPONSE BY ADDING TOTAL NUMBER
GIVEN IN HOUSEHOLD GRID PLUS TOTAL IN A15.
IF ANSWERS DO NOT MATCH, MAKE
APPROPRIATE CHANGES]

9 0

9 _____ days

95 DK

9 96 RF

G6 Do you own or are you buying any of the following items
in the U.S.? [READ OPTIONS/MARK ALL “YES” RESPONSES]
9 a...a plot of land?
9 h...a type of housing, such as a house, mobile home,
condominium, or apartment?
d.
any kind of vehicle, such as a car or truck?:
9

9 f. ...other?:______________________

5

9

None

E2

D37a How far is your current job from your current
residence?
91
I'M LOCATED AT THE JOB
92
WITHIN 9 MILES
93
10-24 MILES
94
25-49 MILES MILES
95
50-74 MILES
96
75 MILES OR MORE

91
93
95
97

9 1 ...DRIVE CAR?
9 2 ...WALK [SKIP TO B10]
9 5 ...PUBLIC TRANSPORTATION (BUS, TRAIN, ETC.)?
[SKIP TO B10]
9 6 ...LABOR BUS, TRUCK, VAN?
9 8 ...“RAITERO”:?
9 4 ...RIDE WITH OTHERS (SHARES RIDE)?
9 7 ...OTHER?:

B1

B10

9 3 ...CHICANO?
9 5...PUERTO RICAN?
9 4 ...OTHER HISPANIC?:
9 7 ...NOT HISPANIC OR LATINO?

B2 Which of the following do you consider yourself?
[READ CHOICES EXCEPT “OTHER.” MARK ONE OR
MORE RESPONSES]: ...
9 1 White?
9 2 Black or African American?
9 4 American Indian/Alaska Native?
9 5 .Asian?
9 6 Native Hawaiian or Pacific
Islander?
9 7 ...Other?:

Do you pay a fee to (responsible in D37 and/or
"raiteros") for rides to work?

B3 Have you ever participated in, attended or received any

NO
YES, A FEE
YES, JUST FOR GAS

job training or attended any of the following special
classes or school in the U.S.? [READ CHOICES.
CHECK ALL THAT APPLY]: ...

In what month and year did you first do any farm work
in the U.S.? (First time FW in the U.S.) [ASK FOR
MONTH/ YEAR]

MONTH

/
/

9 a.
9b
9 c.
9 d.
9 e.
9 f.
9 g.
9 i.
9 j.
9

YEAR

B11 Approximately how many years have you done
farmwork in the U.S.? [COUNT ANY YEAR IN WHICH 15
DAYS OR MORE WERE WORKED].

In the last 2 years [LAST 24 MONTHS], has anyone in
your household (from “Family Grid”)- excluding
yourself - participated in, attended or received any
training, special classes or schools in the U.S.? [READ
CHOICES. CHECK ALL THAT APPLY]: ...
9 a. English/ ESL
9 b. Citizenship?
9 c. Literacy?
9 d. Job training?:
9 e. GED (High School Equivalency)?
9 j. College or university?
9 g. Basic adult education?
9 i.
Migrant Education?
9 k.
Head Start?
Migrant Head Start?
9 l.
9 n. Other?:

Approximately how many years have you done
NON- farmwork in the U.S.? [COUNT ANY YEAR IN
WHICH 15 DAYS OR MORE WERE WORKED]

B13

When was the last time your parents did hired farmwork in the U.S.?
9 0 NEVER
9 1 NOW / WITHIN LAST YEAR
9 2 ONE TO FIVE YEARS AGO
9 3 SIX TO TEN YEARS AGO
9 4 OVER 10 YEARS AGO

...English/ESL?
...Citizenship?
...Literacy?
...Job training:
...GED, High School Equivalency?
...College or University?
...Adult Basic Education?
...Migrant Education?
...Other?:
None

B4

years
B12

[ASK ALL] Which of the following describes you?
[READ CHOICES. CHECK ONLY ONE]: ...

9 1 ...MEXICAN-AMERICAN? 9 2 ...MEXICAN?

D38a Do you have to use the transport (in D37) (IS IT
MANDATORY OR OBLIGATORY)?
9 0 NO
9 1 YES

90
91
92

LESS THAN ONE YEAR 9 2 ONE TO THREE YEARS
FOUR TO FIVE YEARS 9 4 OVER FIVE YEARS
OVER FIVE YEARS/ AS LONG AS I AM ABLE

E4. Could you get a U.S. non-farm job (NF) within a
month?
9 0 NO 9 1 YES
9 7 DON’T KNOW

D37 At your current job, how do you usually get to work?
[READ CHOICES. MARK ONE]:...

D38

How long do you expect to continue doing farm work
(FW in the U.S.)? [READ CHOICES. MARK ONLY ONE]

9 Don’t know
9 None

9 7 DK

6

[IF FOREIGN BORN, ASK];

Where were you born? In
what...

B18.

(d) ...STATE?:
(DEPARTMENT)

B26-27

B16.

When you lived in your country, did
you work in...

9 1 ...AGRICULTURE [FW]?
9 2 ...NON-AGRICULTURE [NF]?
9 3 ...PART FARM AND PART NON-FARM [FW AND
NF]?
9 5 ...NEVER WORKED?

(e) ...MUNICIPALITY
(EQUIVALENT)?:

B17-18. Before coming to the USA, you lived

in what...
(B17)...COUNTRY?:

(B18)...STATE (OR
DEPARTMENT)?:

...And where were your parents born? ...In what...
a. ...COUNTRY?

b. ...STATE (OR EQUIVALENT)

(B26) FATHER:
(B27) MOTHER?:

LANGUAGE SECTION
B7

How well do you speak English? [READ CHOICES. MARK
ONLY ONE RESPONSE]: ...
91
...Not at all?
93
...Somewhat?
92
...A little?
94
...Well?

B20
When you were a child, in
what languages did adults
speak to you

B8 How well do you read English? [READ CHOICES. MARK ONLY
ONE RESPONSE]:
9 1 ...Not at all?
9 3 ...Somewhat?
9 2 ...A little?
9 4 ...Well?

B21
And now, as an adult, what languages can you speak?

at home?

[CHECK

Check all that apply:

ALL THAT
APPLY]

[FOR EACH CHECKED ANSWER, ASK]:

c CREOLE

d MIXTEC

e KANJOBAL

f ZAPOTEC

z OTHER:

believe you are most

B22 And now, how well do
you speak it?

B23 And now, how well do
you read it?

dominant (comfortable)

READ CHOICES. MARK
ONLY ONE PER CHECK]:

[READ CHOICES. MARK
ONLY ONE PER CHECK]:

conversing? [CHECK ONE. If
fully bilingual enter and check
both]

a ENGLISH

b SPANISH

B24
In which language do you

92
93
94

92
93
94

92
93
94

92
93
94

...A LITTLE?
...SOMEWHAT?
...WELL?

...A LITTLE?
...SOMEWHAT?
...WELL?

...A LITTLE?
...SOMEWHAT?
...WELL?

...A LITTLE?
...SOMEWHAT?
...WELL?

92
93
94

...A LITTLE?
...SOMEWHAT?
...WELL?

92
93
94

...A LITTLE?
...SOMEWHAT?
...WELL?

7

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

91
92
93
94

...NOT AT ALL?
...A LITTLE?
...SOMEWHAT?
...WELL?

REMINDER: BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE DAYS ...HAVE YOU BEEN ILL OR
SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU TRAVELED OUT OF THE COUNTRY?” [USE THE “YES” RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:

C4

WORK GRID
REPORT FROM FIRST PERIOD COVERING FEBRUARY 1, 2021 TO PRESENT
C5
C6
C8
C9
C10
FW

PER.
AND
SUB
PER.
NO.

GR
CO
[FW
ONLY]

EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)

CROP

WRITE
ACTIVITY OR TASK WHILE FW,
AB and NF [USE CODES FOR
*NW ONLY]

NF

NW
AB

GR

FW
NF

CO

NW
AB

RECEIVED
UNEMPLOYMENT?

[C1-C2 FOR OFFICE USE ONLY]
C1-C2 C15
C3

DATES FOR PERIODS
OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW, NF,
AB

NW
AB

GR

FW
NF

CO

NW
AB
FW
NF

GR
CO

NW
AB
FW
NF

GR
CO

NW
AB
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW, NF, AB]

207 =
208 =

STATE
and

***FW, NF,
&
AB:
WHY
LEFT?

COUNTRY
[CODE]

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

Y
CO

205 =
206 =

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

N

FW
NF

GR

201 =
202 =
203 =
204 =

____________ ___ 102_____________ ___ ___ ___ ___
County
Farmworker ID
C11
C12
C13
C7

LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL NOTICE(AFTER
LAYOFF)
WAITING FOR START OF SEASON
FAMILY RESPONSIBILITIES/ WORK IN
HOME
IN SCHOOL
LAID UP DUE TO INJURY

209 =
210 =
211 =
212 =
213=

IN-TRANSIT BETWEEN JOBS
VACATION
DID NOT LOOK FOR WORK
OTHER: (SPECIFY IN GRID)
WAITING FOR COVID SITUATION TO
IMPROVE
214= CARE OF CHILD/FAMILY DUE TO COVID
215= SICK WITH COVID
216= NO WORK AVAILABLE DUE TO COVID
217 = WAITING FOR COVID TEST RESULTS
218 = QUARANTINING DUE TO COVID EXPOSURE

COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311= WORK IN OWN/FAMILY FARM
320= NF IN OWN BUSINESS (SPECIFY IN GRID)
341= NF IN “MAQUILA”
359= NF OTHER (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
370 = NW- WAITING FOR COVID SITUATION
TO IMPROVE

8

N

*** C-7 CODES: WHY LEFT “FW”, “NF”, & “AB”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS

12 = NO WORK DUE TO COVID
13= CARE OF CHILD/FAMILY DUE
TO COVID
14= SICK WITH COVID
15 = STOPPED WORKING TO AVOID
COVID/WAITING FOR IMPROVEMENT
16 = QUARANTINE

9 = OTHER (SPECIFY):

REMINDER: BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE DAYS ...HAVE YOU BEEN ILL OR
SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU TRAVELED OUT OF THE COUNTRY?” [USE THE “YES” RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:

C4

WORK GRID
REPORT FROM FIRST PERIOD COVERING FEBRUARY 1, 2021 TO PRESENT
C5
C6
C8
C9
C10
FW

PER.
AND
SUB
PER.
NO.

GR
CO
[FW
ONLY]

EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)

CROP

WRITE
ACTIVITY OR TASK WHILE FW,
AB and NF [USE CODES FOR
*NW ONLY]

NF

NW
AB

GR

FW
NF

CO

NW
AB

RECEIVED
UNEMPLOYMENT?

[C1-C2 FOR OFFICE USE ONLY]
C1-C2 C15
C3

DATES FOR PERIODS
OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW, NF,
AB

NW
AB

GR

FW
NF

CO

NW
AB
FW
NF

GR
CO

NW
AB
FW
NF

GR
CO

NW
AB
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW, NF, AB]

207 =
208 =

STATE
and

***FW, NF,
&
AB:
WHY
LEFT?

COUNTRY
[CODE]

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

Y
CO

205 =
206 =

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

N

FW
NF

GR

201 =
202 =
203 =
204 =

____________ ___ 102_____________ ___ ___ ___ ___
County
Farmworker ID
C11
C12
C13
C7

LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL NOTICE(AFTER
LAYOFF)
WAITING FOR START OF SEASON
FAMILY RESPONSIBILITIES/ WORK IN
HOME
IN SCHOOL
LAID UP DUE TO INJURY

209 =
210 =
211 =
212 =
213=

IN-TRANSIT BETWEEN JOBS
VACATION
DID NOT LOOK FOR WORK
OTHER: (SPECIFY IN GRID)
WAITING FOR COVID SITUATION TO
IMPROVE
214= CARE OF CHILD/FAMILY DUE TO COVID
215= SICK WITH COVID
216= NO WORK AVAILABLE DUE TO COVID
217 = WAITING FOR COVID TEST RESULTS
218 = QUARANTINING DUE TO COVID EXPOSURE

COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311= WORK IN OWN/FAMILY FARM
320= NF IN OWN BUSINESS (SPECIFY IN GRID)
341= NF IN “MAQUILA”
359= NF OTHER (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
370 = NW- WAITING FOR COVID SITUATION
TO IMPROVE

9

N

*** C-7 CODES: WHY LEFT “FW”, “NF”, & “AB”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS

12 = NO WORK DUE TO COVID
13= CARE OF CHILD/FAMILY DUE
TO COVID
14= SICK WITH COVID
15 = STOPPED WORKING TO AVOID
COVID/WAITING FOR IMPROVEMENT
16 = QUARANTINE

9 = OTHER (SPECIFY):

REMINDER: BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE DAYS ...HAVE YOU BEEN ILL OR
SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU TRAVELED OUT OF THE COUNTRY?” [USE THE “YES” RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:

C4

WORK GRID
REPORT FROM FIRST PERIOD COVERING FEBRUARY 1, 2021 TO PRESENT
C5
C6
C8
C9
C10
FW

PER.
AND
SUB
PER.
NO.

GR
CO
[FW
ONLY]

EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)

CROP

WRITE
ACTIVITY OR TASK WHILE FW,
AB and NF [USE CODES FOR
*NW ONLY]

NF

NW
AB

GR

FW
NF

CO

NW
AB

RECEIVED
UNEMPLOYMENT?

[C1-C2 FOR OFFICE USE ONLY]
C1-C2 C15
C3

DATES FOR PERIODS
OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW, NF,
AB

NW
AB

GR

FW
NF

CO

NW
AB
FW
NF

GR
CO

NW
AB
FW
NF

GR
CO

NW
AB
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW, NF, AB]

207 =
208 =

STATE
and

***FW, NF,
&
AB:
WHY
LEFT?

COUNTRY
[CODE]

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

Y
CO

205 =
206 =

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

N

FW
NF

GR

201 =
202 =
203 =
204 =

____________ ___ 102_____________ ___ ___ ___ ___
County
Farmworker ID
C11
C12
C13
C7

LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL NOTICE(AFTER
LAYOFF)
WAITING FOR START OF SEASON
FAMILY RESPONSIBILITIES/ WORK IN
HOME
IN SCHOOL
LAID UP DUE TO INJURY

209 =
210 =
211 =
212 =
213=

IN-TRANSIT BETWEEN JOBS
VACATION
DID NOT LOOK FOR WORK
OTHER: (SPECIFY IN GRID)
WAITING FOR COVID SITUATION TO
IMPROVE
214= CARE OF CHILD/FAMILY DUE TO COVID
215= SICK WITH COVID
216= NO WORK AVAILABLE DUE TO COVID
217 = WAITING FOR COVID TEST RESULTS
218 = QUARANTINING DUE TO COVID EXPOSURE

COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311= WORK IN OWN/FAMILY FARM
320= NF IN OWN BUSINESS (SPECIFY IN GRID)
341= NF IN “MAQUILA”
359= NF OTHER (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
370 = NW- WAITING FOR COVID SITUATION
TO IMPROVE

10

N

*** C-7 CODES: WHY LEFT “FW”, “NF”, & “AB”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS

12 = NO WORK DUE TO COVID
13= CARE OF CHILD/FAMILY DUE
TO COVID
14= SICK WITH COVID
15 = STOPPED WORKING TO AVOID
COVID/WAITING FOR IMPROVEMENT
16 = QUARANTINE

9 = OTHER (SPECIFY):

REMINDER: BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE DAYS ...HAVE YOU BEEN ILL OR
SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU TRAVELED OUT OF THE COUNTRY?” [USE THE “YES” RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:

C4

WORK GRID
REPORT FROM FIRST PERIOD COVERING FEBRUARY 1, 2021 TO PRESENT
C5
C6
C8
C9
C10
FW

PER.
AND
SUB
PER.
NO.

GR
CO
[FW
ONLY]

EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)

CROP

WRITE
ACTIVITY OR TASK WHILE FW,
AB and NF [USE CODES FOR
*NW ONLY]

NF

NW
AB

GR

FW
NF

CO

NW
AB

RECEIVED
UNEMPLOYMENT?

[C1-C2 FOR OFFICE USE ONLY]
C1-C2 C15
C3

DATES FOR PERIODS
OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW, NF,
AB

NW
AB

GR

FW
NF

CO

NW
AB
FW
NF

GR
CO

NW
AB
FW
NF

GR
CO

NW
AB
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW, NF, AB]

207 =
208 =

STATE
and

***FW, NF,
&
AB:
WHY
LEFT?

COUNTRY
[CODE]

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

Y
CO

205 =
206 =

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

N

FW
NF

GR

201 =
202 =
203 =
204 =

____________ ___ 102_____________ ___ ___ ___ ___
County
Farmworker ID
C11
C12
C13
C7

LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL NOTICE(AFTER
LAYOFF)
WAITING FOR START OF SEASON
FAMILY RESPONSIBILITIES/ WORK IN
HOME
IN SCHOOL
LAID UP DUE TO INJURY

209 =
210 =
211 =
212 =
213=

IN-TRANSIT BETWEEN JOBS
VACATION
DID NOT LOOK FOR WORK
OTHER: (SPECIFY IN GRID)
WAITING FOR COVID SITUATION TO
IMPROVE
214= CARE OF CHILD/FAMILY DUE TO COVID
215= SICK WITH COVID
216= NO WORK AVAILABLE DUE TO COVID
217 = WAITING FOR COVID TEST RESULTS
218 = QUARANTINING DUE TO COVID EXPOSURE

COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311= WORK IN OWN/FAMILY FARM
320= NF IN OWN BUSINESS (SPECIFY IN GRID)
341= NF IN “MAQUILA”
359= NF OTHER (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
370 = NW- WAITING FOR COVID SITUATION
TO IMPROVE

11

N

*** C-7 CODES: WHY LEFT “FW”, “NF”, & “AB”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS

12 = NO WORK DUE TO COVID
13= CARE OF CHILD/FAMILY DUE
TO COVID
14= SICK WITH COVID
15 = STOPPED WORKING TO AVOID
COVID/WAITING FOR IMPROVEMENT
16 = QUARANTINE

9 = OTHER (SPECIFY):

REMINDER: BEFORE BEGINNING WITH “THE WORK GRID” ASK FOR “NW” AND “AB” PERIODS: “DURING THE LAST 12 MONTHS, FOR 5 OR MORE DAYS ...HAVE YOU BEEN ILL OR
SICK? ...HAVE YOU BEEN UNEMPLOYED? ...HAVE YOU TRAVELED OUT OF THE COUNTRY?” [USE THE “YES” RESPONSES TO PROBE AND DOCUMENT DATES HERE OR DURING THE QUESTIONS IN THE “WORK GRID”]:

C4

WORK GRID
REPORT FROM FIRST PERIOD COVERING FEBRUARY 1, 2021 TO PRESENT
C5
C6
C8
C9
C10
FW

PER.
AND
SUB
PER.
NO.

GR
CO
[FW
ONLY]

EMPLOYER’S NAME
(FARM WORK, NONFARM WORK AND
WORK ABROAD)

CROP

WRITE
ACTIVITY OR TASK WHILE FW,
AB and NF [USE CODES FOR
*NW ONLY]

NF

NW
AB

GR

FW
NF

CO

NW
AB

RECEIVED
UNEMPLOYMENT?

[C1-C2 FOR OFFICE USE ONLY]
C1-C2 C15
C3

DATES FOR PERIODS
OF
FW, NF, NW, AB

FROM:

TO:

# OF
WORK
DAYS
PER
WEEK?
FW, NF,
AB

NW
AB

GR

FW
NF

CO

NW
AB
FW
NF

GR
CO

NW
AB
FW
NF

GR
CO

NW
AB
* C-5 ACTIVITY CODES: ONLY FOR “NW” (IN THE U.S.A.)
[WRITE ACTIVITY FOR FW, NF, AB]

207 =
208 =

STATE
and

***FW, NF,
&
AB:
WHY
LEFT?

COUNTRY
[CODE]

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

Y
CO

205 =
206 =

CITY

COUNTY NAME
[IF IN A BORDER
COUNTY ASK IF
COMMUTE FROM
MEXICO]

N

FW
NF

GR

201 =
202 =
203 =
204 =

____________ ___ 102_____________ ___ ___ ___ ___
County
Farmworker ID
C11
C12
C13
C7

LOOKING FOR FW AND NF WORK
LOOKING FOR FARM WORK
LOOKING FOR NF WORK
WAITING FOR RECALL NOTICE(AFTER
LAYOFF)
WAITING FOR START OF SEASON
FAMILY RESPONSIBILITIES/ WORK IN
HOME
IN SCHOOL
LAID UP DUE TO INJURY

209 =
210 =
211 =
212 =
213=

IN-TRANSIT BETWEEN JOBS
VACATION
DID NOT LOOK FOR WORK
OTHER: (SPECIFY IN GRID)
WAITING FOR COVID SITUATION TO
IMPROVE
214= CARE OF CHILD/FAMILY DUE TO COVID
215= SICK WITH COVID
216= NO WORK AVAILABLE DUE TO COVID
217 = WAITING FOR COVID TEST RESULTS
218 = QUARANTINING DUE TO COVID EXPOSURE

COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

N

Y
COMMUTE FROM
MEXICO TO DO FW?

N

Y

** C-5 ACTIVITY CODES: ONLY FOR “AB” (WHILE
IN A FOREIGN COUNTRY OR ABROAD):
311= WORK IN OWN/FAMILY FARM
320= NF IN OWN BUSINESS (SPECIFY IN GRID)
341= NF IN “MAQUILA”
359= NF OTHER (SPECIFY IN GRID)
361 = NW - MEDICAL TREATMENT
362 = NW - VACATION
369 = NW - OTHER: (SPECIFY IN GRID)
370 = NW- WAITING FOR COVID SITUATION TO
IMPROVE

12

N

*** C-7 CODES: WHY LEFT “FW”, “NF”, & “AB”?
1 = LAID OFF/END OF SEASON
2 = FIRED
3 = FAMILY RESPONSIBILITIES
4 = SCHOOL
5 = MOVED
6 = HEALTH REASON
7 = VACATION
8 = RETIRED
10 = QUIT
11 = CHANGE JOBS

12 = NO WORK DUE TO COVID
13= CARE OF CHILD/FAMILY DUE
TO COVID
14= SICK WITH COVID
15 = STOPPED WORKING TO AVOID
COVID/WAITING FOR IMPROVEMENT
16 = QUARANTINE

9 = OTHER (SPECIFY):

D1 In the year before last (FROM OCTOBER 2019

D30 How did you get this job? [DO NOT READ CHOICES. MARK
TO OCTOBER 2020) [YEAR BEFORE THE ONE
ONLY ONE RESPONSE]
COVERED IN WORK GRID], how many months
did you do (FW) in the U.S.? [1 DAY OR MORE
9 1 I APPLIED FOR THE JOB ON MY OWN
PER MONTH EQUALS 1 MONTH]

94
95

months
D2 [IF NON-FARM JOB LISTED ON WORK GRID]: For

I WAS RECRUITED BY A GROWER OR HIS FOREMAN
I WAS RECRUITED BY FARM LABOR CONTRACTOR OR HIS
FOREMAN
I WAS REFERRED BY THE EMPLOYMENT SERVICE
I WAS REFERRED BY THE WELFARE OFFICE
I WAS REFERRED BY RELATIVE / FRIEND / WORKMATE
I WAS REFERRED BY LABOR UNION
DAY LABORER / PICKED UP AT SHAPE UP

96

your most recent non-farm (NF) employer, how
97
many hours per week did you work on
98
average?
99
hours
9 10

D3 [IF NON-FARM JOB LISTED] For your most recent 9 97 Other:

non-farm employer (NF), how much were
you paid per week on average?

NP – HANDLING PESTICIDES (IN THE U.S.A.)
NP1f.

In the last 12 months, have you loaded, mixed or applied
pesticides?

D27 How many years have you worked for this
(FW) employer? [ONE DAY/PER YR=ONE YR

9 1 YES

NO

years
NV3 In the last 3 months, how many days did you
work while you were ill?

9 0

9 _____ days

9 95 DK

9 96 RF

D22 If you are injured at work or get sick as a result
of your work, does your employer provide
health insurance or pay for your health care?
9 0

NO 9

1

YES 9 7

DON’T KNOW

D23 If you are injured at work or get sick as a

result of your work, do you get any payment
while you are recuperating (i.e., "workers'
compensation")?
9 0

NO 9

1

YES 9 7

9

1

YES 9 7

NT2a. In the last 12 months, with your current employer, has
anyone given you training or instructions, either inperson or remotely, in the safe use of pesticides (through
video, audio, cassette, classroom lectures, written
material, informal talks or by any other means)?
90

NO

9 1 YES

NS – SANITATION SECTION
“The following questions refer to sanitation at your job with your
current FW employer: ... Does your current employer provide EVERY
DAY...
NS1 ... (potable) clean drinking water and disposable cups?
90
NO WATER, NO CUPS
9 1 YES, WATER ONLY
92
YES, WATER AND DISPOSABLE CUPS 9 7 DON’T KNOW

DON’T KNOW

D24 If you are injured or get sick off the job (e.g.,
at home), does your employer provide health
insurance or pay for your health care (no matter if
you use it or not)?
9 0 NO

NT – TRAINING AND INSTRUCTIONS

NS4 ... a toilet (EVERY DAY)?
9 0 NO
9 1 YES
NS9

97

DON’T KNOW

... (provide) water to wash hands (EVERY DAY)?

9 0 NO

9 1 YES

97

DON’T KNOW

DON’T KNOW
NV4.

NVI Has your current farm employer ever offered
paid time off for COVID, for example to get
vaccinated, recuperate from illness, or care for
a family member, even if you don't use it?

In the last 12 months, with your current farm employer, which
safety practices were in place to prevent the spread of COVID or
other infectious diseases at the workplace?
[READ CHOICES AND MARK ALL MENTIONED]

9 a. Masks were required of all workers
9 b. Workers had to stay six feet apart when possible
9 0 NO
9 c. Soap or sanitizer to clean hands was provided
9
7
YES
DON’T
KNOW
9 1
9 d. Vaccinations were required
9 e.Signs were posted in a language that I can understand
D26 Are you covered by unemployment insurance 9 f. COVID-19 prevention training was offered (in preferred language)
9 z. Other:
if you lose this job?
9 None
9 0 NO
9 1 YES 9 7 DON’T KNOW

13

CURRENT FARM JOB
Now I am going to ask you some questions about
the FW you are CURRENTLY performing for
the EMPLOYER through whom we contacted you
[INCLUDED IN A WORK GRID PERIOD].
D11

9 1 ...BY THE HOUR?
9 2 ...BY THE PIECE? [SKIP TO D13]
9 3 ...COMBINATION HOURLY WAGE AND PIECE
RATE? [ASK D12 THRU D18]
9 4 ...SALARY OR OTHER? [SKIP TO D19]

Are you paid: ...

9 1 ...BY THE HOUR?
9 2 ...BY THE PIECE? [SKIP TO D13]
9 3 ...COMBINATION HOURLY WAGE AND PIECE
RATE? [ASK D12 THRU D18]
9 4 ...SALARY OR OTHER? [SKIP TO D19]

D12

ONLY BY THE HOUR, ENTER AMOUNT AND SKIP TO
“G1C.” IF COMBINATION, ENTER AMOUNT AND
CONTINUE WITH D13]:

How much per hour (to nearest cent)? [IF PAID
ONLY BY THE HOUR, ENTER AMOUNT AND SKIP TO “G1C.”
IF COMBINATION, ENTER AMOUNT AND CONTINUE WITH
D13]:
_____________________________

D12

D13 [IF PAID BY THE PIECE]: Are you paid as an
individual or by the crew? [If the answer is "CREW", ask
questions D14 to D18 consistently in reference to the crew]
D1

9 1 INDIVIDUAL [SKIP to D15]
9 2 CREW
9 1 ...PAYROLL CHECK?
9 2 ...PERSONAL CHECK?
9 3 ...CASH AND CHECK?
D62

D7

How much per hour (to nearest cent)? [IF PAID

D15

Did you get a receipt?

For what time period was that payment?

14

“Now I’m going to ask you some questions about your individual and family income for last year (2021)...
G1C ...What was your total personal income
last year - in 2021- in U.S. dollars [U.S.
earnings only FOR FW AND NF]?

[READ OR SHOW CHOICES. MARK ONLY ONE]

90
9 21
9 22
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 20
9 97
9 96

DID NOT WORK AT ALL IN 2021
LESS THAN 1,000
1,000 TO 2,449
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
40,000 TO 44,999
45,000 TO 54,999
55,000 TO 59,999
60,000 OR MORE
DK (DON’T KNOW)
RF (REFUSE)

G2C How much of that income [in “G1C”] was

from agricultural employment (U.S.
earnings only for FW)? [READ OR SHOW
CHOICES. MARK ONLY ONE]

90
9 21
9 22
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 20
9 97
9 96

DID NOT WORK AT ALL IN 2021
LESS THAN 1,000
1,000 TO 2,449
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
40,000 TO 44,999
45,000 TO 54,999
55,000 TO 59,999
60,000 OR MORE
DK (DON’T KNOW)
RF (REFUSE)

15

G3C What was your family’s total income last
year - in 2021- in U.S. dollars [U.S.
earnings for FW AND NF for all in “FAMILY
GRID”]? [READ OR SHOW CHOICES.
MARK ONLY ONE]
90
9 21
9 22
92
93
94
95
96
97
98
99
9 10
9 11
9 12
9 13
9 14
9 15
9 16
9 17
9 18
9 19
9 20
9 97
9 96

DID NOT WORK AT ALL IN 2021
LESS THAN 1,000
1,000 TO 2,449
2,500 TO 4,999
5,000 TO 7,499
7,500 TO 9,999
10,000 TO 12,499
12,500 TO 14,999
15,000 TO 17,499
17,500 TO 19,999
20,000 TO 22,499
22,500 TO 24,999
25,000 TO 27,499
27,500 TO 29,999
30,000 TO 32,499
32,500 TO 34,999
35,000 TO 37,499
37,500 TO 39,999
40,000 TO 44,999
45,000 TO 54,999
55,000 TO 59,999
60,000 OR MORE
DK (DON’T KNOW)
RF (REFUSE)

a.

NH - PERSONAL HEALTH - LIFE HISTORY [ASK ALL]:
b. Are you currently taking
c. In the last 12 months, in the U.S. and/or abroad, have you seen a
medication, for this
doctor or nurse for (condition “YES” in COLUMN “a”)? [IF ANSWER IS
“YES” FOR THE U.S. AND “AB” MARK BOTH]
condition (in ”a”), that was
prescribed by a medical
provider?

Have you ever – in your whole life -- been told by a doctor or
nurse (health practicioner) that you have the following
condition...
...heart disease?

NH5

9 1 YES:

90

NO

9 96 RF

91

YES

9 0 NO

9 1 YES:

90

NO

9 95 DK

9 96 RF

91

YES

90

NO

91

YES

90

NO

9 95 DK
...asthma?

NH1

...cancer?

NH8

90

NO

9 95 DK

91

YES:

9 96

RF

a.
And have you ever -- in your
whole life – been told by a
doctor or nurse that you
have...
NH3 ...high

blood pressure?

9 0 NO
9 1 YES
9 95 DK
9 96 RF
NH12

...high cholesterol?

9 0 NO
9 1 YES
9 95 DK
9 96 RF

TYPE OF CANCER?

9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:

NAME OF COUNTRY

9 0 NO
9 1 YES, IN THE U.S.A.
9 2 YES, “AB”:

90
91
92

NAME OF COUNTRY

NO
YES, IN THE U.S.A.
YES, “AB”:

NAME OF COUNTRY

NH – INDIVIDUAL PERSONAL HEALTH HISTORY (LIFETIME) [INTERVIEWER: FIRST ASK ALL QUESTIONS IN FIRST COLUMN.]
g.
d.
e.
f.
b.

...ever been
tested for this
condition?

90

NO

91

YES

9 95 DK

90

NO

91

YES

9 95 DK

What was the outcome
(result, the last time)?

91
92
93
94
9 95
91
92
93

NORMAL
PREHYPERTENSION
HIGH
DID NOT RECEIVE IT
DK (FORGOT)

NORMAL
BORDERLINE
HIGH
9 4 DIDN’T RECEIVE IT
9 95 DK (FORGOT)

When was the last
test taken?

Where was Are you currently taking
medication, for this
the test
condition (in “a”), that
taken?:
*[USE CODE]
was prescribed by a
medical provider?

9 1 0 TO 12 months
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)
9 1 0 TO 12 months
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)

90

NO

91

YES

90

NO

91

YES

c.
In the last 12 months, in the
U.S. and/or abroad, have
you seen a doctor or nurse
for (condition in “a”)?

90

NO

91

YES, IN THE U.S.A.

92

YES, “AB”:

90

NO

91
92

YES, IN THE U.S.A.
YES, “AB”:

*CODES FOR ( COLUMN “g” ): NH3 - NH12 - NH13
1 = COMMUNITY/MIGRANT HEALTH CENTER
2 = PRIVATE MEDICAL DOCTOR’S OFFICE/PRIVATE CLINIC

3 = HOSPITAL
4 = EMERGENCY ROOM

5 DENTIST
6 PHARMCY

16

7 TESTING SITE
97 = OTHER: __________

95 = DK
96 = RF

CONTINUATION OF NH – INDIVIDUAL PERSONAL HEALTH HISTORY (LIFETIME) [INTERVIEWER: FIRST ASK ALL QUESTIONS IN FIRST COLUMN.]
a.

And how about these other conditions,
have you ever -- in your whole life –
been told by a doctor or nurse that you
have the following conditions...
NH2

...diabetes?

9 0 NO
9 1 YES
9 95 DK

9 96 RF

[IF RESPONDENT IS A WOMAN, AND
AN SWER IS “YES” ASK]:
Was it diagnosed during pregnancy?:

9 0 NO
9 1 YES
9 95 DK
NH6

...tuberculosis?

9 0 NO
9 1 YES
9 95 RF

NH10

9 96 RF

0 TO 12 MONTHS

HIGH SUGAR LEVEL

92

13 TO 24 MONTHS

9 1 YES

93

LOW SUGAR LEVEL

93

2 TO 5 YEARS

9 95 DK

94

DIDN’T RECEIVE IT

94

MORE THAN 5 YRS

9 95

DK (FORGOT)

NO

9 95
90

NO

9 95 DK

90

NO

9 96 RF

9 1
9 2
9 4
9 95
91
92

DK (FORGOT)
NORMAL
ABNORMAL
DIDN’T RECEIVE IT
DK (FORGOT)
POSITIVE
NEGATIVE

94

DIDN’T RECEIVE IT

9 95 DK

9 95

DK (FORGOT)

90

9 1
92

NEGATIVE

94

DIDN’T RECEIVE IT

NO

9 1 YES

...other?:

9 0 NO
9 1 YES:
9 95 RF
9 96 RF

91

92

90

9 1 YES

NH15 ...COVID?

9 0 NO
9 1 YES
9 95 RF

NORMAL

9 1 YES
9 96 RF

f.
When was the last test taken?

91

9 96 RF

...urinary tract infection?

9 0 NO
9 1 YES
9 95 DK
NH4

e.
d.
What was the outcome (result) of
...ever been
the last test?
tested for
this
condition?

9 95 DK

90

NO

9 1 YES
9 95 DK

*Codes for column “g”
1
COMMUNITY/MIGRANT HEALTH CENTER
2
PRIVATE CLINIC OR DOCTOR’S OFFICE

9

95

91
92

POSITIVE

DK (FORGOT)
POSITIVE
NEGATIVE

94

DIDN’T RECEIVE IT

9 95

DK (FORGOT)

g.
Where was
the test
taken?:
*[ENTER
CODE]

9 1 0 TO 12 MONTHS
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)
9 1 0 TO 12 MONTHS
9 2 13 TO 24 MONTHS
9 3 2 TO 5 YRS
9 4 MORE THAN 5 YRS
9 95 DK (FORGOT)
9 1 0 TO 3 MONTHS
9 2 4 TO 6 MONTHS
9 3 7 TO 10 MONTHS
9 4 MORE THAN 10 MONTHS
9 95 DK (FORGOT)
9 1
9 2
9 3
9 4
9 95

0 TO 12 MONTHS
13 TO 24 MONTHS
2 TO 5 YRS
MORE THAN 5 YRS
DK (FORGOT)

3 HOSPITAL
4 EMERGENCY ROOM

5 DENTIST
6 PHARMACY
7 COMMUNITY TESTING SITE
95 = DK

17

b.
Are you currently
taking medication,
for this condition
(in “a”), that was
prescribed by a
medical provider?

c.
In the last 12 months, in the U.S.
and/or abroad, have you seen a doctor
or nurse for this condition (in “a”)? [IF
ANSWER IS “YES” FOR THE U.S. AND
“AB” MARK BOTH]

90

NO

90

NO

91

YES, IN THE U.S.A.

91

YES

92

YES, “AB”:

90

NO

91

YES

90

NO

91

YES

90

NO

91

YES

90

NO

91

YES

90

NO

91

YES, IN THE U.S.A.

92

YES, “AB”:

90

NO

91

YES, IN THE U.S.A.

92

YES, “AB”:

90

NO

91

YES, IN THE U.S.A.

92

YES, “AB”:

90

NO

91

YES, IN THE U.S.A.

92

YES, “AB”:

96 = RF
97 OTHER: ____________

HA – QUALITY OF AND ACCESS TO HEALTH CARE SECTION
HA1 [INTERVIEWER ]: Now, I would like to ask you a few questions about health care services that you may have used in the last 12 months. [FIRST ASK QUESTIONS IN THE FIRST COLUMN. READ
OPTIONS & MARK ALL RESPONSES] ...In the LAST YEAR (12 MONTHS) in the USA, have you used any type of health care service (including telehealth) from doctors, nurses, dentists, clinics, or
hospitals: ...
NOTE: EXPLAIN THAT ILLNESS
BELOW REFERS TO: “A physical
illness, as well as a mental health
problem or substance abuse.”

9 a ...FOR ILLNESS?
9 0 NO: [ASK HA7]

9 95 DK

91

9 1.
9 2.
9 3.
9 95

YES

9 96 RF

9 96 RF

9 d ...FOR DENTAL TREATMENT
(DUE TO PROBLEM WITH
TEETH)?
9 0 NO:[ASK HA7] 9 1 YES

9 95 DK

9 96 RF

9 e ...FOR ROUTINE DENTAL
CLEANING/CHECK-UP?
9 0 NO:[ASK HA7] 9 1 YES

9 95 DK

9 96 RF

*CODES FOR “HA2”
1 COMMUNITY/MIGRAN
6 Telehealth
T HEALTH CENTER
2 PRIVATE CLINIC OR
w/community/
DOCTOR’S OFFICE
migrant center
3 HOSPITAL
4 EMERGENCY ROOM 8 Telehealth with
97=OTHER:
private doctor or
____________
clinic

When (last time)?

9 2. 2 TO 6 MONTHS
9 3. 7 TO 12 MONTHS
9 95 DK

9 c ...FOR ROUTINE OR PREVENTIVE
CARE?
9 0 NO:[ASK HA7] 9 1 YES

9 95 DK

HA3

9 1. LAST MONTH

YES

9 96 RF

9 b ...FOR INJURY?
9 0 NO:[ASK HA7]

9 95 DK

91

*HA2
...And where
did you go
(last time)?
*[ENTER
CODES]

1
2
3
4
5

LAST MONTH
2 TO 6 MONTHS
7 TO 12 MONTHS
DK

9 1.
9 2.
9 3.
9 95

LAST MONTH
2 TO 6 MONTHS
7 TO 12 MONTHS
DK

9 1.
9 2.
9 3.
9 95

LAST MONTH
2 TO 6 MONTHS
7 TO 12 MONTHS
DK

9 1.
9 2.
9 3.
9 95

LAST MONTH
2 TO 6 MONTHS
7 TO 12 MONTHS
DK

**HA4
HA5 In general, how satisfied were YOU with the
***HA6
Did you get any help to
care YOU received at your LAST visit for
Why weren’t you
pay for the cost of that
(“YES” in HA2)? [ASK ALL OPTIONS, MARK
(completely) very
health service?***[
ONE ]: Were you...
satisfied with the
“YES” OR “NO”, ASK
health care received at
HOW IT WAS PAID.
that visit?
ENTER CODES THAT
**[ENTER CODE]
APPLY]:
9 0 NO:
[ENTER CODES]
9 1 YES:
[ENTER CODES]

91
92
93

...VERY SATISFIED?

9 0 NO:
[ENTER CODES]
9 1 YES:
[ENTER CODES]

91
92
93

...VERY SATISFIED?

91
92
93

...VERY SATISFIED?

91
92
93

...VERY SATISFIED?

91
92
93

...VERY SATISFIED?

9 0 NO:
[ENTER CODES]
9 1 YES:
[ENTER CODES]
9 0 NO:
[ENTER CODES]
9 1 YES:
[ENTER CODES]

9 0 NO:
[ENTER CODES]
9 1 YES:
[ENTER CODES]

**CODES FOR “HA4"
I paid the bill out of
6 Billed, but did
“my own pocket”
not pay
Medicaid / Medicare
7 Worker’s
Public clinic did not
compensation
charge
8 I paid some (copay)
Employer provided
health plan
95 = DK
Self or family bought
96 = RF
individual health plan
97 Other: ________

1
2
3

4

95= DK
96 = RF

18

****HA7
[If “NO” in “HA1",
ask]: Why haven't
you used health
services [for "NO"
in "HA1"]
[ ENTER CODES]

...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]

...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]

...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]

...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]

...SOMEWHAT SATISFIED? [ASK HA6]
...NOT AT ALL SATISFIED? [ASK HA6]

***CODES FOR “HA6"
COST TOO MUCH 5 CONDITION DID NOT
HAD TO WAIT TOO
IMPROVE AFTER
LONG
TREATMENT OR
LANGUAGE
MEDICATION
PROBLEM 6 DR. DID NOT DIAGNOSE
COULD NOT
OR TREAT CONDITION
COMMUNICATE
95 = DK
MISTREATED BY
96 = RF
DR. OR OTHER
97 OTHER: _____________
STAFF

****CODES FOR “HA7"
1=
2=
3=
4=

Did not know where to go
No transportation
Too far away
Health Center not open when
needed
5 = No need to go / Does not get sick
6= Too expenive
7 = No insurance
8= Fearof COVI D
9= Limited/No appts due to COVID
10= I was sick with COVID
11 = I was exposed to COVID and
therefore could not get an appt
95= DK 96= RF
97= OTHER ______________________

HA8: And in the LAST 12 MONTHS, in the USA, was
there ever a time when you wanted or needed health
care, but could not get it? (e.g., for a routine exam, a
dental appointment or because you were injured or
sick)
9 0 NO ( ASK HA10)

9 1 YES

9 95 DK

9 96 RF

GA-2

HA10: [ASK ALL]... (How about) In a foreign country

HA9: Why could you not get the health care you wanted (or
needed)?

(e.g., Mexico), have you used any type of health
service in the last year (LAST 12 MONTHS) [IF

[CHECK ALL THAT APPLY]

9a
9b
9c
9d
9f
9g

Did not know where to go
No transportation
Too far away
Health Center not open when needed
Too expensive
No insurance

9 h Fear of COVID
9 i Limited/No appts due to
COVID
9 j I had COVID
9 k Exposed to COVID
9 z Other:

“YES ,” ASK AND ENTER COUNTRY]
9 0 NO
9 1 YES, NAME OF COUNTRY?:

Now, I am going to ask you some questions about your health...

Over the last 2 weeks, how often have you been bothered by the following problems?

Not at all

Several days

More than half the days

Nearly every day

1

...Feeling nervous, anxious or on edge?

0

1

2

3

2

...Not being able to stop or control worrying?

0

1

2

3

Not at all

Several days

More than half the days

PQ-2 Over the last 2 weeks, how often have you been bothered by the following problems?

Nearly every day

1

...Little interest or pleasure in doing things?

0

1

2

3

2

...Feeling down, depressed, or hopeless?

0

1

2

3

NV5. [If have faced barriers to getting tested for COVID. What have the barriers
been? [DO NOT READ CHOICES. MARK ALL MENTIONED]:
9 a. Not sick so do not need testing
9 b. Unsure where testing locations are in my community
9 c. No testing is available in my community
9 d. Cost of testing
9 e. Concerns about immigration status and testing
9 f. Not sure what to do if I test positive
9 g. Need to be able to work so it does not matter
9 h. Fear of losing my job if test is positive
9 z. Other:

G4 In the last 2 years [LAST 24 MONTHS], have you or anyone in your
household received benefits or used the services of any of the
following social programs? [READ CHOICES. CHECK ALL THAT
APPLY]: ...

9 r.

...Welfare (general assistance) or TANF (Temporary
Assistance for Needy Families)?

9 b. ...Food stamps?
9 c.
9 d.
9 s.
9 e.
9 h.
9 i.
9 j.
9 k.
9 l.
9 m.
9 n.

...Disability insurance?
...Unemployment insurance?
...Additional unemployment benefits related to COVID?

NV6. Have you received a COVID vaccination?
        9 0
NO
9 1 YES (SKIP TO NV8)

....Social security?
....Low income housing?
...Public health clinic?
...Medicaid?
....WIC?
....Disaster relief
....Legal Advice or services
...Other? ____________________________

9 ...None

NV7. Why not? [DO NOT READ CHOICES. MARK ALL MENTIONED THEN SKIP TO DA1]:
9 a. Not sure where to get vaccinated 9 e. Concerns about immigration status
9 b. Unsure of safety of vaccine s
9 f. Concerns about costs
9 c. Worried about side effects
9 g. No time to get vaccinated
9 d. Do not feel it is necessary
9 h. Other:
NV8. Did you receive your vaccine in the U.S.?

9 ...Don’t know

9 0 NO (SKIP TO DA1)

9 1 YES

9 1 YES

NV9. Where did you get vaccinated? (MARK ALL THAT APPLY):

NV4. Have you faced barriers to getting tested for COVID?
9 0 NO [skip to NV6]

9 95 Don’t Know (SKIP TO NV8)

9 95 Don’t Know
19

9 a. Community/Migrant Health Center 9 d. County or public vaccination event
9 b. Pharmacy
9 e. Private Clinic/Doctor
9 c. Farm or worksite
9 f. Other:

DA. DIGITAL ACCESS
DA1Do you or any member of your family
[“Household Grid”] have access to digital
information sources (i.e., internet,

What devices?

cellular phone with internet, etc.)?
[CHECK WHO IF “YES”]

B.

Spouse?

C.

Children?

9 0 NO 9 1 YES
9 0 NO 9 1 YES
9 0 NO 9 1 YES

D.

Other?:

9 0 NO 9 1 YES

A.

Worker?

DA7.Have you used, or has anyone helped

you use, any digital device to
seek or obtain information
about ...

DA2

Computer

DA3 Cellular phone

with Internet

[MARK RESPONSES FOR DEVICES “U”]

DA4 Cellular phone with Text DA5

Tablet

DA6 Other
[Specify]:

device?

9 0 NO
9 0 NO
9 0 NO

9 1 YES
9 1 YES
9 1 YES

9 0 NO 9 1 YES
9 0 NO 9 1 YES
9 0 NO 9 1 YES

9 0 NO 9 1 YES
9 0 NO 9 1 YES
9 0 NO 9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

9 0 NO 9 1 YES

9 0 NO 9 1 YES

9 0 NO

9 1 YES

9 0 NO

9 1 YES

DA8.

What devices have you used?
[MARK ALL RESPONSES]

DA9.

Who helped you use the
device (in “DA8") to seek or
obtain the information (in
“DA7")? [MARK ALL
RESPONSES:]

a.

...health insurance?

9 0 NO
k.

91

...a telephone or virtual consult with
a doctor/nurse?

9 0NO
g.

YES

91

YES

...health information or a health
problem?

9 0 NO
b....seeking
9 0 NO
c.

90

91

YES

employment?

91

YES

...training and/or education?
NO

91

YES

d....child care?

9 0 NO
e....housing?
9 0 NO

9 1 YES

9 1 YES

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

CELLULAR PHONE WITH TEXTING

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

CELLULAR PHONE WITH TEXTING

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

9 1.COMPUTER

CELLULAR PHONE WITH TEXTING

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

CELLULAR PHONE WITH TEXTING

CELLULAR PHONE WITH TEXTING

CELLULAR PHONE WITH TEXTING

CELLULAR PHONE WITH TEXTING

20

9 1.Self

9 2.

Spouse?

9 3. Children? 9 4.
9 1.Self
9 2.

Other?:

9 3. Children? 9 4.

Other?:

9 1.Self

Spouse?

9 2.

Spouse?

9 3. Children? 9 4.

Other?:

9 1.Self

Spouse?

9 2.

9 3. Children? 9 4. Other?:
9 1.Self
9 2. Spouse?
9 3. Children? 9 4. Other?:
9 1.Self
9 2. Spouse?
9 3. Children? 9 4. Other
9 1.Self

9 2. Spouse?

9 3. Children? 9 4. Other

DA7.Have you used, or has anyone helped

DA8. What devices have you used? [MARK ALL RESPONSES. FOR WHERE?
ASK FOR VENUES]

f. ...benefits? [e.g., Unemployment, Social

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 0 NO

9 2. TABLET

9 4.

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

you use, any digital device to
seek or obtain information
about ...

Security, food stamps, retirement, etc.]

9 1 YES:

CELLULAR PHONE WITH TEXTING

SPECIFY:

h. ....news?
9 0 NO

9 1 YES

i. ...communication/calls?
9 0 NO
9 1 YES

CELLULAR PHONE WITH TEXTING

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

j. entertainment or social networks
(FaceBook, WhatsApp, etc.)?
9 0 NO
9 1 YES

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

z.

9 1.COMPUTER

9 3. CELLULAR PHONE WITH INTERNET

9 2. TABLET

9 4.

...other?: [SPECIFY]:

CELLULAR PHONE WITH TEXTING

CELLULAR PHONE WITH TEXTING

CELLULAR PHONE WITH TEXTING

21

DA9. Who helped you use the device
(in “DA8") to seek or obtain
the information (in “DA7")?
[MARK ALL RESPONSES:]

9 1.Self

9 2. Spouse?

9 3. Children? 9 4. Other
9 1.Self

9 2. Spouse?

9 3. Children?
9 1.Self

9 4.Other ?

9 2. Spouse?

9 3. Children? 9 4. Other
9 1.Self

9 2. Spouse?

9 3. Children? 9 4. Other
9 1. Self

9 2. Spouse?

9 3. Children? 9 4. Other

LEGAL STATUS

We are interested in knowing whether any of the following apply to you. Please be assured that no one
besides us will know your response.
L2b PROGRAMS [DO NOT READ OPTIONS]:
L1
What is your current legal status in the U.S.? [READ
CHOICES IF NECESSARY]:

91

AMNESTY UNDER 5 YEAR PROGRAM
[“TIME”]

I AM A NATURALIZED U.S. CITIZEN (FOREIGN BORN,
NATURALIZED). (ASK: “BEFORE BECOMING A NATURALIZED
U.S. CITIZEN, UNDER WHICH PROGRAM DID YOU APPLY TO
OBTAIN YOUR PERMANENT RESIDENCE?”) [POSSIBLE
ANSWERS IN L2: 1 - 9, 97). THEN ASK: L4-1, L4-2, AND L4-3]

92

AMNESTY UNDER SAW (90 DAY)
PROGRAM [“FW” - “FIELD WORK”]

93

CUBAN/HAITIAN ENTRANT

94

SPOUSAL PETITION PROGRAM/FAMILY
UNITY

PERMANENT RESIDENT/GREEN CARD (RIGHT TO RESIDE AND
WORK IN THE U.S.) (ASK L2: “UNDER WHICH PROGRAM DID
YOU APPLY?”) [POSSIBLE ANSWERS: 1 HASTA 9 Y 97). THEN
ASK: L4-1 AND L4-2]

95

LABOR CERTIFICATION PROGRAM

96

REGISTRY PROGRAM

97

POLITICAL ASYLUM

91

I AM A U.S. CITIZEN BY BIRTH [SKIP TO NEXT PAGE]

92

93

94

95

96

97

98

BORDER CROSSING CARD/COMMUTER CARD (RIGHT TO
9 8 REFUGEE
CROSS THE BORDER AND WORK IN THE U.S.) (ASK L2: “UNDER
WHICH PROGRAM DID YOU APPLY?”) [POSSIBLE ANSWERS: 9, 9 9 PROTECTIVE STATUS (TEMPORARY)
12, 13, Y 97. THEN ASK: L3, L4-1 AND L4-2]
9 10 GUEST WORKER PROGRAM
[“BRACERO”]
PENDING STATUS (WITHOUT DOCUMENTS, APPLIED, AWAITING
9 11 STUDENT
OFFICIAL DECISION) (ASK L2: “UNDER WHICH PROGRAM DID
YOU APPLY?”) [POSSIBLE ANSWERS: 1- 9, 14, 15 AND 97.
9 12 TOURIST
THEN ASK: L3, AND L41]
9 13 BORDER CROSSING CARD/ “PASSPORT”
UNDOCUMENTED (APPLICATION DENIED/DID NOT APPLY TO
ANY PROGRAMS) [POSSIBLE ANSWERS: “NONE.” SKIP TO
9 14 DACA (Deferred Action for Childhood
NEXT PAGE]
Arrivals.
• Entered USA under 16 yrs. old
TEMPORARY RESIDENT - NON IMMIGRANT VISA (ONLY FOR
before June 15, 2007;
SPECIFIED TIME) [ASK L2: “UNDER WHICH PROGRAM DID YOU
• Under 31 as of June 15, 2012.
APPLY?” POSSIBLE ANSWERS: 10 - 97. THEN ASK: L3 AND L41]
• Have continuously resided in the
USA from June 15, 2007 to the
OTHER [IF RELEVANT AND APPROPRIATE ASK L2, L3, L4-1, L4-2,
present)
AND L4-3. THEN SKIP TO NEXT PAGE]:

9 97 OTHER:
9 99 NOT ANSWERED

L3

Do you have general work authorization?:
9 0 NO

9 1 YES

9 7 DON’T KNOW
L4

1

When did you apply to the 2
program (in L2)?

/

(Month)
/

DATE STATUS BECAME EFFECTIVE:
[Only for those who responded 3
"2,3, or 4" in L1]: When did you
obtain your legal status?

/

(Year)

9 96 REFUSE
[Only for those who
responded "2" in L1]:
When did you obtain your
naturalization/ become a
U.S. citizen?
/

(Month)
/

(Year)

22

(Month)
/

(Year)

JBS International, Inc.
155 Bovet Road, Suite 210
San Mateo, CA 94402-3108
Phone: 650.373.4900
Fax: 650.348.0260

INDIVIDUAL AGREEMENT TO BE A RESEARCH SUBJECT
OMB CONTROL NUMBER: 1205-XXXX

INTRODUCTION/PURPOSE
You are invited to participate in this survey for the Department of Labor because you are currently working on a
farm. The purpose of the survey is to learn more about the employment, living conditions, and the
health of farm workers.
PROCEDURES TO BE FOLLOWED
You will be asked to answer some questions about your work history and about your health. The interview will
last approximately 45 minutes.
RISKS
Since we will only be asking you questions, there is very little risk to you as a result of being in the survey.
You may refuse to answer any question at any time, with no penalty.
BENEFITS
There are no direct benefits to you from being in the survey. Information obtained through this research,
however, may help federal, state, and private farm worker programs improve services to workers like
you.
PRIVACY
Your answers to the interview will be kept private to the extent allowed by law. This means that the interview
record will be kept in a locked file, and only researchers on the survey will be allowed to see it.
Your name will not appear on any reports about the survey. (See back of page for details.)
ALTERNATIVES TO PARTICIPATION
Participating in this survey is voluntary and you can quit at any time. You can also choose not to participate
in any part of the interview at any time, with no penalty. Whether or not you participate in this
survey will not affect benefits and services to which you are normally entitled. You will be paid for
the time you are spending in this interview. At any time, you may ask the researchers to explain any
part of the survey.
WHO TO CALL WITH QUESTIONS
If you have questions about the research survey, including questions about your rights as a research
subject, you may call JBS International (toll free) at 877- SAY-NAWS (or 877-729-6297). They will
refer your questions to Daniel Carroll at the Department of Labor, at (202) 693-2795.
I have read and understand the statement above. My questions about any unclear or confusing statements
have been answered clearly. I agree to participate in this survey as a research subject. I admit that
I have received a copy of this form and $30 for my participation.
-----------------------------------------------------------------Signature of Subject

------------------------------------Date

(See reverse)

23

In accordance with the Privacy Act of 1974, as amended (5 U.S.C.552a),
we are notifying you that this study is authorized by the U.S. Department of
Labor, Employment and Training Administration (ETA). Your voluntary
participation is important to the success of this study and will enable the
ETA to understand the labor market and living experiences of U.S.
farmworkers. Under written agreement with research organizations, the
ETA may release certain information necessary for research but only after
all identifying information has been removed. Unless required by law, or
necessary for litigation or legal proceedings and except as indicated in this
statement, we will hold all personal identifiers (e.g. name, address, and
social security number) in total confidence and will not release them.

Notwithstanding any other provision of law, no person is required to respond to nor shall a person
be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a
currently valid Office of Management and Budget control number. Public reporting burden for this
collection of information, which is voluntary, is estimated to average 45 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate to the Office of Policy Development, Evaluation and
Research, ETA, Department of Labor, Room N5641, 200 Constitution Avenue, N.W., Washington,
D.C. 20210.

24

JBS International, Inc.
155 Bovet Road, Suite 210
San Mateo, CA 94402-3108
Phone: 650.373.4900
Fax: 650.348.0260

INDIVIDUAL AGREEMENT TO BE A RESEARCH SUBJECT
OMB CONTROL NUMBER: 1205-XXXX

INTRODUCTION/PURPOSE
You are invited to participate in this survey for the Department of Labor because you are currently working
on a farm. The purpose of the survey is to learn more about the employment, living conditions,
and the health of farm workers.
PROCEDURES TO BE FOLLOWED
You will be asked to answer some questions about your work history and about your health. The interview will
last approximately 45 minutes.
RISKS
Since we will only be asking you questions, there is very little risk to you as a result of being in the survey.
You may refuse to answer any question at any time, with no penalty.
BENEFITS
There are no direct benefits to you from being in the survey. Information obtained through this research,
however, may help federal, state, and private farm worker programs improve services to workers like
you.
PRIVACY
Your answers to the interview will be kept private to the extent allowed by law. This means that the interview
record will be kept in a locked file, and only researchers on the survey will be allowed to see it.
Your name will not appear on any reports about the survey. (See back of page for details.)
ALTERNATIVES TO PARTICIPATION
Participating in this survey is voluntary and you can quit at any time. You can also choose not to participate
in any part of the interview at any time, with no penalty. Whether or not you participate in this
survey will not affect benefits and services to which you are normally entitled. You will be paid for
the time you are spending in this interview. At any time, you may ask the researchers to explain any
part of the survey.
WHO TO CALL WITH QUESTIONS
If you have questions about the research survey, including questions about your rights as a research
subject, you may call JBS International (toll free) at 877- SAY-NAWS (or 877-729-6297). They will
refer your questions to Daniel Carroll at the Department of Labor, at (202) 693-2795.
I have read and understand the statement above. My questions about any unclear or confusing statements
have been answered clearly. I agree to participate in this survey as a research subject. I admit that
I have received a copy of this form and $30 for my participation.
-----------------------------------------------------------------Signature of Subject
(See reverse)

------------------------------------Date

25

In accordance with the Privacy Act of 1974, as amended (5 U.S.C.552a),
we are notifying you that this study is authorized by the U.S. Department of
Labor, Employment and Training Administration (ETA). Your voluntary
participation is important to the success of this study and will enable the
ETA to understand the labor market and living experiences of U.S.
farmworkers. Under written agreement with research organizations, the
ETA may release certain information necessary for research but only after
all identifying information has been removed. Unless required by law, or
necessary for litigation or legal proceedings and except as indicated in this
statement, we will hold all personal identifiers (e.g. name, address, and
social security number) in total confidence and will not release them.

Notwithstanding any other provision of law, no person is required to respond to nor shall a
person be subject to a penalty for failure to comply with a collection of information subject to the
requirements of the Paperwork Reduction Act unless that collection of information displays a
currently valid Office of Management and Budget control number. Public reporting burden for this
collection of information, which is voluntary, is estimated to average 45 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate to the Office of Policy Development, Evaluation and
Research, ETA, Department of Labor, Room N5641, 200 Constitution Avenue, N.W., Washington,
D.C. 20210.

26