Disability Perception Survey (DPS) - Phone Version

Disability Perception Survey (DPS)

Appendix A_DPS survey

Disability Perception Survey (DPS) - Phone Version

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Disability Perceptions Survey


CAWI VERSION:

Would you like to take this survey in English or Spanish?

¿A usted le gustaría completar esta encuesta en inglés o español?


  1. English/Inglés

  2. Spanish/Español


If LANGSWITCH=1, 77, 98, 99 continue in English

IF LANGSWITCH=2, switch to Spanish language version of the survey


CATI VERSION:

We are offering this survey in both English and Spanish.  Which would you prefer?

 Estamos ofreciendo esta encuesta en inglés y español. ¿Cuál preferiría?


  1. English/Inglés

  2. Spanish/Español



[CAWI]Thank you for agreeing to participate in our new AmeriSpeak survey!

¡Gracias por participar en nuestra nueva encuesta de AmeriSpeak!


[ALL]This survey is about disability and benefits.

[CAWI] To thank you for sharing your opinions, we will give you a reward of 20,000 AmeriPoints after completing the survey. As always, your answers are confidential.
Para agradecerle que esté compartiendo su opinión, le daremos una recompensa de 20,000 después de completar esta encuesta. Como siempre, sus respuestas son confidenciales.


[CAWI] Please use the "Continue" and "Previous" buttons to navigate between the questions within the questionnaire. Do not use your browser buttons.
Por favor utilice los botones “Continuar” y “Anterior” para navegar entre las preguntas del cuestionario. No utilice los botones de su navegador.




CONSENT.

OMB: 0960-0788


NORC at the University of Chicago is conducting the Disability Perceptions Survey (DPS) on behalf of the Social Security Administration (SSA). The purpose of the survey is to learn more about American adults’ knowledge and understanding of the Social Security Disability Insurance (SSDI) program and who qualifies for this benefit. We are also interested in learning if having COVID-19 affected this knowledge. You will be asked questions about your experience with SSDI as well as the experiences of those you may know. Ultimately, we will examine how this knowledge and these experiences affect the future use of services. This survey is being conducted for research purposes.

We will need your Social Security number (SSN) for this survey so that SSA can link your responses to your future use of services. Your responses, or choosing not to answer any of the questions in the survey, will not affect your eligibility for SSDI or Supplemental Security Income (SSI) benefits or any other form of assistance in any way. Your SSN and the other information we collect from you for this survey will be safeguarded from unauthorized use and disclosure. The information you provide will be protected under the Privacy Act of 1974. For more information on how SSA may use your information, see the Privacy Act Statement.


Participation in this survey is voluntary. You have the right to stop at any time and there is no penalty for refusing to participate.


We estimate that it will take approximately 20 minutes to complete this survey. You will be given 20,000 AmeriPoints upon completion.


If you have questions about your rights as a survey participant, you may contact NORC’s Internal Review Board (IRB) toll-free at (866) 309-0542.


By clicking ‘Continue’, you are indicating that you have read the above and consent to participate in this survey.



S1.

The Social Security Administration will use the results of this survey to get a better understanding of people’s knowledge about SSDI and their likelihood of applying for benefits in the future. By collecting Social Security Numbers along with survey responses, SSA will be able to learn about the types of people who apply for SSDI and find out what additional information they might need about the program. Your responses to this survey will NOT be used to determine eligibility for benefits but will be used for research purposes.


Please provide your social security number in the spaces below.


[____][____][____]-[____][____]-[____][____][____][____]



S2.

Please note that to complete the survey and be eligible for the incentive, we need your Social Security Number.


[____][____][____]-[____][____]-[____][____][____][____] Social Security Number


9999999999. I do not wish to provide this information



[CAWI] Thank you for your time today. Unfortunately you are not eligible for this study. We value your opinion and hope that you will participate in future AmeriSpeak surveys.

Gracias por su tiempo hoy. Lamentablemente usted no es elegible para este estudio. Valoramos su opinión y esperamos que usted participe en futuras encuestas AmeriSpeak.


[CAWI] We will redirect you to the AmeriSpeak Member Portal in [n] seconds.

[CAWI] Nosotros lo/la redirigiremos al Portal de Miembros AmeriSpeak en [n] segundos.


[CATI] Thank you for your time today. Unfortunately, you are not eligible for this study. Thank you so much for your participation. We will be in touch when your next survey is available. Have a great day/evening.

[CATI] Gracias por su tiempo hoy. Lamentablemente usted no es elegible para este estudio. Muchas gracias por su participación. Estaremos en contacto cuando su próxima encuesta esté disponible. ¡Qué tenga un buen día/tarde!


[[CATI] , ONLY OFFER THIS IF PROMPTED BY RESPONDENT:  I mentioned earlier that we would complete the survey if you were eligible, and it appears that you are not for this particular survey.  We appreciate your time and will be in touch with your next survey soon.]

[[CATI] ONLY OFFER THIS IF PROMPTED BY RESPONDENT:  Mencioné anteriormente que completaríamos la encuesta si usted era elegible, y al parecer usted no lo es para esta encuesta en particular. Le agradecemos por su tiempo y pronto estaremos en contacto con su próxima encuesta.]



Q1.

How familiar are you with the Social Security Disability Insurance (SSDI) program?


RESPONSE OPTIONS:

  1. Very familiar

  2. Somewhat familiar

  3. Familiar

  4. Not at all familiar



Q2.

How familiar are you with Supplemental Security Income (SSI) program?


RESPONSE OPTIONS:

  1. Very familiar

  2. Somewhat familiar

  3. Familiar

  4. Not at all familiar



DISPLAY_1.

This survey is about the Social Security Disability Insurance (SSDI) program. This program provides benefits to workers who have a disabling condition that prevents them from working.


There is another program, called the Supplemental Security Income (SSI) program, which also provides benefits to eligible disabled individuals.


Please note that this survey is about SSDI only, not SSI.


[CAWI: Listed below are key facts about SSDI and how it is different from SSI.]

[CATI: I will now read key facts about SSDI and how it is different from SSI.]


Social Security Disability Insurance (SSDI)

Supplemental Security Income (SSI)

Earned by workers paying Social Security taxes on their wages

Not required to have a work history

Not need based

Need based


Eligibility depends on income and resources

Benefit amounts are based on earnings

Benefit amounts are not based on earnings


There is a maximum monthly payment

Provides benefits to disabled workers

Provides benefits to disabled adults


Provides benefits to disabled children

Provides benefits to adults disabled since childhood


Provides benefits to certain dependents

Does not provide benefits to dependents



Part 1. Background and Future Outlook


DISPLAY_2.

The following questions concern your personal experience with SSDI; your future outlook on health, work, and the possibility of having to apply for disability benefits; and your preferred methods for receiving information related to the SSDI program.



F1.

Have you ever applied, or are you currently applying for Social Security Disability Insurance (SSDI) disability benefits?


CAWI RESPONSE OPTIONS:

        1. Yes

        2. No


CATI RESPONSE OPTIONS:

        1. YES

        2. NO



[SHOW IF F1=1]

F1a.

What was the outcome of the application?


RESPONSE OPTIONS:

  1. Awarded benefits and still receiving them

  2. Awarded benefits but no longer receiving them

  3. Awaiting a decision on the application

  4. Denied and currently appealing the decision

  5. Denied



F2_1.

Thinking about family, friends, coworkers, neighbors, and acquaintances who are 18 to 64 years old, do you know anyone who has a disabling condition that limits their ability to work?


By disabling condition we mean anything that makes it hard for people to work, or hard to work as many hours as they would like, or limits the type of work they can do.


CAWI RESPONSE OPTIONS:

        1. Yes

        2. No


CATI RESPONSE OPTIONS:

        1. YES

        2. NO



[SHOW IF F2_1=1]

F2_2.

Have any of the people you know with a disabling condition applied for SSDI disability benefits?


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No

  3. Don’t Know


CAWI RESPONSE OPTIONS:

  1. YES

  2. NO

  3. DON’T KNOW



[SHOW IF F2_2=1]

F2_3

About how many people do you know who have applied for disability benefits?


CAWI RESPONSE OPTIONS:

1. 0

2. 1

3. 2-3

4. 4-6

5. 7-10

6. 10-19

7. 20-29

8. 30 or More


CATI RESPONSE OPTIONS:

1. 0

2. 1

3. 2-3

4. 4-6

5. 7-10

6. 10-19

7. 20-29

8. 30 or More



[SHOW IF F2_3=1-100]

F2_4.

[IF F2_3=2-100: Please think about the person you know best who has applied for disability benefits.] What is the current status of this person’s application for SSDI disability benefits?


RESPONSE OPTIONS:

  1. Awarded benefits and still receiving them

  2. Awarded benefits but no longer receiving them

  3. Awaiting a decision on the initial application

  4. Denied and currently appealing the decision

  5. Denied

  1. Don’t know



[SHOW IF F2_1=1]

F2_5.

Have any of the people you know with disabling conditions not yet applied for SSDI disability benefits?


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No

  3. Don’t Know


CATI RESPONSE OPTIONS:

  1. YES

  2. NO

  3. DON’T KNOW



[SHOW IF F2_5=1]

F2_6

How many people with disabling conditions do you know who have not yet applied for SSDI disability benefits?


CAWI RESPONSE OPTIONS:

1. 1

2. 2-3

3. 4-6

4. 7-10

5. 10-19

6. 20-29

7. 30 or More


CATI RESPONSE OPTIONS:

1. 1

2. 2-3

3. 4-6

4. 7-10

5. 10-19

6. 20-29

7. 30 or More



[SHOW IF F2_6=1-100]

F2_7.

[IF F2_6=2-100: Please think about the person you know best who has not yet applied for benefits.] Do you think this person is planning to apply for SSDI disability benefits?


RESPONSE OPTIONS:

  1. Yes

  2. No

  1. Don’t know




[IF F2_7=2]

F2_8.

What do you think are the reasons why this person does not plan on applying for SSDI disability benefits?


[CAWI - REMOVE BOLD] Select all that apply.

[CATI] SELECT ALL THAT APPLY

<CAWI remove bold> Seleccione todas las opciones que correspondan.

[CATI] SELECCIONE TODAS LAS OPCIONES QUE CORRESPONDAN.


RESPONSE OPTIONS:

  1. They still work or are able to work

  2. They do not believe they meet SSA’s definition of disability

  3. They do not have the required work history

  4. They have reached the age of retirement and receive Social Security retirement benefits

  5. Unaware of SSDI benefits

  6. Not willing to apply due to the stigma attached to receiving benefits

  7. They don’t know how to apply or think it’s too complicated

  8. Other, please specify:



F4a.

In the past year, did you look for any information about SSDI?


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No


CATI RESPONSE OPTIONS:

  1. YES

  2. NO



[SHOW IF F4A=1]

F4b.

Where did you look for information?


GRID ITEMS:

  1. [CAWI: My; CATI: Your] employer

  2. A doctor’s office or health clinic

  3. Family or friends

  4. State unemployment office

  5. Workers’ compensation office

  6. Social Security Administration (SSA)

  7. Another government agency

  8. An attorney

  9. An insurance company

  10. A non-profit organization

  11. Another source, please describe:


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No


CATI RESPONSE OPTIONS:

  1. YES

  2. NO



[SHOW IF F4A=1]

F4c.

Overall, how helpful was the information that you found?


CAWI RESPONSE OPTIONS:

  1. Very helpful

  2. Somewhat helpful

  3. Not very helpful

  4. I was not able to find any information


CATI RESPONSE OPTIONS:

  1. Very helpful

  2. Somewhat helpful

  3. Not very helpful

  4. You were not able to find any information



F4d.

In the past year, have you heard anything about SSDI from any of the following sources?


GRID ITEMS:

  1. [CAWI: My employer][CATI: Your employer]

  2. A doctor’s office or health clinic

  3. Family or friends

  4. State unemployment office

  5. Workers’ compensation office

  6. Social Security Administration (SSA)

  7. Another government agency

  8. Another source (such as an attorney, insurance company, non-profit organization); please specify:


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No


CATI RESPONSE OPTIONS:

  1. YES

  2. NO



F6.

Based on what you know about the SSDI program, how likely is it that you will apply for disability benefits [IF S_AGE<63: in the next 5 years][IF S_AGE>62: before you turn 67]?


  1. 1 - Not very likely

  2. 2

  3. 3

  4. 4

  5. 5

  6. 6

  7. 7 - Extremely likely

  8. [CAWI: I am][CATI: You are] already on SSDI [EXCLUSIVE]



F7.

In the next 5 years, do you expect your health to improve, get worse, or stay about the same?


RESPONSE OPTIONS:

  1. Improve

  2. Get worse

  3. Stay about the same



DISPLAY_3.

Now we would like to ask you a question about your current employment.



D1.

Are you currently working for pay at a job or business?


RESPONSE OPTIONS:

  1. Yes, full-time

  2. Yes, part-time

  3. No, not working



[SHOW IF D1=1,2]

F8a.

In the next 5 years, if you developed a long-term health problem and lost your job, would you apply for disability benefits?


CAWI RESPONSE OPTIONS:

  1. Yes

  2. Yes, but only if I could not find another job or otherwise make ends meet

  3. No, would not apply


CATI RESPONSE OPTIONS:

  1. Yes

  2. Yes, but only if you could not find another job or otherwise make ends meet

  3. No, would not apply



[SHOW IF F8A=2]

F8b.

Which of the following resources would you rely on?


CAWI GRID ITEMS:

  1. [SHOW IF S_AGE>56] I would apply for early retirement benefits through Social Security

  2. I would try to collect an early pension or other retirement benefit from a previous employer

  3. I would try to find another job

  4. I would support myself through savings, income from a spouse’s job, or other source of income

  5. I would apply for unemployment benefits


CATI GRID ITEMS:

  1. [SHOW IF S_AGE>56] You would apply for early retirement benefits through Social Security

  2. You would try to collect an early pension or other retirement benefit from a previous employer

  3. You would try to find another job

  4. You would support yourself through savings, income from a spouse’s job, or other source of income

  5. You would apply for unemployment benefits


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No


CATI RESPONSE OPTIONS:

  1. YES

  2. NO



P6.

Do you think of the SSDI disability program as a “welfare program”?


CAWI RESPONSE OPTIONS:

  1. Yes

  2. No


CATI RESPONSE OPTIONS:

  1. YES

  2. NO



P8.

Some individuals who potentially qualify for disability benefits do not apply. Which of the following do you think is the most common reason for not applying for these benefits?


RESPONSE OPTIONS:

  1. They like their jobs

  2. They earn more from working than they would receive in benefits

  3. They feel there is social stigma attached to receiving benefits

  4. They think the application process is long and complicated

  5. Other, please specify:


Part 2. General Knowledge [K] of the Social Security Disability Programs



PART2_INTRO.

The following questions ask about your general knowledge of the Social Security Disability Insurance (SSDI) program. Your answers to these questions will help SSA understand what people know and don’t know about SSDI and help us figure out how to better inform people about this benefit. Please answer them as best you can by yourself, without looking up any of the answers. Your best estimate is fine.



K1.

In general, how long must a health problem last to be considered disabling for receipt of SSDI benefits?


RESPONSE OPTIONS:

  1. 6 months

  2. 12 months

  3. 5 years

  4. The health problem must be permanent

  1. Don’t know



K2.

Does ability to find a job matter in qualifying for SSDI benefits?


RESPONSE OPTIONS:

  1. Yes

  2. No

  1. Don’t know



K3.

What, if any, are the requirements for receiving SSDI benefits?


[CAWI - REMOVE BOLD] Select all that apply.

[CATI] SELECT ALL THAT APPLY

<CAWI remove bold> Seleccione todas las opciones que correspondan.

[CATI] SELECCIONE TODAS LAS OPCIONES QUE CORRESPONDAN.


RESPONSE OPTIONS:

  1. The disabling condition is considered severe

  2. The disabling condition prevents working at substantial levels

  3. The disabling condition has lasted, or is expected to last, twelve months or more

  4. All of the above

  5. None of these are requirements

  1. Don’t know



K5.

Does SSA ever check to see if SSDI beneficiaries are still disabled?


RESPONSE OPTIONS:

  1. No, disability is considered permanent

  2. Yes, every year

  3. Yes, every 3 years

  4. Yes, at least every 7 years

  1. Don’t know



P1.

Thinking about the U.S. as a whole, what percentage of the working age population do you think receive SSDI disability benefits at some point in their lives?


By ‘working-age population’, we mean people ages 18 to 64. This includes people in that age range who are not working.


RESPONSE OPTIONS:

  1. Less than 10%

  2. 10-20%

  3. 20-30%

  4. More than 30%

  1. Don’t know



P2.

Thinking about the U.S. as a whole, what percentage of 18 to 64 year olds do you think are currently receiving SSDI disability benefits?


RESPONSE OPTIONS:

  1. Less than 5%

  2. 5-10%

  3. 10-15%

  4. More than 15%

  1. Don’t know



P3.

Thinking about the U.S. as a whole, what percentage of SSDI disability applicants do you think are ultimately approved for benefits?


RESPONSE OPTIONS:

  1. Less than 10%

  2. 10-25%

  3. 25-50%

  4. More than 50%

  1. Don’t know



P4.

Thinking about the last ten years, do you think it has become easier or harder to receive SSDI disability benefits?


RESPONSE OPTIONS:

  1. Easier

  2. Harder

  3. About the same

  1. Don’t know



P5.

On average, about how much of a person’s work-related income do you think SSDI benefits will cover? Do you think SSDI will cover all, most, about half, or less than half of what people would otherwise earn through work?


[CATI] If you don’t know, you may say “Don’t know”.


CAWI RESPONSE OPTIONS:

  1. All

  2. Most

  3. About half

  4. Less than half

  1. Don’t know


CATI RESPONSE OPTIONS:

  1. ALL

  2. MOST

  3. ABOUT HALF

  4. LESS THAN HALF

  1. DON’T KNOW


  1. Were you employed at the beginning of the pandemic (in March 2020)?

    • Yes

    • No


  1. [IF Q1= YES] Since the beginning of the pandemic (i.e., since March 2020), have you experienced any of the following changes to your work due to COVID? [SELECT ALL THAT APPLY.]

  1. I decided to stop working for my employer.

  2. I was involuntarily laid off or let go by my employer.

  3. I started working for a new employer.


  1. Compared to the beginning of the pandemic, are your savings now higher, lower, or about the same as when the pandemic started?

  1. My savings are now higher.

  2. My savings are now lower.

  3. My savings are the same.


  1. Have you ever tested positive for COVID?

    1. Yes

    2. No


  1. [IF Q5=YES] When was the date of your most recent positive COVID Test?

Month/Year


  1. [IF Q5=YES] How would you categorize your symptoms from having COVID 19?

  1. Severe symptoms

  2. Moderate symptoms

  3. Mild symptoms

  4. No symptoms


  1. Have you received a COVID-19 vaccine?


  1. Has the COVID pandemic made you think you are more or less likely to apply for disability benefits through SSDI?

    1. Yes, I think I am MORE likely to apply.

    2. Yes, I think I am LESS likely to apply.

    3. No, it has not changed my thinking about this.


  1. Did the COVID pandemic raise your awareness of the SSDI program?

    1. Yes

    2. No


  1. Thinking about others, if a worker who was diagnosed with COVID continued to have symptoms six months later, do you think they should apply for SSDI benefits?

    1. Yes

    2. No


  1. How likely do you think a worker who experienced symptoms of COVID for six months would be to qualify for SSDI benefits?

    1. Not at all likely to qualify

    7. Extremely likely to qualify



Part 3. Examples: Dealing with Disability



PART3_INTRO.

We are nearly done. Just one more section.


This section includes some brief hypothetical scenarios about people in various health-related and employment circumstances. Following each scenario are a few questions about your views on the person’s particular situation. Please answer these questions to the best of your ability. There are no right or wrong answers.



V1_A.

Sam is 40 years old. He has worked his entire adult life as a construction worker. Sam recently developed pain in his back and legs. The pain is present almost all of the time. Sam takes medication for the pain, which helps somewhat, but he still has a difficult time moving around and lifting things at work.


If you were in Sam’s situation, how likely would you be to apply for SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to apply

  7. Extremely likely to apply



V1_B

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Sam is 40 years old. He has worked his entire adult life as a construction worker. Sam recently developed pain in his back and legs. The pain is present almost all of the time. Sam takes medication for the pain, which helps somewhat, but he still has a difficult time moving around and lifting things at work.


How likely do you think Sam is to qualify to receive SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to qualify

  7. Extremely likely to qualify



V1_C

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Sam is 40 years old. He has worked his entire adult life as a construction worker. Sam recently developed pain in his back and legs. The pain is present almost all of the time. Sam takes medication for the pain, which helps somewhat, but he still has a difficult time moving around and lifting things at work.


A. If Sam had been experiencing symptoms for more than a year, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


B. If Sam were able to do another job instead of construction, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify



V2_A.

Mary is 57 years old. She is a bilingual customer service worker. She has a mild mental impairment caused by a recent stroke. Mary is still five years away from the earliest age that she can file for retirement benefits. She is struggling to make ends meet.


If you were in Mary’s situation, how likely would you be to apply for SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to apply

  7. Extremely likely to apply



V2_B

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Mary is 57 years old. She is a bilingual customer service worker. She has a mild mental impairment caused by a recent stroke. Mary is still five years away from the earliest age that she can file for retirement benefits. She is struggling to make ends meet.


A. If Mary were diagnosed with COVID and continued to have mild symptoms 12 months later, do you think she would be more or less likely to qualify for SSDI benefits?

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


B. If Mary’s work hours were reduced due to the pandemic and were never restored, do you think she would be more or less likely to qualify for SSDI benefits?

1.Definitely less likely to qualify

  6. Definitely more likely to qualify


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to qualify

  7. Extremely likely to qualify



V2_C

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Mary is 57 years old. She is a bilingual customer service worker. She has a mild mental impairment caused by a recent stroke. Mary is still five years away from the earliest age that she can file for retirement benefits. She is struggling to make ends meet.


A. If Mary’s mental impairment was more severe, do you think she would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


B. If Mary became unable to work as a bilingual customer service worker, do you think she would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify



V3_A.

Diane is a 30-year-old attorney. In her free time she is a competitive cyclist who regularly participates in races. Yesterday, Diane was hit by a car while biking and broke her leg. She is recovering from her injury. She is expected to be off work for 9 months during her recovery.


If you were in Diane’s situation, how likely would you be to apply for SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to apply

  7. Extremely likely to apply



V3_B

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Diane is a 30-year-old attorney. In her free time she is a competitive cyclist who regularly participates in races. Yesterday, Diane was hit by a car while biking and broke her leg. She is recovering from her injury. She is expected to be off work for 9 months during her recovery.


How likely do you think Diane is to qualify to receive SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to qualify

  7. Extremely likely to qualify



V3_C

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Diane is a 30-year-old attorney. In her free time she is a competitive cyclist who regularly participates in races. Yesterday, Diane was hit by a car while biking and broke her leg. She is recovering from her injury. She is expected to be off work for 9 months during her recovery.


A. If Diane had been experiencing symptoms and out of work for more than a year, do you think she would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


B. If Diane became unable to work as an attorney, do you think she would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify



V4_A.

Bill is 58 years old and has a high school education. He has worked most of his life at an auto manufacturing plant. He has developed severe arthritis as a result of this work. Six months ago, his auto plant relocated overseas and Bill was laid off. He has since developed clinical depression. He has not been able to get another manufacturing position in his rural area.


If you were in Bill’s situation, how likely would you be to apply for SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to apply

  7. Extremely likely to apply



V4_B

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Bill is 58 years old and has a high school education. He has worked most of his life at an auto manufacturing plant. He has developed severe arthritis as a result of this work. Six months ago, his auto plant relocated overseas and Bill was laid off. He has since developed clinical depression. He has not been able to get another manufacturing position in his rural area.


How likely do you think Bill is to qualify to receive SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to qualify

  7. Extremely likely to qualify



V4_C

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Bill is 58 years old and has a high school education. He has worked most of his life at an auto manufacturing plant. He has developed severe arthritis as a result of this work. Six months ago, his auto plant relocated overseas and Bill was laid off. He has since developed clinical depression. He has not been able to get another manufacturing position in his rural area.


A. If Bill were able to do another job instead of manufacturing, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


B. If Bill were further from retirement age, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


C. If Bill had more education, such as a master’s degree, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify



V5_A.

Daniel is 48 years old and never finished high school. He only speaks Spanish and has asthma. He has worked most of his adult life, but has trouble finding and keeping a job. It is not clear if his health problems or other issues contribute to his difficulties in finding and keeping a job.


If you were in Daniel’s situation, how likely would you be to apply for SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to apply

  7. Extremely likely to apply



V5_B

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Daniel is 48 years old and never finished high school. He only speaks Spanish and has asthma. He has worked most of his adult life, but has trouble finding and keeping a job. It is not clear if his health problems or other issues contribute to his difficulties in finding and keeping a job.


How likely do you think Daniel is to qualify to receive SSDI disability benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Not at all likely to qualify

  7. Extremely likely to qualify



V5_C

[CATI] ONLY READ OPENING PASSAGE IF RESPONDENT REQUESTS INFORMATION AGAIN; IT IS THE SAME AS THE PREVIOUS QUESTION


Daniel is 48 years old and never finished high school. He only speaks Spanish and has asthma. He has worked most of his adult life, but has trouble finding and keeping a job. It is not clear if his health problems or other issues contribute to his difficulties in finding and keeping a job.


A. If Daniel’s health problems were more severe, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


B. If Daniel were closer to retirement age, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


C. If Daniel had more education, such as a high school diploma, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify


D. If Daniel were able to speak English, do you think he would be more likely or less likely to qualify for SSDI benefits?


RESPONSE OPTIONS; HORIZONTAL DISPLAY:

  1. Definitely less likely to qualify

  7. Definitely more likely to qualify



[SHOW IF MODE=CAWI]

DISPLAY_END.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number.  We estimate that it will take about 20 minutes to read the instructions, gather the facts, and answer the questions. Send only comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden to:  SSA, 6401 Security Blvd, Baltimore, MD  21235-6401.



QFINAL1.

Thank you for your time today. To help us improve the experience of AmeriSpeak members like yourself, please give us feedback on this survey.

Gracias por su tiempo hoy. Para ayudarnos a mejorar la experiencia de los miembros de AmeriSpeak como usted, por favor envíenos sus comentarios sobre esta encuesta.


[RED TEXT – CAWI ONLY] If you do not have any feedback for us today, please click “Continue” through to the end of the survey so we can make sure your opinions are counted and for you to receive your AmeriPoints reward.

[RED TEXT – CAWI ONLY] Si usted no tiene ningún comentario para nosotros hoy, por favor haga clic en "Continuar" hasta el final de la encuesta para que podamos contar sus opiniones y para que usted pueda recibir su recompensa de AmeriPoints.


Please rate this survey overall from 1 to 7 where 1 is Poor and 7 is Excellent.

Por favor califique esta encuesta en términos generales del 1 al 7, siendo 1 Pobre y 7 Excelente.


Poor






Excellent

1

2

3

4

5

6

7


Pobre






Excelente

1

2

3

4

5

6

7



[SINGLE CHOICE – CAWI ONLY]

QFINAL2.

Did you experience any technical issues in completing this survey?

¿Tuvo algún inconveniente técnico al completar esta encuesta?


  1. Yes – please tell us more in the next question

  2. No


    1. Sí - por favor, cuéntenos más en la próxima pregunta

  1. No


[CATI version needs “no” option]

QFINAL3.

Do you have any general comments or feedback on this survey you would like to share? If you would like a response from us, please email [email protected] or call (888) 326-9424.

QFINAL3. ¿Tiene algún comentario u observación sobre esta encuesta que le gustaría compartir con nosotros? Si desea recibir una respuesta de nosotros, por favor envíe un mail a [email protected] o llámenos al (888) 326-9424.



END.

[CATI version]

This is the end of the survey. We will add 20,000 AmeriPoints to your AmeriPoints balance for completing the survey. If you have any questions at all for us, you can email us at [email protected] or call us toll-free at 888-326-9424. Let me repeat that again: email us at [email protected] or call us at 888-326-9424. Thank you for participating in our new AmeriSpeak survey! 

Esas fueron todas las preguntas. Agregaremos 20,000 AmeriPoints a su saldo de AmeriPoints por completar la encuesta. Si tiene alguna pregunta, puede enviarnos un correo electrónico a [email protected] o llamarnos al número gratuito 888-326-9424. Permítame repetirlo nuevamente: envíenos un correo electrónico a [email protected] o llámenos al 888-326-9424. ¡Gracias por participar en nuestra nueva encuesta AmeriSpeak! 


[CAWI version]

Those are all the questions we have. We will add 20,000 AmeriPoints to your AmeriPoints balance for completing the survey. If you have any questions at all for us, you can email us at [email protected] or call us toll-free at 888-326-9424. Thank you for participating in our new AmeriSpeak survey! 

Esas fueron todas las preguntas. Agregaremos 20,000 AmeriPoints a su saldo de AmeriPoints por completar la encuesta. Si tiene alguna pregunta, puede enviarnos un correo electrónico a [email protected] o llamarnos al número gratuito 888-326-9424. ¡Gracias por participar en nuestra nueva encuesta AmeriSpeak! 


You can close your browser window now if you wish or click Continue below to be redirected to the AmeriSpeak member website.

Ya puede cerrar la ventana de su explorador si lo desea o puede hacer clic en Continuar para ser redireccionado al sitio de usuario de AmeriSpeak.





Privacy Act Statement
Collection and Use of Personal Information

Section 1110 of the Social Security Act, as amended, allows us to collect this information. Furnishing us this information is voluntary, and the information will not be used to determine SSA benefits. However, failing to provide all or part of the information may result in you not becoming a participant, and/or not receiving compensation.


We will use the information to learn more about American adults’ knowledge and understanding of the Social Security Disability Insurance (SSDI) program and who qualifies for this benefit. We may also share your information for “routine uses”, including the following:


  • To a congressional office in response to an inquiry from that office made at the request of the subject of the record; and



  • To a contractor under contract to SSA for the performance of research and statistical activities directly related to this system of records.



In addition, we may share this information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and disclose this information in computer matching programs, in which our records are compared with other records to establish or verify a person’s eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts under these programs.


A list of additional routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0199, entitled Extramural Surveys, as published in the Federal Register (FR) on January 11, 2006, at 71 FR 1835. Additional information, and a full listing of all of our SORNs, is available on our website at www.ssa.gov/privacy/.


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