OMB Clearance Number: 2528-0259
Expires: XX/XX/XXXX
Appendix E:
Adult Head of Household Survey
SC1. Hi, my name is [INTERVIEWER NAME] and I am calling from Abt Associates. Abt Associates is an independent research company, and we are helping the U.S. Department of Housing and Urban Development (HUD) to complete this study. May I please speak with [ADULT HEAD OF HOUSEHOLD NAME].
SC2. I know that I may be calling on your cell phone right now. If you are currently driving, we will call you back at another time. Are you currently driving?
1 |
NO, |
[GOTO SC3] |
2 |
YES, CURRENTLY DRIVING/NOT AVAILABLE |
[SCHEDULE CALL BACK] |
3 |
DID NOT AGREE TO PARTICIPATE |
[THANK AND END – SOFT REFUSAL] |
88 |
DK (VOL) |
DK [THANK AND END – SOFT REFUSAL] |
99 |
REF (VOL) |
REFUSED [THANK AND END – SOFT REFUSAL] |
SC3. Are you in a safe place to talk right now? By a safe place I mean someplace that you can talk privately, where other people can’t hear our conversation., and someplace that you are free from distractions.
1 |
Yes, safe place to talk |
[GO TO SCREENER] |
2 |
No, call me later |
[SCHEDULE CALL BACK] |
88 |
DK (VOL) |
[THANK AND END. DISPO AS SOFT REFUSAL] |
99 |
REF (VOL) |
[THANK AND END. DISPO AS HARD REFUSAL] |
You might remember meeting with one of my co-workers back in [DATE OF STUDY ENROLLMENT] at [INSERT SHELTER NAME] to talk about a study that we are conducting to find about what kinds of housing and services are best for families who experience homelessness. We last talked to you on [DATE OF LAST INTERVIEW]. Today, I would like to talk to you about participating in an interview that will take about 60 minutes to complete.
First, I just need to verify that I am speaking with the correct person.
SC4. What is your date of birth?
Respondent’s Birthday: ___ / _____/ _______
SC5. [IF DOB DOESN’T MATCH RECORDS] What are the last 4 digits of your Social Security Number?
RECORD LAST 4 DIGITS: ___ ___ ___ ___
[REVIEW CONSENT SCRIPT]
As stated in the consent form we just reviewed, the U.S. Office of Management and Budget approved the collection of this information. If you want to provide comments regarding this burden estimate or any other aspect of this collection of information, instructions can be found on the consent form. I want to remind you that your participation is voluntary. You can choose not to answer any question that I ask.
At the end of the interview, we will email you a $50 gift card in appreciation for your time.
Do you have any questions?
[INTERVIEWER: ANSWER QUESTIONS ACCORDINGLY]
If you have any other questions, even after we finish this interview, you may also call the study toll-free phone number at 1-xxx-xxx-xxxx.
If you have any questions about your rights as a participant in this study, you can call the Abt Associates Institutional Review Board (IRB) Administrator, toll free at (xxx-xxx-xxxx).
Okay, let’s get started.
We know that it has been a long time since you first enrolled in this study. As a reminder, you became part of the study in [DATE OF STUDY ENROLLMENT], when you were about [AGE AT ENROLLMENT] years old.
When we talk today I am going to ask you about your experiences. We are interested in learning about your experiences since you enrolled in the study in [DATE OF ENROLLMENT] about [# OF YEARS SINCE ENROLLMENT] ago, and since the last time we talked, [DATE OF LAST INTERVIEW]. Some questions will be asked of a more specific time period. We will provide you with information to help you think about the specific time periods of interest when we first ask about them.
First, I’d like to ask about where you are living/staying right now.
Can you please confirm the address where you are living/staying now?
Is there a complex/building name?
Is there an apartment number?
What city do you live in?
What state do you live in?
What is the zip code?
How long have you lived in this place? You can tell me this answer in days, weeks, months, or years, whichever is easiest for you.
Number of days
Number of weeks
Number of months
Number of years
Refused
Don’t know
Which of the following best describes your current living situation? [Ask this only until receive YES response and then skip to A.4 of A.6 if specified]
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Yes |
No |
REF |
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TERMINATE SCRIPT: I’m sorry but I am having trouble calling up your record. I will try to resolve this issue with my supervisor. I may call back to reschedule the interview at a later time. Do you think that you will be able to stay in the place where you are living/staying now for as long as you want?
Yes [SKIP TO A6: Now, I’d like to you to think about the last six months—that is, since (SIX MONTHS PRIOR DATE). Were there any times when you experienced homelessness…]
No
Refused
Don’t know
[ASK ONLY IF RESPONDENT DOESN’T THINK THEY CAN STAY AS LONG AS THEY WANT A4=NO, REF, DK] Why don’t you think you will be able to stay in this place for as long as you want? What would you say is the main reason?
It is not my house or apartment
I won’t be able to continue to pay the rent
The program I’m in has a time limit
The landlord/owner has told me I will have to leave
Housing too small/ I need a bigger space
Other (specify:________________________)
Refused
Don’t know
Throughout this section, I will ask you questions about different timeframes. The first timeframe is the last six-month period. When I ask about ‘the last six months’ please think about six months back from today—that is, since [SIX MONTHS PRIOR TO DATE OF INTERVIEWDATE].
Were there any times when you experienced homelessness in the last six months? By experiencing homelessness, I mean times where you didn't have a regular place to live, and you were living in an emergency shelter, transitional housing, or in an unsheltered location.
Experiencing homelessness also can include living in a place not typically used for sleeping such as on the street, in a car, in an abandoned building, or in a bus or train station in the past six months.
Please DO NOT include any times when you may have stayed with friends or relatives because you did not have your own place to stay.
Yes
No [SKIP TO A.9]
Refused [SKIP TO A.9]
Don’t know [SKIP TO A.9]
[ASK ONLY IF THEY HAVE EXPERIENCED HOMELESSNESS (A6=1)] How many times did you experience homelessness in the last six months, that is from [SIX MONTH PRIOR MONTH/YEAR] to now?
Number of times ___________
Refused
Don’t know
[ASK ONLY THEY HAVE EXPERIENCED HOMELESSNESS (A6=1)] Now think about all of the times you have experienced homelessness in the past 6 months, that is from [SIX MONTH PRIOR MONTH/YEAR]. What would you say is the total number of days, weeks, or months that you have experienced homelessness in the past 6 months?
Number of days
Number of weeks
Number of months
Refused
Don’t know
Again, please think about the last six months from [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW DATE] to today. Were there any times when you were living with a friend or relative because you could not find or afford a place of your own?
Yes
No [SKIP TO A.11]
Refused [SKIP TO A.11]
Don’t know [SKIP TO A.11]
[ASK ONLY IF SPENT SOME TIME LIVING WITH A FRIEND OR RELATIVE (A9=YES)] Altogether, how much time in the past six months, that is from [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW DATE] to today, would you say you spent living with a friend or relative because you could not find or afford a place of your own? You can tell me this answer in days, weeks, or months, whichever is easiest for you.
Number of days
Number of weeks
Number of months
Refused
Don’t know
Now I’d like to ask you to think about the past year, that is since [MONTH/YEAR ONE YEAR PRIOR TO INTERVIEW]. Think about all of the different places you have lived/stayed during the past year. How many different places have you lived/stayed? Please include the place where you currently live/stay.
# of places: ___________________
Refused
Don’t know
The next few questions focus on the time period between the start of the COVID-19 pandemic, that is March 2020, through six months ago, [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW DATE].
As you may recall, March 2020 is when the COVID-19 pandemic really began to peak and social distancing guidelines went into effect worldwide. When we ask about the start of the COVID-19 pandemic, please think back to that time in March 2020.
Were there any times you experienced homelessness between the start of the COVID-19 pandemic in March 2020 and [MONTH/YEAR SIX MONTHS PRIOR TO INTERVIEW]? By experiencing homelessness, I mean times when you didn't have a regular place to live and you were living in a homeless shelter, transitional housing, or staying in an unsheltered location because you had nowhere else to go? Experiencing homelessness also can include living in a place not typically used for sleeping such as on the street, in a car, in an abandoned building, or in a bus or train station in the past six months.
Please DO NOT include any times when you may have stayed with friends or relatives because you did not have your own place to stay.
Yes
No
Refused
Don’t know
Have you participated in any program to help you with your housing between the beginning of the COVID-19 pandemic in March 2020 and today? This could be a housing program where you lived or a program that helped you pay the rent in your own apartment or house.
Yes
No
Refused
Don’t know
For the next couple of questions, I’d like to ask you about a longer time period. I would like you to think back to early 2018.. Our records show that you would have been about [AGE IN EARLY 2018] years old at that time.
Thinking back to the period between early 2018 and the start of the COVID-19 pandemic-in March 2020. Were there any times you experienced homelessness during that period? Again, by experiencing homelessness, I mean times when you didn’t have a regular place to live and you were living in a homeless shelter, transitional housing or staying in an unsheltered location because you had nowhere else to go. Experiencing homelessness also can include living in a place not typically used for sleeping such as on the street, in a car, in an abandoned building, or in a bus or train station in the past six months.
Please DO NOT include any times when you may have stayed with friends or relatives because you did not have your own place to stay.
Yes
No
Refused
Don’t know
An eviction is when your landlord forces you to move when you don't want to. Were you, or a person you were staying with, ever evicted between early 2018 and today, that is over the past 5 years?
Yes
No
Refused
Don’t know
Still thinking about the time between early 2018 up until today, the past 5 years, did people you were living with ever ask you to move out?
Yes
No
Refused
Don’t know
Now I’d like to spend some time talking about your current household. I’ll start with your marital status and then ask about some people you told us about in prior interviews to see if they are still living with you now. I will also ask about any new people living with you now.
What is your marital status? Are you currently…
Single, never married
Married or living in a marriage like situation
Widowed
Separated/Divorced
Refused
Don’t know
Now
I am going to read you the first names of people who you told us were
part of your family during a prior interview. These interviews could
have been done at any time since [DATE OF STUDY ENROLLMENT] when you
enrolled in the study. For each name I read, please tell me if they
are still living with you.
Is [NAME1] who was born in [DOB MO/YR], living with you now?
IF DOB=MISSING: Is [NAME], who is about [AGE] years old, living with you now?
IF DOB AND AGE=MISSING AND PERSON IS A CHILD WHO WAS PRESENT AT STUDY ENROLLMENT: Is [NAME1] who was a child] IF DOB AND AGE=MISSING AND PERSON IS AN ADULT WHO WAS PRESENT AT STUDY ENROLLMENT: Is [NAME1] who was an adult]/when we first talked to you in [DATE OF STUDY ENROLLMENT] living with you now?
Yes
No
IF VOLUNTEERED: CHILD/PERSON IS DECEASED (Skip to condolence script)
Refused
Don’t Know
CONDOLENCE SCRIPT: I am sorry for your loss. Do you need to take a minute before we go on?
[ASK IF DOB IS KNOWN] Our records show that [NAME]’s date of birth is [DISPLAY DOB]. Is that correct?
Yes SKIP TO B.5: [Has (NAME 1) lived with you at least some of the time…]
No
Refused SKIP TO B.5: [Has (NAME 1) lived with you at least some of the time…]
Don’t know SKIP TO B.5: [Has (NAME 1) lived with you at least some of the time…]
[ASK ONLY IF DATE OF BIRTH IS NOT KNOWN OR IT IS WRONG (B3=NO, REFUSED, DON’T KNOW)] What is [NAME]’s date of birth?
ENTER DATE: ______/_____/_____
Month / Day / Year
Refused
Don’t know
[ASK IF FOCAL CHILD AGE UNDER 18 AND NO LONGER LIVING IN HOUSEHOLD (B2=NO, REFUSED, DON’T KNOW)] Has [NAME1] lived with you at least some of the time in the past six months?
Yes, at least half of the time SKIP TO B.7: [Does (NAME 1) have a disability…?]
Yes, less than half of the time
None of the time
Volunteered: child is deceased (READ CONDOLENCE SCRIPT) SKIP TO NEXT PERSON
Refused SKIP TO NEXT PERSON
Don’t know SKIP TO NEXT PERSON
CONDOLENCE SCRIPT: I am sorry for your loss. Do you need to take a minute before we go on?
[ASK IF FOCAL CHILD AGE 17 AND UNDER AND LIVES THERE ‘LESS THAN HALF THE TIME’OR ‘NONE OF THE TIME’ (B5=2 OR 3)] During the past six months, about how often did you spend one or more hours a day with [NAME1]? Was it…:
Every day or nearly every day
A few times a week
At least once per month
Less than once per month
Not at all
Refused
Don’t know
[ASK OF ALL HOUSEHOLD MEMBERS LIVING IN HOUSEHOLD AGE 18 OR OVER] Is [NAME] currently enrolled in any classes, at some place that is providing education or training? Please consider only classes that [NAME] has been enrolled in for one month or more.
Yes
No
Refused
Don’t know
ASK OF ALL HOUSEHOLD MEMBERS LIVING IN HOUSEHOLD AGE 18 OR OVER] Is [NAME] currently working for pay?
Yes
No
Refused
Don’t know
[ASK OF ALL HOUSEHOLD MEMBERS LIVING IN HOUSEHOLD AGE 18 OR OVER] Does [NAME] have a disability that limits or prevents them from working?
Yes
No
Refused
Don’t know
[ASK IF AGE 17 OR YOUNGER AND CHILD IS PRESENT OR HAS SOME CONTACT WITH FAMILY HEAD (EITHER B2 = 1 YES OR B5=1 At least half of the time OR B6 = 1,2,3,4)] Does [NAME] have a disability? That could include either a physical, emotional, or mental health condition.
Yes
No
Refused
Don’t know
For the next few questions, please think back to [DATE OF STUDY ENROLLMENT], when you enrolled in the study while in [SITE]. I would like you to think about the period of time from that date through today, when answering the next few questions.
[ASK OF ALL CHILDREN PRESENT IN SHELTER AT STUDY ENROLLMENT OR EVER PRESENT IN A SUBSEQUENT INTERVIEW, EXCEPT IF DECEASED]
[IF CURRENTLY UNDER AGE 18 ASK:] Was there ever a time since [DATE OF STUDY ENROLLMENT] when [NAME] was not living with you?
[ELSE (IF CURRENTLY AGE 18 OR OLDER ASK):] Was there ever a time between [DATE OF STUDY ENROLLMENT] and [NAME]’s 18th birthday, when [NAME] was not living with you?
Yes
No SKIP TO B.13 [Are there any other people that are living with you…]
Refused SKIP TO B.13 [Are there any other people that are living with you…]
Don’t know SKIP TO B.13 [Are there any other people that are living with you…]
[ASK IF THERE WAS A TIME CHILD WAS NOT WITH RESPONDENT B10=1] [IF CURRENTLY UNDER AGE 18 ASK:] When [NAME] was not living with you, did [NAME] ever live in a foster care arrangement?
[IF CURRENTLY AGE 18 OR OLDER ASK:] Before [NAME] turned 18, did [NAME] ever live in a foster care arrangement?
Foster care arrangements can sometimes include placements with relatives that are arranged by the child welfare system.
Yes
No
Refused
Don’t know
Are there any other people that are living with you right now whom we haven’t talked about?
Yes
No SKIP TO B.24 (We would like to know if you decide to move, who in your family will move with you)
Refused SKIP TO B.24 (We would like to know if you decide to move, who in your family will move with you)
Don’t know SKIP TO B.24 (We would like to know if you decide to move, who in your family will move with you)
[ASK ONLY IF HOUSEHOLD MEMBERS NOT ALREADY DISCUSSED (B11=1)] How many other people who we haven’t talked about yet, but are living with you right now are adults, 18 years old or older? Please include children who are now 18 years old or older.
Number of adults __________________
Refused
Don’t know
[ASK ONLY IF HOUSEHOLD MEMBERS NOT ALREADY DISCUSSED (B11=1)] How many other people who we haven’t talked about yet, but are living with you right now are children, 17 years old or younger? Please do not include children who are now 18 years old or older.
Number of children __________________
Refused
Don’t know
[ASK ONLY IF B11a>0, REPEAT FOR UP TO 5 NEW ADULTS] Please tell me the first and last names of the adults who are living with you now whom we haven’t talked about. By adults I mean people 18 years old or older, including children who are now 18 or older. Do not include yourself.
[ASK ONLY IF B11a>0, REPEAT FOR UP TO 5 NEW CHILDREN] Please tell me the first and last names of the children who are living with you now whom we haven’t talked about. By children I mean people 17 years old or younger. Please do not include children 18 years old or older. Do not include yourself.
[INTERVIEWER: IF RESPONDENT IS RELUCTANT TO PROVIDE NAMES, EXPLAIN THAT NICKNAMES OR INITIALS ARE FINE.]
[ASK B14-B21 ONLY OF NEW MEMBERS IDENTIFIED IN B11a AND B11b, REPEAT FOR UP TO 10 NEW MEMBERS] Now I have some questions about the adults and children you just told me about. These are the people WHO ARE LIVING WITH YOU NOW but who we did not discuss already. I will start with the adults and then ask about the children.
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NEW FAMILY MEMBER 1 [NAME] |
NEW FAMILY MEMBER 2 [NAME]) |
NEW FAMILY MEMBER 3 [NAME] |
NEW FAMILY MEMBER 4 [NAME] |
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or partner's parent
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partner's parent
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partner's parent
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partner's parent
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B16a.[IF DOB IS UNKNOWN ASK: How old is [NAME]? |
___/___/_____ MM DD YYYY
AGE: ____
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__/___/_____ MM DD YYYY
AGE: ____
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___/___/_____ MM DD YYYY
AGE: ____
Don’t know |
___/___/_____ MM DD YYYY
AGE: ____
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If [NAME] is enrolled but or enrolled but on summer vacation or between terms, please answer “Yes” |
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B.21 [ASK OF ALL ADULTS AND CHILDREN LIVING IN THE HOUSEHOLD NOW (B2=YES, AND THE B.12 AND B.13 SERIES] We would like to know if you decide to move, who in your family will move with you. I am going to read you the name of the people who are currently living with you. For each person, please tell me if you think she/he would move with you. If you moved, would [DISPLAY NAME OF PERSON] move with you?
Members of the Household |
Yes |
No |
REF |
DK |
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For the next questions, when I ask you about the people in your family, I would like you to include those people we just talked about who live with you now and would move with you if you moved.
I am now going to ask you about the place where you are living now.
[ASK ONLY IF A3 k, m, n, OR o are NO] Not including kitchens, bathrooms and hallways, how many rooms are there in your house/apartment/ living space available for the use of your family?
1
2
3
4
5
6 or more
Refused
Don’t know
Do household members sometimes go to sleep elsewhere because there is not enough space in your house/apartment/living space? [IF NEEDED: By “elsewhere” I mean a place outside of your living space.]
Yes
No
Refused
Don’t know
Does anyone in the household regularly sleep in a room other than a bedroom because there are not enough bedrooms?
Yes
No
Refused
Don’t know
Overall, how would you describe the condition of your current house/apartment/living space? Would you say it is in:
Excellent condition
Good condition
Fair condition
Poor condition
Refused
Don’t know
Now I am going to ask you some questions about problems that people have in some homes/apartments/ living spaces. Where you live now/in your current living space, how much of a problem are the following? Please tell me if they are a big problem, a small problem, or not a problem at all.
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Big problem |
Small problem |
Not a problem at all |
REF |
DK |
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In the month that just passed, that is [MONTH ONE MONTH PRIOR TO INTERVIEW DATE], what did you and the people in your family pay [as rent/for the mortgage/ and any condo fee]? We are interested only in knowing the amount of the [rent/mortgage/condo fee] payment that you and your family paid, not any amount that may have been paid by other people who live here, other people who don't live here, or a government program.
[$ PAID LAST MONTH] $____________________
Refused
Don’t know
I have entered [$ AMOUNT FROM C6 (In the month just past, what did you and the people in your family pay….)] as the amount you and the people in your family paid last month for your [mortgage/rent/condo fees]. Is that right?
Yes
No REPEAT C.6
In the month that just passed, what was the total amount you and the people in your family paid for utilities that were not included as part of the [mortgage/rent or condominium fees]? By all utilities, I mean electricity, heat, gas, and water. We are interested only in knowing the total amount of utility payments that you and your family paid, not any amount that may have been paid by other people or a government program.
Amount paid last month $_______________
No payment/included in rent or in condominium fee
Refused
Don’t know
I have entered [$FILL AMOUNT FROM C.8] as the amount that you and your family paid for all utilities. Is that right?
Yes
No REPEAT C.8
Refused
Don’t know
What is the total amount of all utility payments for a typical month—that is not a month with unusually high or low heat or air conditioning bills?
Typical cost per month $ ___________________________
No payment/included in rent or in condominium fee
Refused
Don’t know
I have entered $[amount from C9 (What is the total amount of all utility payments…)] as the amount you and family members who are with you here pay in a typical month for all utilities. Is this correct?
Yes
No REPEAT C.10
Refused
Don’t know
Now I’d like to ask a few questions about your work experience.
Last week, did you do any work for pay?
Yes (SKIP TO D.3, How many jobs…)
No
Refused
Don’t know
Now I’d like you again think back to March 2020, the beginning of the COVID-19 pandemic. Between March 2020 and today, have you done any work for pay? This could include any jobs you may currently have, even if you didn't work for pay last week.
Yes
No (SKIP TO D.12 Thinking about the last month, did you, or anyone in your famil….)
Refused (SKIP TO D.12 Thinking about the last month, did you, or anyone in your famil….)
Don’t know (SKIP TO D.12 Thinking about the last month, did you, or anyone in your famil….)
[ASK IF D.1=YES OR D.2=YES] Now, keep thinking back to the time period since March 2020, that is from the beginning of the COVID-19 pandemic to today. Since March 2020, how many different jobs have you had? Please include all jobs.
# of jobs ______________
Refused
Don’t know
Now I’d like to know a little more about your [main job/ current job/most recent job], especially about how much you work and how much you earn from your [main job/ current job/most recent job] job.
[ASK IF D1=YES OR D2=YES] How many hours per week do/did you usually work at your [main/current//most recent] job? [IF NEEDED: By main job, I mean the one at which you usually work the most hours.]
# of hours __________
Refused
Don’t know
[ASK IF D.1=YES OR D.2=YES] For your main/current/most recent job, what is the easiest way for you to report your total earnings before taxes or other deductions: hourly, weekly, monthly, annually, or on some other basis?
Hourly
Daily
Weekly
Bi-weekly (every 2 weeks)
Twice monthly
Monthly
Annually
Per unit
Other (specify__)
Refused
Don’t know
[ASK IF D.1=YES OR D.2=YES] [Do/Did] you usually receive overtime pay, tips, or commissions (at your main/current/your most recent) job?
Yes
No
Refused
Don’t know
[ASK IF D.1=YES OR D.2=YES] Including overtime pay, tips, and commissions, what [are/were] your usual [earnings on this job], before taxes or other deductions?
Enter dollar amount $___________
Refused
Don’t know
[ASK THIS QUESTION ONLY OF PEOPLE WHO REPORT BEING PAID ON A DAILY BASIS, D5., “For your (main)/most recent job, what is the easiest way …” =2] How many days a week do you usually work?
Number of days______________ [SKIP to D11]
Refused
Don’t know
[ASK THIS QUESTION ONLY OF PEOPLE THAT REPORT BEING PAID ANNUALLY, D.5, “For your (main)/most recent job, what is the easiest way…” =7] How many weeks a year do you get paid for?
Number of weeks______________ [SKIP to D11]
Refused
Don’t know
[ASK THIS QUESTION ONLY OF PEOPLE WHO REPORT BEING PAID BY THE UNIT (D.5 “For your (main)/most recent job, what is the easiest way…” =8)] For how many [UNITS] are you usually paid per week (on this job)?
Number of units______________
Refused
Don’t know
[ASK IF D.1=YES OR D.2=YES] Now I’d like to understand your work experience just over the last six months. Since [SIX MONTH PRIOR MONTH/YEAR], how many of months did you work for pay at least for part of the month? Please include any months you worked for pay, even if you did not work the entire month.
# of months ______________
Refused
Don’t know
Now I would like to ask you about different sources of income or assistance you or people in your family living with you now may receive. Your responses to these questions will not affect your family’s eligibility for housing assistance or other types of assistance. By family, I mean the people we talked about before who live with you now and who would move with you if you moved.
Thinking about the last month, that is, the last 30 days, did you, or anyone in your family who is with you now receive any assistance or income from:
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Yes |
No |
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During the calendar year2022, what was the total amount of cash income, before taxes or other deductions, you and all the people in your family received? Please include money from your main job, work on the side, welfare, SSI, SSDI, help from your family and friends, child support, alimony, and any other money income received by you or any other household member.
[Confirm combined annual income]
ENTER DOLLAR AMOUNT: $___ ____ ____ , ____ ____ _____
Refused SKIP TO D.14
Don’t know SKIP TO D.14
[ASK THIS QUESTION ONLY OF THOSE WHO PROVIDE A DOLLAR AMOUNT IN D13] I have entered $[amount from D13] as the typical combined annual income for you and all the people in your family who live with you. Is this correct?
Yes SKIP TO D.19 (EITC)
No REPEAT D.13 (COMBINED ANNUAL INCOME)
[ASK THIS ONLY OF THOSE WHO REFUSE OR DON’T KNOW D13] Would it amount to $10,000 or more?
Yes
No SKIP TO D.18 [Would it amount to $5,000 or more?]
Refused SKIP TO D.18 [Would it amount to $5,000 or more?]
Don’t know SKIP TO D.18 [Would it amount to $5,000 or more?]
[ASK THIS ONLY OF THOSE WHO RESPOND YES TO EARNING $10,000 OR MORE IN D14] Would it amount to $20,000 or more?
Yes
No SKIP TO D.17 [Would it amount to $15,000 or more?]
Refused SKIP TO D.17 [Would it amount to $15,000 or more?]
Don’t know SKIP TO D.17 [Would it amount to $15,000 or more?]
[ASK THIS ONLY OF THOSE WHO RESPOND YES TO EARNING $20,000 OR MORE IN D15] Would it amount to $30,000 or more?
Yes SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
No SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
Refused SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
Don’t know SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
[ASK THIS ONLY OF THOSE WHO DO NOT RESPOND YES TO EARNING $20,000 OR MORE IN D15] Would it amount to $15,000 or more?
Yes SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
No SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
Refused SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
Don’t know SKIP TO D.19 [Did you or will you claim the Earned Income Tax Credit…]
[ASK THIS ONLY OF THOSE WHO DID NOT RESPOND YES TO EARNING $10,000 OR MORE IN D.14] Would it amount to $5,000 or more?
Yes
No
Refused
Don’t know
Did you or will you claim the Earned Income Tax Credit for [PRIOR YEAR]?
[INTERVIEWER IF RESPONDENT ASKS WHAT THIS IS READ]: The federal government has a special rule that allows working people who earn less than a certain amount each year to take advantage of something called the Earned Income Tax Credit, or EITC. They can claim the Earned Income Tax Credit by filling out a special form called Schedule EITC when they fill out their income taxes, or they can fill out a special form with their employer.
Yes
No
Refused
Don’t know
Did you or anyone in your household receive an “Advance Child Tax Credit” payment, that is an advance payment from the expansion of the child tax credit as part of the Federal Government’s 2021 American Rescue Plan? Please report "yes" if you received the payment as a paper check or as a direct deposit.
Yes
No
Refused
Don’t know
Now I have some questions about your schooling.
What is the highest grade or year of regular school that you have completed and gotten credit for?
Kindergarten to 6th grade
7th to 12th grade –no diploma
High school graduate/have diploma
High school equivalent (GED) general educational development
Some college
Technical certificate
Associates degree
Bachelor’s degree
Master’s degree, doctorate degree, or other professional degree (FOR EXAMPLE, MD, DDS, DVM, LLB, JD)
Refused
Don’t know
Do you have a high school diploma or a GED?
GED
High school diploma
Neither
Refused
Don’t know
Do you have a technical certificate or vocational accreditation?
Yes
No SKIP TO INTRO TO D.24
Refused SKIP TO INTRO TO D.24
Don’t know SKIP TO INTRO TO D.24
What kind of technical certificate of vocational accreditation have you received? Have you received: [SELECT ALL THAT APPLY]
An Occupational/Vocational Certificate (such as certified nursing assistant)
Please specify the type of certificate: _____
An Occupational/Vocational License (such as electrician, plumber, nurse)
Please specify the type of license: _____
Associate’s Degree
Other technical certificate or vocational accreditation. Please specify the type of certificate or accreditation: ______________
Refused
Don’t know
As I mentioned at the start of the interview, you became part of the study in [DATE OF ENROLLMENT], when you would have been about [AGE IN YEARS] years old. I’d like you to think back to that time when answering the next few questions.
Now I’d like you to think about any regular school or training you have had since the beginning of the study in [DATE OF ENROLLMENT]. Have you participated in any school or training program that lasted at least two weeks that was designed to help you find a job, improve your job skills, or learn a new job? [INTERVIEWER NOTE IF NEEDED: Please include any classes you are taking toward an associates degree, bachelor’s degree, or master’s degree.]
Yes
No SKIP TO D.28 FOOD INSECURITY
Refused SKIP TO D.28 FOOD INSECURITY
Don’t know SKIP TO D.28 FOOD INSECURITY
How many different school or training programs have you participated in since [DATE OF ENROLLMENT]?
Number of programs______________
Refused
Don’t know
What kind of schooling or training was that? [REPEAT FOR UP TO 6 PROGRAMS]
|
Training #1 |
Training #2 |
Training #3 |
Training #4 |
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Altogether since [DATE OF ENROLLMENT], about how many months would you say you have spent in school or training programs that were designed to help you find a job, improve your job skills, or learn a new job?
Number of months______________
Refused
Don’t know
Okay, now I’d like you to think just about the last 30 days, that would be since [MONTH PRIOR TO INTERVIEW]. These next questions are about the food eaten in your household in the last 30 days and whether you were able to afford the food you need.
Some people may find the next few questions too personal. Please remember you can choose not to answer any question.
I'm going to read you two statements that people have made about their food situation. Please tell me whether the statement was OFTEN true, SOMETIMES true, or NEVER true for (you/you and the other members of your household in the last 30 days)
D.28a The first statement is: “The food that I bought just didn’t last, and I didn’t have money to buy more.” Was that often, sometimes, or never true for you in the last 30 days?
Often true
Sometimes true
Never true
Refused
Don’t know
D.28b The second statement is “We couldn't afford to eat balanced meals.” Was that often, sometimes, or never true for you in the last 30 days?
Often true
Sometimes true
Never true
Refused
Don’t know
In the past 30 days, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn’t enough money for food?
Yes
No
Refused
Don’t know
In the last 30 days, did you ever eat less than you felt you should because there wasn't enough money to buy food?
Yes
No
Refused
Don’t know
In the last 30 days, were you ever hungry but didn't eat because you couldn't afford enough food?
Yes
No
Refused
Don’t know
In the last 30 days, did you or other adults in your household ever not eat for a whole day because there wasn't enough money for food?
Yes
No
Refused
Don’t know
Now I’d like you to think about the past six months, that is since [SIXMONTHPRIORDATE]. How often does it happen that you do not have enough money to afford:
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Never |
Once in a while |
Fairly often |
Very often |
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In general, how do your family's finances usually work out at the end of the month? Do you find that you usually end up with…?
Some money left over
Just enough money to make ends meet
Not enough money to make ends meet
Refused
Don’t know
How would a $400 emergency expense that you had to pay impact your ability to pay your other bills this month?
Would still be able to pay all my bills
Could not pay some bills
Refused
Don’t know
Now thinking about all of your household’s current debts, including mortgages, bank loans, student loans, money owed to people, medical debt, past-due bills, and credit card balances that are carried from prior months...As of today, which of the following statements describes how manageable your household debt is?
Have a manageable amount of debt
Have a bit more debt than is manageable
Have far more debt than is manageable
Do not have any debt
Refused
Don’t know
The next few questions are about your health and refer to how you are doing now.
Overall, how would you rate your health during the past month/30 days?
Excellent
Very good
Good
Fair
Poor
Refused
Don’t know
Do you have health insurance?
Yes
No SKIP TO E.3 Place usually goes when sick
Refused SKIP TO E.3 Place usually goes when sick
Don’t know SKIP TO E.3 Place usually goes when sick
[ASK IF RESPONDENT HAS HEALTH INSURANCE (E2=1)]: What kind of health insurance or health care coverage do you have? [SELECT ALL THAT APPLY]
Private health insurance plan from employer or workplace
Private health insurance plan purchased directly
Private health insurance plan through a state or local government or community program
Medicaid
Medicare
Military health care/VA
No coverage of any type
Other (specify) ___________________________
Refused
Don’t know
Is there a place you usually go when you are sick and need health care?
Yes
There is no place [SKIP to E.4 How much time during the past month have you felt…]
More than one place
Refused
Don’t know
What kind of place?
A doctor’s office or health center
Urgent care or clinic in a drug store or grocery store
Hospital emergency room
A VA Medical Center or VA outpatient clinic
Some other place
Does not go to one place most often
Refused
Don’t know
How much of the time during the past month have you felt ...
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All
of |
Most
of |
Some of the time |
A little of the time |
None of the time |
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Now I would like to ask you some questions about alcohol and drugs. These are questions about different experiences some people may have if they use drugs or alcohol. We are asking these questions of everyone in the study. Remember that the information you provide will be kept private and your name will never be linked to your responses in reports.
Do you sometimes take a drink in the morning when you first get up? By a drink I mean a drink of an alcoholic beverage like beer, wine, or liquor.
Yes
No
IF VOLUNTEERED “I DON’T DRINK ALCOHOL”
Refused
Don’t know
During the past 6 months, has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
Yes
No
Refused
Don’t know
During the past 6 months, have you had a feeling of guilt or remorse after drinking?
Yes
No
Refused
Don’t know
During the past 6 months, have you failed to do what was normally expected of you because of drinking?
Yes
No
Refused
Don’t know
During the past 6 months have you lost friends, a spouse, or romantic partner because of drinking?
Yes
No
Refused
Don’t know
Now, I have some questions about illegal drugs (per local laws). By illegal drugs, I mean things like), ecstasy, cocaine, crack, heroin, speed, uppers, downers, etc. You should also include marijuana and opioids (e.g., oxycontin, fentanyl) if you used them in a way that was not prescribed by a doctor.
Remember that the information you provide will be kept private and your name will never be linked to your responses in reports. Some people may find the next few questions too personal. Please remember you can choose not to answer any question.
Thinking about the past 6 months that is since [6 MONTHS PRIOR].
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Yes |
No |
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REMEMBER, THIS IS IN THE PAST 6 MONTHS… |
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Now I’d like you to think back a little further to the last year. That is, since [MONTH ONE YEAR PRIOR].
In the last year, have you ever been physically abused or threatened with violence by a person who you were romantically involved with, such as a spouse, boy/girlfriend, or partner?
Yes
No
Refused
Don’t know
Now I would like to talk to you about your children. I’m going to ask you about [LIST NAMES OF UP TO 3 MINOR FOCAL CHILDREN]. I’m going to start with [FOCAL CHILD 1 NAME]. [IF B.2 = deceased or B5=deceased SKIP TO NEXT CHILD IF MORE THAN ONE FOCAL CHILD].
Is [CHILD] enrolled in school now? [If [CHILD] is home schooled, doing remote learning, or on winter, spring, or summer break please answer Yes.]
Yes
No
Refused
Don’t know
[ASK IF CHILD NOT ENROLLED (F1=2)] When was [CHILD] last enrolled in school?
Enter Date ____/____/______
MM/DD/YYYY
Refused
Don’t know
Never in school
What is the highest grade or year of school that [CHILD] has ever completed?
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Some college, but no degree
Associates degree
Bachelor’s degree
Refused
Don’t know
[ask only if CHILD is age 16 or 17 or F3=12th grade or higher] Does [CHILD] have a GED or high school diploma?
GED
High school diploma
Neither
Refused
Don’t know
Now I have some questions about the schools [CHILD] has attended since you started participating in the study. As a reminder, you became part of the study in [DATE OF STUDY ENROLLMENT],when you were about [AGE AT ENROLLMENT].
Since [DATE OF STUDY ENROLLMENT] when your child was [AGE AT ENROLLMENT]:
F.5a How many different elementary schools [IF ENROLLED: has [CHILD] attended]/[IF NOT CURRENTLY ENROLLED: did [CHILD] attend]]? ___________
F.5b [IF F3=4th GRADE OR HIGHER] How many different middle schools or junior high [[IF ENROLLED: has [CHILD] attended]/[IF NOT CURRENTLY ENROLLED: did [CHILD] attend]?] ___________________
F.5c [ASK IF F3=9th GRADE OR HIGHER] How many different high schools [[IF ENROLLED: has [CHILD] attended]/[IF NOT CURRENTLY ENROLLED: did [CHILD] attend]? _____________
Did [CHILD] ever have to change schools in the middle of a school year?
Yes
No
Refused
Don’t know
Since you began participating in the study, around [DATE OF ENROLLMENT], has [CHILD’S NAME] repeated a grade or been prevented from moving on to the next grade or level in school?
Yes
No
Refused
Don’t know
Now for the next few questions I’d like you to think about the past 12 months. That would be from [MONTH YEAR 12 MONTHS PRIOR TO INTERVIEW] and today.
During the past 12 months, has [CHILD] gone to a special class for gifted students or done advanced work in any subject?
Yes
No
Refused
Don’t know
During the past 12 months, has [CHILD] gone to a special class or gotten special help in school for learning challenges?
Yes
No
Refused
Don’t know
During the past 12 months, has anyone from [CHILD’S] school asked someone to come in and talk about problems [CHILD] was having with behavior?
Yes
No
Refused
Don’t know
During the past 12 months, has [CHILD] been suspended or expelled from school?
Yes
No
Refused
Don’t know
Think about [CHILD’S] report card at the end of the last term. Would you describe the report card as:
Mostly As (90-100)
Mostly Bs (80-89)
Mostly Cs (70-79)
Mostly Ds (69-60)
Mostly Fs (59 and below)
Did not receive traditional letter grades
No letter grade assigned
Other: ____________________________
Refused
Don’t know
How many days in the past month has your child missed school?
Interviewer: if conducting interview during the summer, ask parent to remember the last month of school. If needed, remind parent that there are usually 22 school days in a typical month.
# of days: ________________
Refused
Don’t know
Think about the last completed school year. Was your child absent from in-person or remote school for 15 or more days in the entire school year?
Yes
No
Refused
Don’t know
How much does [CHILD’S NAME] currently like school? Would you say:
Not at all
Not very much
Some
Pretty much
Very much
Refused
Don’t know
Overall, how would you rate [CHILD’s NAME] experiences at school in the past year? Would you say that he/she has had:
Mostly positive experiences
Both positive and negative experiences
Mostly negative experiences
Refused
Don’t know
Now we would like to talk about [CHILD’s NAME]’s health.
Would you say [CHILD’S NAME]’s health in general is excellent, very good, good, fair, or poor?
Excellent
Very good
Good
Fair
Poor
Refused
Don’t know
Do you take [CHILD’S NAME] to a particular doctor’s office, clinic, health center, hospital, or other place if he/she is sick or if you need advice about his/her health?
Yes
No [SKIP TO F.20—Did child receive a physical examination]
Refused [SKIP TO F.20—Did child receive a physical examination]
Don’t know [SKIP TO F.20—Did child receive a physical examination]
[ASK IF THERE IS A REGULAR PLACE CHILD GOES (F19=1)] Can you tell me where you take [CHILD’S NAME] when he/she is sick?
A doctor’s office or health center
Urgent care or clinic in a drug store or grocery store
Hospital emergency room
A VA Medical Center or VA outpatient clinic
Some other place
Does not go to one place most often
Refused
Don’t know
During the past 12 months, did [CHILD’S NAME] receive a physical examination or well-child check-up?
Yes
No
Refused
Don’t know
Now I’d like you to think back to when [CHILD] was born.
Was [CHILD’S NAME] born more than 3 weeks before his or her due date?
Yes
No
Refused
Don’t know
Think back to[CHILD’S NAME] weight at birth. Would you say [CHILD’S NAME] was
Underweight
About right weight
Refused
Don’t know
[If B6 = 3, 4, or 5, 7, 8 (at least one per month, less than once per month, not at all, REF, DK), SKIP to F.24]. For each of the following items I read, please tell me if it is Not True, Sometimes True, or Certainly True for your child. Would you say that your child is…
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Not true |
Sometimes true |
Certainly true |
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As a reminder, you became part of the study in [DATE OF STUDY ENROLLMENT] Please think about that date when answering the next few questions.
[FOR CHILD >= 12 YEARS OLD] Since [DATE OF ENROLLMENT], has [CHILD’S NAME] had any problems that involved the police contacting you (the parent/guardian)?
Yes
No
Refused
Don’t know
[FOR CHILD >= 12 YEARS OLD] Since [DATE OF ENROLLMENT], has [CHILD’S NAME] been arrested?
Yes
No
Refused
Don’t know
[If B6 = 3 4, 5, 7, 8 (at least one per month or less than once per month, not at all, REF, DK), END MODULE]. Now I have some questions about your daily activities with [CHILD]. I will read a list of items. Please tell me if you and your child do each one Almost always; Most days; Sometimes; Rarely; or Almost Never.
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Almost always |
Most days |
Sometimes |
Rarely |
Almost never |
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F26 is asked once, if multiple children in the household repeat F1-F25 for each additional child and then ask F26.
These are some statements about your living situation. For each statement that I read to you, please tell me whether the statement is True or False for you and your household. For some statements you may feel that they are True some of the time but not always. Determine whether the statement is True or False more than half of the time and answer accordingly. [ASK ONLY ONE TIME]
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True |
False |
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Now I would like to talk to you about some of the children we’ve talked about in prior interviews who are now adults—that is they are now age 18 or over. I’m going to ask you about [LIST NAMES OF UP TO 3 ADULT FOCAL CHILDREN]. I’m going to start with [FOCAL CHILD 1 NAME]. [ONLY SKIP SERIES IF CHILD IS DECEASED.]
Has [CHILD] ever been married?
Yes
No
Refused
Don’t know
Does [CHILD] have any biological child(ren) of their own?
Yes
No
Refused
Don’t know
Last month did [CHILD] do any work for pay?
Yes
No SKIP TO G.5: Highest grade attended
Refused SKIP TO G.5: Highest grade attended
Don’t know SKIP TO G.5: Highest grade attended
[ASK IF ADULT CHILD DID WORK LAST MONTH (G3=1)] During the last month, how many hours did [CHILD] usually work each week?
_________________
What is the highest grade or year of school that [CHILD] has ever completed?
Kindergarten to 6th Grade
7th to 12th grade –no diploma
High school graduate/have diploma
High school equivalent (GED) general educational development
Some college
Technical certificate
Associates degree
Bachelor’s degree
Master’s degree, doctorate degree, or other professional degree (for example, MD, DDS, DVM, LLB, JD)
Refused
Don’t know
Does [CHILD] have a GED or high school diploma?
GED
High school diploma
Neither
Refused
Don’t know
Did [CHILD] get a college degree?
Yes
No
Refused
Don’t know
As a reminder, you became part of the study in [DATE OF STUDY ENROLLMENT], when you were [AGE AT TIME OF ENROLLMENT] years old.
Since you began participating in the study, around [DATE OF STUDY ENROLLMENT], how many different schools has [CHILD’S NAME] attended?
How many elementary schools? Number: ____________
How many middle schools? Number: ____________
How many high schools? Number: ____________
How many colleges? Number: ____________
Since you enrolled in the program in [DATE OF STUDY ENROLLMENT] has [CHILD] participated in any school or training programs that lasted at least two weeks that were designed to help him/her find a job, improve his/her job skills or learn a new job?
Yes
No
Refused
Don’t know
Now I’d like to ask some questions about [CHILD]’s housing experiences.
Has your child ever experienced homelessness on their own when you were not with them? By experiencing homelessness, we mean times where you child didn't have a regular place to live, and they were living in an emergency shelter, transitional housing, or in an unsheltered location.
Yes
No
Refused
Don’t know
Has your child ever doubled-up or couch surfed when you were not with them?
Yes
No
Refused
Don’t know
The COVID-19 pandemic brought a lot of changes to many people. We are interested in understanding how you and others in your household may have been affected by COVID-19. We know that this was a difficult time for many people and the questions may trigger painful memories. Please know that you can choose not to answer any question. We can also pause the interview for a moment if you need to take a short break.
We have a list of resources that you can call if you need assistance or just want to talk further about these difficult experiences. I will send those numbers to you with your consent form.
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Yes |
No |
Refused |
Don’t know |
VOL: Not applicable, no children in school or childcare |
H1. Did you or anyone in your household have work hours cut or reduced? |
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H2. Were you, or anyone in your household, asked to work more hours than usual? |
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H3. Were you anyone in your household temporarily laid off or furloughed? |
¨ |
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H4. Did you or anyone else in your household lose your job? |
¨ |
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H5. Did you or anyone in your household reduce or leave work due to child care or other family responsibilities? |
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H6. Did the pandemic prevent you or anyone in your household from being able to find a job? |
¨ |
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H7. Did any child(ren) miss a significant amount of school or childcare because of COVID-19? |
¨ |
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H8. Did you fall behind on rent [or mortgage] payments at any time during the pandemic? |
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H9. [ASK IF THEY FELL BEHIND DURING PANDEMIC (H8 =1)] Is your household currently caught up on rent [or mortgage] payments? |
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H10. Do you have internet access in the place you live now? |
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H11. Did any child(ren) have trouble with learning remotely during the COVID-19 pandemic because of a lack of access to the internet? |
¨ |
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H12. Has anyone in your household (counting all people you lived with) died from COVID-19? |
¨ |
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CONDOLENCE SCRIPT: I am sorry for your loss. Do you need to take a minute before we go on?
When we first met your family a dozen years ago in [DATE OF STUDY ENROLLMENT], you were staying in the [NAME OF SHELTER AT RANDOM ASSIGNMENT], a shelter for families experiencing homelessness. Establishing stable housing after a period of homelessness can be difficult.
Overall, which of the following statements do you think best describes your housing situation over the past 12 years? READ LIST, SELECT ONE ANSWER ONLY
Generally stable throughout
Generally unstable throughout
Was unstable earlier on, but then found more stable housing
Was stable earlier on, but then experienced more instability
Mixed – some periods of stability, some periods of instability
Some other pattern - (Briefly describe)
Could you tell us a bit more? Why would you say you had that experience? [OPEN END]
Now I’d like to confirm your contact information so that we can reach you in the future. This will also help us know where to send your gift card.
What is your first name? _______________________________________
What is your middle name? ________________________________
What is your last name? ___________________________________
Does your name have a suffix? ______________________________
Do you have a mailing address? _______________________________________________
What is your phone number? [Captures phone number for home, cell, work, other]
_____________________________
Do you have another phone number we could use to try to reach you?
Yes
No SKIP to J.9
What is this phone number, starting with the area code? Is this a home, cell, work, or other phone number?
_____________________________
1 HOME PHONE
2 CELL PHONE
3 WORK PHONE
4 OTHER PHONE
Do we have your permission to text you at this number?
YES
NO
Do you have an email address?
Yes
No SKIP to J.9
What is your email address? ________________________________________________________
Now that [NAME] is older, we would like to invite them to participate in the study so we can learn about their experiences as an adult. In order for us to invite them and obtain their consent to participate, we need to be able to reach them. When we contact them within a few weeks, we will explain the study and let them decide whether to participate. We will not use their contact information for any other purpose. Could you please share [CHILD’s] address, phone number, and email? [REPEAT FOR UP TO FIVE ADULT CHILD(REN)]
Name |
Mailing Address |
Telephone Number |
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Refused
Don’t know
[IF PROVIDED CONTACT INFORMATION] We would appreciate if you would let them know your family participated in this study and that we will be trying to contact them in the coming weeks. Please let them know that a researcher from Abt Associates will call them to explain the study and ask them if they want to participate in this important research.
Thank you very much for your time today. To help us be able to get back in touch with you in the future, we would like to review the names, telephone numbers and addresses of two people we talked about last time we spoke who will always know how to reach you. This information will be kept strictly confidential and will only be used if we are unable to contact you.
When we last spoke on [Last Interview MMYYYY] you said that [CONTACT #1] was a person who would always know where you are and how to reach you. Is [CONTACT#1] still a person who does not live with you and will always know how to contact you.
Yes
No SKIP to J.15
IF J.13=yes, confirm [CONTACT #1] information: name, address, phone, cell phone, email, and relationship to respondent. [REPEAT FOR UP TO 3 CONTACTS].
IF J13=NO: Could you please tell me the name of [a/another] person who does not live with you and will always know how to contact you? We will not tell them why we are trying to contact you other than to participate in a research study.? [IF YES, CONFIRM [CONTACT #1] INFORMATION. IF NO, PROCEED TO NEXT CONTACT.]
Thank you very much for your time today. You are an important part of the Family Options Study, and we appreciate you taking the time to talk with us.
We will send you an email with a link to redeem your $50 gift card, as a token of our appreciation for your time. You should receive it within two weeks. If you do not have a valid email address, we can send your gift card by mail.
[PATH 1: IF PHONE INTERVIEW AND (J.10=1)]
We have your email as (DISPLAY EMAIL ADDRESS FROM J.7). Is this correct?
YES, CORRECT [SKIP TO END_1]
NO, NOT CORRECT [SKIP TO H13I13_EMAIL]
VOL: DON’T HAVE INTERNET ACCESS AND NEED A PHYSICAL GIFT CERTIFICATE [SKIP TO PATH 3]
What email address should we use to send you the gift certificate information?
[EMAIL ADDRESS] ____________________________ [SKIP TO END_1]
Thank you so much for your time. The company Virtual Incentives will be sending you an email with instructions on how to collect and redeem your $50 gift certificate. Reward emails come from "[email protected]" and you should receive your email within 14 days.
[PATH 2: IF FIM=IN PERSON]
I am about to give you a letter with the instructions to follow to collect and redeem your $50 virtual reward. The letter has a link to collect your reward.
If you do not have internet access, we can mail you your reward instead. Do you have internet access?
1. R HAS INTERNET ACCESS
2. R DOES NOT HAVE INTERNET ACCESS [SKIP TO PATH 3]
Once you go to the Virtual Incentives site, you will be able to select your preference for your reward. Please follow the instructions in the letter. If you need assistance with your Virtual Reward, please contact [email protected] and reference the longer link at the bottom of the letter.
[PATH 3: IF (FIM=IN PERSON AND I7=2) OR (FIM=PHONE AND (I12=2 OR I13=2))
We will mail you a gift certificate valued at $50. First I’ll need to confirm I have the right address to send this to you. Is <ADDRESS> correct?
CAPI: DISPLAY ADDRESS FROM I1 through I6
CAPI: IF WE COLLECT UPDATE, THIS NEW ADDRESS SHOULD UPDATE THE SAMPLE
YES, CORRECT [SKIP TO H13c]
NO, NOT CORRECT
What address should we use to mail you the gift certificate?
What is your street address or PO box number? [PRE-FILL FROM FILE]
Is there a complex or building name? [PRE-FILL IFROM FILE]
Is there an apartment number? [PRE-FILL FROM FILE]
In what city? [PRE-FILL FROM FILE]
In what state? [PRE-FILL FROM FILE]
What is the zip code? [PRE-FILL FROM FILE]
Thank you so much for your time. We will process your preference for the gift certificate and you should receive it in the mail within 30 days.
[RESOURCES BELOW TO BE MAILED TO PARTICIPANT]
We know that some of the questions may have reminded you of unpleasant experiences in your life. We are providing all participants with a list of resources that you can call or contact online. Some of these resources can help with things like applying for different types of assistance. Other included organizations many people find helpful if they are upset after remembering a traumatic experience. Others may be helpful in case answering any of these questions made you uncomfortable or upset. We encourage you to contact one of the resources below as needed, especially to discuss any of these experiences if you are upset.
Thank you for your participation in the Family Options Study. We have enclosed a copy of the consent form for your reference, as well as a copy for you to sign and return to us in the enclosed envelope. We also included a copy of the Information Release Form for your reference.
Community Resources
Type of Organization(s) |
Name of Organization(s) and Contact Information |
General resource with specialists who can provide assistance in accessing local resources to address a variety of needs including food, housing, and utility assistance, as well as legal and employment services. Requests can be made anonymously. |
United Way 211 Call 211 |
Income Assistance/Temporary Assistance for Needy Families (TANF)/Welfare |
Office of Family Assitance Help for Families | The Administration for Children and Families (hhs.gov) |
Energy assistance |
Low Income Home Energy Assistance Program (LIHEAP) Call: 1-866-674-6327 Email: [email protected] |
General food assistance/food stamps |
Food and Nutrition Service SNAP State Directory of Resources | Food and Nutrition Service (usda.gov) |
Free and reduced meals for students |
Food and Nutrition Service, National School Lunch Program |
Food banks, emergency food |
Feeding America |
Public health insurance (Medicaid) for adults |
Medicaid |
Public health insurance (Medicaid and SCHIP) for children |
Children’s Health Insurance Program (CHIP) Find Coverage for Your Family | InsureKidsNow.gov To apply: 1-800-318-2596 |
Mental health assistance for adults |
National Alliance on Mental Illness Call: 1-800-950-6264 (NAMI) Text: 62640 Email: [email protected] Find Your Local NAMI | NAMI: National Alliance on Mental Illness |
Job training and job placement assistance |
Department of Labor |
Help with budgeting |
Financial Literacy and Education Commission MyMoney.gov, My Money Tools Consumer Resources | Consumer Financial Protection Bureau (consumerfinance.gov) |
Information about savings or checking accounts (including programs for the unbanked, individual development accounts, etc.) |
Consumer Financial Protection Bureau cfpb_checklist_opening_bank_account_web.pdf (consumerfinance.gov) |
National toll-free hotlines
Crisis Counseling related to natural or human-caused disaster, including the COVID-19 pandemic |
SAMSHA National Distress Hotline
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1-800-985-5990 |
Trained Crisis Counseling for people experiencing mental health-related distress |
National Suicide and Crisis Hotline |
988 |
Suicide prevention
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National Suicide Prevention Hotline
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1-800-SUICIDE (1-800-784-2433) |
Domestic violence |
National Domestic Violence Hotline |
1-800-799-SAFE (7233) |
Abuse and sexual assault
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Rape Abuse & Incest Network National Hotline
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1-800-656-HOPE (4673) |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Abt Single-Sided Body Template |
| Author | Katheleen Linton |
| File Modified | 0000-00-00 |
| File Created | 2023-09-03 |