Form SIPP_Attachment_A_ SIPP_Attachment_A_Instrument_Booklet_2023

CTRLNUM
**NON-DISPLAYED ITEM**

START
CENSUS CATI/CAPI SYSTEM

^VERDATE
^VERSION
SIPP

SURVEY OF INCOME AND PROGRAM PARTICIPATION

PSU: ^I_PSU
DATE IS: ^DATE
TIME IS: ^TIME

OMB Control Number: 0607-1000
Expiration Date: December 31, 2023

CASE STATUS IS: ^CSTATUS
INTERVIEW MODE: ^I_NXTINTFLG
APPOINTMENT: ^CALLBACK
ADDRESS:
HNO HNOSUF STRNAME
UNITDES
GQUNITINFO
NONCITYADD
PHYSDES
PO, ST ZIP5-ZIP4
BLDGNAME
1. Proceed - Personal interview
2. Proceed - Telephone interview
3. Set appointment for visit or call back
4. Quit - Do not attempt now
5. Ready to transmit, no more follow-up needed

FIX206
The current outcome code for this case is a 206 - At least one household member's interview is a
sufficient partial.
If you have incomplete person-level interviews in this case, you will be asked to Type Z these people
on the following screens, after completing contact information.

Page 1 of 537

If you proceed, this 206 will be changed to a 207, and the case will be transmitted to your RO in your
next transmission. If you do NOT wish to wrap up this case, back up now using your Left or Up arrow
key. If you need to make this case a noninterview (Type A, B, or C), you must first proceed to wrap this
case up as a partial and then restart the case BEFORE transmitting.
1. Closeout the case with an outcome code of 207

INTRO_D
^NAMEFIL_INTROD
Some of the questions have already been answered. Let me see where we should begin.
Enter 1 to continue, ask the CARI consent question.
Then press END to go to the first unanswered question.
1. Enter 1 to continue

INTRO
Hello. I'm ... from the United States Census Bureau. Here is my identification card.
Show ID card.
We are conducting a survey on the economic situation of people who live in the United States. I
have some questions to ask you.
^INCENTIVE_FIL
Did you receive our letter?
If the respondent did not receive an advance letter, give or read the letter to the respondent before
proceeding.
1. Proceed
2. Inconvenient time - try again later
3. Reluctant respondent - hold for refusal follow-up
4. Noninterview or ENTIRE household moved
5. Contacted incorrect household - END INTERVIEW

CARICON1
? [F1]

Page 2 of 537

This interview may be recorded for quality control purposes. Is that okay?
1. Yes
2. No

NONINTERVIEW
^NONINTFILL
1. Type A noninterview
2. Type B noninterview
3. Type C noninterview or ENTIRE household moved
4. Type D noninterview

TYPE_A
Enter Type A noninterview code.
1. No one home
2. Temporarily absent
3. Refused
4. Language problem
5. Unable to locate
6. Other Type A

TYPEA__SP
Specify the kind of 'other' Type A noninterview.

TYPE_B
Enter Type B noninterview code.
1. Vacant regular (REG)
2. Vacant - storage of household furniture
3. Unfit or to be demolished
4. Under construction, not ready
5. Converted to temporary business or storage
6. Unoccupied tent or trailer site
7. Permit granted, construction not started
8. Temporarily occupied by persons with URE
Page 3 of 537

9. Occupied by persons under 15 years of age
10. ENTIRE household institutionalized
11. ENTIRE household on active duty in the Armed Forces
12. Other Type B

TYPEB__SP
Specify the kind of 'other' Type B noninterview.

TYPE_C
Enter code for Type C noninterview or ENTIRE household moved.
1. Demolished
2. House or trailer moved
4. Converted to permanent business or storage
5. Merged
6. Condemned
7. Unused Serial number/Listing sheet line
8. Removed during subsampling
10. ENTIRE household deceased
11. ENTIRE household moved out of the country
13. ENTIRE household moved together to known address OUTSIDE of FR's area
14. ENTIRE household moved together to known address WITHIN FR's area
15. ENTIRE household moved together to unknown address
16. ENTIRE household merged with another SIPP household
17. ENTIRE household moved and split into several new SIPP households

18. ENTIRE household moved - further work needed to obtain address (NOTE: the parent case will remain on your l
19. Other Type C
20. Spawned in error
21. Unlocatable sample address
22. Unit does not exist or unit is out of scope

TYPEC__SP
Specify the kind of 'other' Type C noninterview.

SPAWN_SP
Enter the reason why the household was spawned in error.
Page 4 of 537

TYPE_D
Enter Type D noninterview code.
1. ENTIRE household moved, address unknown
2. ENTIRE household moved within the U.S.; RO determined case is outside SIPP limits

NI_RACE
Enter your best guess as to the Race of the reference person.
Mark all that apply.
1. White
2. Black/African American
3. American Indian or Alaska Native
4. Asian
5. Native Hawaiian or Other Pacific Islander
6. Other

NI_SEX
Enter your best guess as to the sex of the reference person.
^ENTERFIL
1. Male
2. Female

NI_SIZE
Ask or verify with some knowledgeable individual.
Enter your best guess as to the total number of people in the household. Count all children and
adults.
^ENTERFIL

NI_TENURE
Ask or verify with a knowledgeable individual, or enter your best guess.
Are the living quarters...
Page 5 of 537

Read answer categories.
1. Owned or being bought by someone in the household?
2. Rented?
3. Occupied without payment of rent?

TYPEA_DISCUSS
You must discuss this case with your supervisor before transmitting it as a ^TYPEAD noninterview.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

DIAL
Dial this number: (^I_AREA) ^I_PREFIX-^I_SUFFIX ^I_EXTN
Secondary number: (^SAREA) ^SPREFIX-^SSUFFIX ^SEXTN
Introduce yourself to the household respondent
^HHRESP_FIL
STREET ADDRESS: ^I_HNO ^I_HNOSUF ^I_STRNAME
1. Someone answers - BEGIN INTERVIEW
2. Someone answers - SET APPOINTMENT
3. No contact - answering machine/busy/no answer
4. New telephone number or telephone disconnected
5. Not attempted now

HHAPPT_DATE
I'd like to schedule a time to complete the interview.
What DATE would be best to conduct the interview?
Enter date (MM/DD/YYYY)

Page 6 of 537

HHAPPT_TIME
(What TIME would be best to conduct the interview?)
Enter the time (hours, minutes, and am or pm).

CTRLNUM
**NON-DISPLAYED ITEM**

DASSIST_AREA
Call Directory Assistance in your area, if necessary, to obtain the correct telephone number for this
household.
CURRENT TELEPHONE NUMBER: (^I_AREA) ^I_PREFIX - ^I_SUFFIX ^I_EXTN
What is the new telephone number for the ^REFPER_DASSIST household?
Enter new area code.
Enter 000 if the household does not have a telephone.
Display the household address as follows:
^I_HNO ^I_HNOSUF ^I_STRNAME
^I_UNITDES
^I_GQUNITINFO
^I_NONCITYADD
^I_PHYSDES
^I_PO, ^I_ST ^I_ZIP5-^I_ZIP4
^I_BLDGNAME

DASSIST_PREFIX
Call Directory Assistance in your area, if necessary, to obtain the correct telephone number for this
household.
CURRENT TELEPHONE NUMBER: (^I_AREA) ^I_PREFIX - ^I_SUFFIX ^I_EXTN
(What is the new telephone number for the ^REFPER_DASSIST household?
Enter new prefix.
Display the household address as follows:
^I_HNO ^I_HNOSUF ^I_STRNAME
^I_UNITDES
^I_GQUNITINFO
Page 7 of 537

^I_NONCITYADD
^I_PHYSDES
^I_PO, ^I_ST ^I_ZIP5-^I_ZIP4
^I_BLDGNAME

DASSIST_SUFFIX
Call Directory Assistance in your area, if necessary, to obtain the correct telephone number for this
household.
CURRENT TELEPHONE NUMBER: (^I_AREA) ^I_PREFIX - ^I_SUFFIX ^I_EXTN
(What is the new telephone number for the ^REFPER_DASSIST household?
Enter new suffix.
Display the household address as follows:
^I_HNO ^I_HNOSUF ^I_STRNAME
^I_UNITDES
^I_GQUNITINFO
^I_NONCITYADD
^I_PHYSDES
^I_PO, ^I_ST ^I_ZIP5-^I_ZIP4
^I_BLDGNAME

DASSIST_EXTN
Call Directory Assistance in your area, if necessary, to obtain the correct telephone number for this
household.
CURRENT TELEPHONE NUMBER: ^I_AREA ^I_PREFIX - ^I_SUFFIX ^I_EXTN
(What is the new telephone number for the ^REFPER_DASSIST household?
Enter new extension (if applicable).
Display the household address as follows:
^I_HNO ^I_HNOSUF ^I_STRNAME
^I_UNITDES
^I_GQUNITINFO
^I_NONCITYADD
^I_PHYSDES
^I_PO, ^I_ST ^I_ZIP5-^I_ZIP4
^I_BLDGNAME

Page 8 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

YR_BUILT
TTABX
TEXTRA
TABX_INTRO
TABX_FR
OTHLIVQTR
BEGINT
We will begin the interview with questions about who lives here, their ages, how they're related to
each other, and other information. Then I will ask you questions about your jobs and other
sources of income. After that, I'll have similar questions about the other people who live here.
^BEGINT_FIL
Enter 1 to continue.
1. Enter 1 to continue

VERIFY_ADDRESS
? [F1]
I have your address listed as:
ADDRESS:
^I_HNO ^I_HNOSUF ^I_STRNAME
^I_UNITDES
^I_GQUNITINFO
^I_NONCITYADD
^I_PHYSDES
^I_PO, ^I_ST ^I_ZIP5-^I_ZIP4
^I_BLDGNAME
(Is this your exact address, or correct with only minor changes?)
Do not use the address change screen to indicate that an entire household has moved.
1. YES, address is EXACTLY CORRECT as listed
2. Address is MOSTLY CORRECT, but needs some minor changes
3. INCORRECT ADDRESS - terminate interview, find correct address
Page 9 of 537

NEW_HNO
? [F1]
Enter the correct House Number or press ENTER for Same.

NEW_HNOSUF
? [F1]
Enter the correct House Number Suffix or press ENTER for Same.

NEW_STRNAME
? [F1]
Enter the correct Street Name or press ENTER for Same.

NEW_UNITDES
? [F1]
Enter the correct Apartment or Unit Number or press ENTER for Same.

NEW_GQUNITINFO
? [F1]
Enter the correct GQ Unit Information or press ENTER for Same.

NEW_NONCITYADD
? [F1]
Enter the correct Non-City Style Address or press ENTER for Same.
Enter a P.O. Box here.

NEW_PHYSDES
? [F1]
Enter the correct Physical Description or press ENTER for Same.

NEW_PO
Page 10 of 537

? [F1]
Enter the correct Locality or press ENTER for Same.

NEW_ST
? [F1]
Enter the correct State Abbreviation or press ENTER for Same.
AL. Alabama
AK. Alaska
AZ. Arizona
AR. Arkansas
CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
NE. Nebraska
NV. Nevada
NH. New Hampshire
NJ. New Jersey
Page 11 of 537

NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
SD. South Dakota
TN. Tennessee
TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming

NEW_ZIP5
? [F1]
Enter the correct Zip Code or press ENTER for Same.

NEW_ZIP4
? [F1]
Enter the correct 4-Digit Zip Code or press ENTER for Same.

NEW_ZIP
**NON-DISPLAYED ITEM**

NEW_BLDGNAME
? [F1]
Enter the correct Building Name or press ENTER for Same.
Page 12 of 537

VERIFY_MAILADDR
? [F1]
Is this also your mailing address?
1. Yes
2. No

NEW_MHNO
? [F1]
Enter the correct House Number for the mailing address or press ENTER for Same.

NEW_MHNOSUF
? [F1]
Enter the correct House Number Suffix for the mailing address or press ENTER for Same.

NEW_MSTRNAME
? [F1]
Enter the correct Street Name for the mailing address or press ENTER for Same.

NEW_MUNITDES
? [F1]
Enter the correct Apartment or Unit Number of the mailing address or press ENTER for Same.

NEW_MGQUNITINFO
? [F1]
Enter the correct GQ Unit Information of the mailing address or press ENTER for Same.

NEW_MNONCITYADD
? [F1]
Enter the correct Non-City Style Mailing Address or press ENTER for Same.

Page 13 of 537

Enter a P.O. Box here.

NEW_MPO
? [F1]
Enter the correct Locality of the mailing address or press ENTER for Same.

NEW_MST
? [F1]
Enter the correct State Abbreviation of the mailing address or press ENTER for Same.
AL. Alabama
AK. Alaska
AZ. Arizona
AR. Arkansas
CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
Page 14 of 537

NE. Nebraska
NV. Nevada
NH. New Hampshire
NJ. New Jersey
NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
SD. South Dakota
TN. Tennessee
TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming

NEW_MZIP5
? [F1]
Enter the correct Zip Code of the mailing address or press ENTER for Same.

NEW_MZIP4
? [F1]
Enter the correct 4-Digit Zip Code of the mailing address or press ENTER for Same.

NEW_MZIP
**NON-DISPLAYED ITEM**

Page 15 of 537

ACCESS
? [F1]
Ask if not apparent.
Do you have direct access to your home, either from the outside or through a common hall?
1. Yes
2. No

MERGE
This household must be merged with the household through which access is gained.
Refer to your Interviewer's manual to determine if the merged household is in or out of the SIPP
sample.
1. Merged - in SIPP sample
2. Merged - NOT in SIPP sample

LIVQTR
Enter type of living quarters.
1. House, apartment, flat
2. Unit in rooming house, hotel, motel, etc.
3. Mobile home or trailer
4. Other housing unit
5. Student quarters
6. Other group quarters unit
7. Tent or trailer site

NUMBER_UNITS
Ask if not apparent.
How many housing units, both occupied and vacant, are there in this structure?
1. One, detached
2. One, attached
3. Two
4. 3 - 4
5. 5 - 9
Page 16 of 537

6. 10 - 19
7. 20 - 49
8. 50 or more

TENURE
Are your living quarters...
Read answer categories.
1. Owned or being bought by someone in the household?
2. Rented?
3. Occupied without payment of rent?

RENTSUB
^RENTSUBQTEXT
Include respondents who live in a building owned by a Public Housing Authority (i.e., the housing
authority is the respondent's landlord) as receiving a rent subsidy.
1. Yes
2. No

VOUCHER
Does anyone in this household receive a housing voucher?
A housing voucher gives a renter the right to choose where to live AND it helps pay the rent.
1. Yes
2. No

AMOUNTSPELL
**NON-DISPLAYED ITEM**

ASTCODE
**NON-DISPLAYED ITEM**
Page 17 of 537

ASTCODE2
**NON-DISPLAYED**

ASTCODE_RET
**NON-DISPLAYED ITEM**

BUSINESS_CODE
**NON-DISPLAYED ITEM**

CARICONFLAG
***NON-DISPLAYED ITEM****
1. Yes
2. No

CARNO
**NON-DISPLAYED ITEM**

CHILD_LNO
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

DAD_IN_HOUSE
*** NON-DISPLAYED ITEM ***

DISABLECODE
**NON-DISPLAYED ITEM**

ED_RETURNING
**NON-DISPLAYED ITEM**

FS_RETURNING
Page 18 of 537

**NON-DISPLAYED ITEM**

GA_RETURNING
**NON-DISPLAYED ITEM**

INVBUSINESS_CODE
**NON-DISPLAYED ITEM**

LNGD_MEALS
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

LNPAR1
**NON-DISPLAYED ITEM**

LNPAR2
**NON-DISPLAYED ITEM**

LNOPRX
**NON-DISPLAYED ITEM**

LNSP
**NON-DISPLAYED ITEM**

MARITAL_RETURNING
**NON-DISPLAYED ITEM**

MHLOAN_CODE
**NON-DISPLAYED ITEM**

MOM_IN_HOUSE
Page 19 of 537

*** NON-DISPLAYED ITEM ***

MONTHCODE
**NON-DISPLAY ITEM**

MOVER_LNO
**NON-DISPLAY ITEM**

PLPCNTLT5T2
**NON-DISPLAYED ITEM**

PLINTDATE
**NON-DISPLAYED ITEM**

PROPLOAN_CODE
**NON-DISPLAYED ITEM**

PSTATUS
**NON-DISPLAYED ITEM**

RES_RETURNING
**NON-DISPLAYED ITEM**

RETIRECODE
**NON-DISPLAYED ITEM**

SLFPRX
**NON-DISPLAYED ITEM**

SSI_RETURNING
**NON-DISPLAYED ITEM**

SSCHLDFLAG
Page 20 of 537

**NON-DISPLAYED ITEM**

SUPPORTPMTCODE
**NON-DISPLAYED ITEM**

SURVRCODE
**NON-DISPLAYED ITEM**

TANF_RETURNING
**NON-DISPLAYED ITEM**

TYPE_RECVEH_NUM
**NON-DISPLAYED ITEM**

UEMP_COMP_CODE
**NON-DISPLAYED ITEM**

URE_NUM
**NON-DISPLAYED ITEM**

VABENEFITCODE
**NON-DISPLAYED ITEM**

WIC_RETURNING
**NON-DISPLAYED ITEM**

NBIOKIDHHROS
**NON-DISPLAYED ITEM**

NUMCLD27
**NON-DISPLAYED ITEM**

NUMCLD314
Page 21 of 537

**NON-DISPLAYED ITEM**

NUMCLD014
**NON-DISPLAYED ITEM**

NUMCLD617
**NON-DISPLAYED ITEM**

NUMCLD05
**NON-DISPLAYED ITEM**

NALLKIDALLROS
NUM_BIOKIDS
*** NON-DISPLAYED ITEM ***

CHILDLIST05
CHILDLIST617
BIOCHILDLIST
PAR_BIOCHILDLIST
NCLD27_HH
**NON-DISPLAYED ITEM**

NCLD314_HH
**NON-DISPLAYED ITEM**

NCLD014_HH
**NON-DISPLAYED ITEM**

NCLD617_HH
**NON-DISPLAYED ITEM**

NCLD05_HH
**NON-DISPLAYED ITEM**
Page 22 of 537

NCLD017_HH
**NON-DISPLAYED ITEM**

CHILDLIST0
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

ORIG_NROSIZE
BHHLD_MBR_LEAVE
**NON-DISPLAYED ITEM**

ROSTER_CHANGE
*** NON-DISPLAYED ITEM ***
1. Yes
2. No

PREROST
^QSTNTXT_PREROST
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PNUM
**NON-DISPLAYED ITEM**

PERMOVED
Page 23 of 537

PERDECEASED
PERSTAT
^PERSTATFILL
1. Deceased
2. Institutionalized or in other group quarters (e.g., nursing home, hospital, correctional facility)
3. On active duty in the Armed Forces
4. Moved outside of U.S.
5. Marital-status reasons (e.g., marriage, civil union, partnership, cohabitation, separation or divorce)
6. Job-related reasons
7. Attending college or boarding school, or other educational reason
8. Other family changes (e.g., change in custody, child moves out on his own)
9. Listed in error in prior wave
10. Other
11. Reinstate person

CM_PERSTAT
**NON-DISPLAYED ITEM**
1. Active Household Member
3. Inactive, but may come back
4. Deceased

ROST_FNAME
^QSTNTXT_ROSTER
Enter first name.
Confirm the spelling of the person's first name. This information will be important for tracking movers in
future waves.
Enter 999 if no more people or no new people.
^MAX20

ROST_MNAME
^QSTNTXT_ROSTER
Enter middle name.
Page 24 of 537

ROST_LNAME
^QSTNTXT_ROSTER
Enter last name.
Confirm the spelling of the person's last name. This information will be important for tracking movers in
future waves.

ROST_ONAME
^QSTNTXT_ROSTER
Enter other or maiden name.

HHRESP2
HHRESP2TEXT
1. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
2. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
3. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
4. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
5. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
6. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
7. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
8. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
9. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
10. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
11. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
12. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
13. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
14. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
15. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
16. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
17. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
18. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
19. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15
20. Display the LNO, ^FNAME, and ^LNAME where HHSTAT = (1, 3) AND AGE(LNO) >= 15

USUAL
? [F1]
Page 25 of 537

^QSTNTXT_USUAL
1. Yes
2. No

NOTHERE
NOTHERE_FILL
1. LNO ROST_FNAME ROST_LNAME
2. LNO ROST_FNAME ROST_LNAME
3. LNO ROST_FNAME ROST_LNAME
4. LNO ROST_FNAME ROST_LNAME
5. LNO ROST_FNAME ROST_LNAME
6. LNO ROST_FNAME ROST_LNAME
7. LNO ROST_FNAME ROST_LNAME
8. LNO ROST_FNAME ROST_LNAME
9. LNO ROST_FNAME ROST_LNAME
10. LNO ROST_FNAME ROST_LNAME
11. LNO ROST_FNAME ROST_LNAME
12. LNO ROST_FNAME ROST_LNAME
13. LNO ROST_FNAME ROST_LNAME
14. LNO ROST_FNAME ROST_LNAME
15. LNO ROST_FNAME ROST_LNAME
16. LNO ROST_FNAME ROST_LNAME
17. LNO ROST_FNAME ROST_LNAME
18. LNO ROST_FNAME ROST_LNAME
19. LNO ROST_FNAME ROST_LNAME
20. LNO ROST_FNAME ROST_LNAME

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

URE_NUM
Page 26 of 537

**NON-DISPLAYED ITEM**

NITESTAY
During a typical week over the last month or so, how many nights did ^NAME_NOTHERE stay
here overnight, or was there no usual pattern?
11. Three or fewer
12. Four or more
13. No usual pattern
14. Other

NITESTAY_SP
What 'other' living arrangement?

ASKURE
Is there another place where ^NAME_NOTHERE ^LIVES_ASKURE and ^SLEEPS_ASKURE most
of the time?
1. Yes
2. No

AWAYSCH
Ask if necessary:
AREIS ^NAME_NOTHERE...
... a student away attending school,
... non-married,
... whose permanent residence is here?
1. Yes to all 3
2. No

AWAYTRV
Ask if necessary:
^DODOES ^NAME_NOTHERE usually live here but AREIS away traveling for work, or on vacation,
or in the hospital?

Page 27 of 537

1. Yes
2. No

MISSED_PER
? [F1]
MISSEDPER_TEXT
1. Yes
2. No

ANYMOREPEOPLE
We've listed 20 people living in this household, which is the maximum number that can be
collected on the household roster. How many additional people (not counting the 20 already listed
on the household roster) live here?

USUAL1
Is this the address where

Read name(s) lives and sleeps most of the time?

Display the names of the people added to the household roster via MISSED_PER.
1. Yes
2. No

NOTHEREONE
Ask or verify.
Who doesn't live or sleep here most of the time? Anyone else?
Mark all that apply.
1. LNO ROST_FNAME ROST_LNAME
2. LNO ROST_FNAME ROST_LNAME
3. LNO ROST_FNAME ROST_LNAME
4. LNO ROST_FNAME ROST_LNAME
5. LNO ROST_FNAME ROST_LNAME
6. LNO ROST_FNAME ROST_LNAME
7. LNO ROST_FNAME ROST_LNAME
Page 28 of 537

8. LNO ROST_FNAME ROST_LNAME
9. LNO ROST_FNAME ROST_LNAME
10. LNO ROST_FNAME ROST_LNAME
11. LNO ROST_FNAME ROST_LNAME
12. LNO ROST_FNAME ROST_LNAME
13. LNO ROST_FNAME ROST_LNAME
14. LNO ROST_FNAME ROST_LNAME
15. LNO ROST_FNAME ROST_LNAME
16. LNO ROST_FNAME ROST_LNAME
17. LNO ROST_FNAME ROST_LNAME
18. LNO ROST_FNAME ROST_LNAME
19. LNO ROST_FNAME ROST_LNAME
20. LNO ROST_FNAME ROST_LNAME

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

URE_NUM
**NON-DISPLAYED ITEM**

CHECKPT
According to the rules of this survey,

Read name(s) will be included in this interview.

Display the ROST_FNAME, and ROST_LNAME of all non-deleted people on the final
household roster.
If everyone on the household is deleted or the list of people is otherwise empty, display: There are no
persons remaining to interview. To wrap up this case as a Type B, type 1 and press Enter.
1. Enter 1 to continue

NOHHRESP
Since you do not stay or live here most of the time, who is available to answer the remaining
Page 29 of 537

questions?
Read name(s).
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

OTHRRP
All people listed have another residence where they usually live. They will not be included in this
interview. Take one of the following actions:
Enter 0 if the residence information is incorrect.
Enter a 1 if no other adult maintains this address as his or her usual place of residence. This designates
this address as a Type B noninterview.
0. The information about usual residence is incorrect
1. No other adult maintains this address as his/her usual residence

CTRLNUM
**NON-DISPLAYED ITEM**

Page 30 of 537

LNO
**NON-DISPLAYED ITEM**

LEAVE_MO
^INTROLEAVE_FIL When did ^FNAME ^LNAME ^WHYLEFTFIL?
Enter the month.
0. Before ^MONTH1 ^CALENDAR_YRFIL
1. ^MONTH1 ^CALENDAR_YRFIL
2. ^MONTH2 ^CALENDAR_YRFIL
3. ^MONTH3 ^CALENDAR_YRFIL
4. ^MONTH4 ^CALENDAR_YRFIL
5. ^MONTH5 ^CALENDAR_YRFIL
6. ^MONTH6 ^CALENDAR_YRFIL
7. ^MONTH7 ^CALENDAR_YRFIL
8. ^MONTH8 ^CALENDAR_YRFIL
9. ^MONTH9 ^CALENDAR_YRFIL
10. ^MONTH10 ^CALENDAR_YRFIL
11. ^MONTH11 ^CALENDAR_YRFIL
12. ^MONTH12 ^CALENDAR_YRFIL
13. ^MONTH13 ^INTYEARFIL
14. ^MONTH14 ^INTYEARFIL
15. ^MONTH15^INTYEARFIL
16. ^MONTH16 ^INTYEARFIL
17. ^MONTH17 ^INTYEARFIL
18. ^MONTH18 ^INTYEARFIL

LNO
**NON-DISPLAYED ITEM**

OTHRRP_WHO
Whose information is incorrect?
1. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
2. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
3. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
4. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
Page 31 of 537

5. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
6. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
7. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
8. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
9. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
10. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
11. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
12. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
13. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
14. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
15. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
16. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
17. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
18. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
19. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
20. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
21. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
22. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
23. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
24. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1
25. LNO ROST_FNAME, ROST_LNAME where UREFLAG = 1

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

OTHRRP_FIX
What information about ^HISHER residence needs to be corrected...
Read answer categories.
Mark all that apply.
1. Is this the place where ^TEMPNAME ^LIVESLEEPFIL most of the time?
2. How many night ^DODOES ^TEMPNAME stay here overnight?
Page 32 of 537

3. Is there another place where ^TEMPNAME ^LIVESLEEPFIL most of the time?
4. ^C_AREIS ^TEMPNAME a non-married student away attending school whose permanent residence is here?
5. C_DODOES ^TEMPNAME usually live here but is away traveling for work , or on vacation, or in a hospital?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ENTER_MO
^INTROLEAVE_FIL When did ^YOUHEORSHE start living here?
Enter the month.
0. Before ^MONTH1 ^CALENDAR_YRFIL
1. ^MONTH1 ^CALENDAR_YRFIL
2. ^MONTH2 ^CALENDAR_YRFIL
3. ^MONTH3 ^CALENDAR_YRFIL
4. ^MONTH4 ^CALENDAR_YRFIL
5. ^MONTH5 ^CALENDAR_YRFIL
6. ^MONTH6 ^CALENDAR_YRFIL
7. ^MONTH7 ^CALENDAR_YRFIL
8. ^MONTH8 ^CALENDAR_YRFIL
9. ^MONTH9 ^CALENDAR_YRFIL
10. ^MONTH10 ^CALENDAR_YRFIL
11. ^MONTH11 ^CALENDAR_YRFIL
12. ^MONTH12 ^CALENDAR_YRFIL
13. ^MONTH13 ^INTYEARFIL
14. ^MONTH14 ^INTYEARFIL
15. ^MONTH15^INTYEARFIL
16. ^MONTH16 ^INTYEARFIL
17. ^MONTH17 ^INTYEARFIL
18. ^MONTH18 ^INTYEARFIL

ENTER_REASON
Page 33 of 537

^QSTNTXT_REASONENT
Mark all that apply.
1. Birth
2. Marital-status reasons (e.g., marriage, civil union, partnership, cohabitation, separation, or divorce)
3. Returned to household after missing one or more waves
4. Other family changes (e.g., change in custody, adoption, or parent/child joins the household)
5. From an institution or other group quarters (e.g., nursing home, hospital, correctional facility)
6. From Armed Forces barracks
7. From outside the U.S.
8. Should have been listed as a member in Wave 1
9. Job-related reasons
10. Lived at this address before sample person(s) entered
11. Other

MAIN_REASON
What was the main reason ^FNAME ^LNAME ^JOINFIL the household?
1. Fill with 1st. reason selected in TRSNENT
2. Fill with 2nd. reason selected in TRSNENT
3. Fill with 3rd. reason selected in TRSNENT
4. Fill with 4th. reason selected in TRSNENT
5. Fill with 5th. reason selected in TRSNENT
6. Fill with 6th. reason selected in TRSNENT
7. Fill with 7th. reason selected in TRSNENT
8. Fill with 8th. reason selected in TRSNENT
9. Fill with 9th. reason selected in TRSNENT
10. Fill with 10th. reason selected in TRSNENT
11. Fill with 11th. reason selected in TRSNENT

RSNENT_SP
What is the 'other' reason ^FNAME ^LNAME joined this household?

CTRLNUM
**NON-DISPLAYED ITEM**

Page 34 of 537

LNO
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SEX
^C_AREISWAS ^TEMPNAME male or female?
Response selected should be based on the respondent's answer to the question and not based on
observation.

1. Male
2. Female

REFPER2
Who ^OWNRENTFIL this home - that is, what names are on the ^DEEDLEASEFIL?
If the respondent can't identify an owner or renter, enter the line number of the head of household.
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
Page 35 of 537

12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

RELRP
**NON-DISPLAYED ITEM**
1. Spouse (Husband/Wife)
2. Unmarried Partner
3. Child (Biological, Step, Adopted)
4. Grandchild
5. Parent (Mother/Father)
6. Brother/Sister
7. Other Relative (Uncle, cousin, mother-in-law, father-in-law, etc.)
8. Foster Child
9. Housemate/Roommate
10. Roomer/Boarder
11. Other non-relative
12. Current or Former Spouse (Husband/Wife)
13. Current or Former Unmarried Partner

RELRPEXP
A, ? [F1]

Page 36 of 537

Ask or verify
^QSTNTXT_RELRP
1. Opposite sex husband/wife/spouse
2. Opposite sex unmarried partner
3. Same sex husband/wife/spouse
4. Same sex unmarried partner
5. Child
6. Grandchild
7. Parent
8. Sibling
9. Parent/Child In-law (mother/father, son/daughter in-law)
10. Brother/Sister in-law
11. Aunt/Uncle, Niece/Nephew
12. Other relative
13. Foster child
14. Housemate/Roommate
15. Roomer/Boarder
16. Other non-relative

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

DOB_BMONTH
^ASKORVERIFY
What ^ISWAS ^PTEMPNAME date of birth?
Enter month.
1. January
2. February
Page 37 of 537

3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

DOB_BDAY
^ASKORVERIFY
(What ^ISWAS ^PTEMPNAME date of birth?)
Enter day.

DOB_BYEAR
^ASKORVERIFY
(What ^ISWAS ^PTEMPNAME date of birth?)
Enter year.

WHICH_AGE
^C_AREIS ^TEMPNAME now?
Read answer categories.

1. ^AGEX or
2. ^AGEX+1 years old?
3. Neither is correct DO NOT READ

Page 38 of 537

AGEGES
? [F1]
How old would you say ^TEMPNAME ^AREISWAS?
Enter best estimate of age.

FRGES
Enter your best estimate of ^NAMEFIL age.

PWAVE_AGE
PWAVE_EXISTS
UNDERAGE
Both the household reference person and the household respondent must be 15 years of age or older.
You reported that the ^WHICHPERSONFIL is under 15. Since no one in the household is 15 years of
age or older, the household is a Type B Noninterview.
Enter 1 to continue.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ORIGIN
B
^ASKORVERIFY
^C_AREISWAS ^TEMPNAME of Hispanic, Latino, or Spanish origin? (Such as Mexican, Mexican
American, Chicano, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, or some other Hispanic,
Latino, or Spanish origin.)

1. Yes
Page 39 of 537

2. No

HISPAN
B
^ASKORVERIFY
^C_AREISWAS ^TEMPNAME Mexican, Mexican American, Chicano, Puerto Rican, Cuban,
Salvadoran, Dominican, Colombian, or some other Hispanic, Latino, or Spanish origin?
Mark all that apply.
1. Mexican, Mexican American, Chicano
2. Puerto Rican
3. Cuban
4. Salvadoran
5. Dominican
6. Colombian
7. Other Hispanic, Latino, or Spanish origin

OROTSP
What ^AREISWAS the name of ^PTEMPNAME other Hispanic, Latino, or Spanish origin?
Please use the category "Other Hispanic, Latino, or Spanish origin" for responses that do not appear
elsewhere on the list.

PWAVE_ORIGIN
PWAVE_HISPAN
PWAVE_OROTSP
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

RACE
Page 40 of 537

C, ? [F1]
^ASKORVERIFY
Question text for RACE question
Mark all that apply.
1. White
2. Black or African American
3. American Indian or Alaska Native
4. Asian
5. Native Hawaiian or Other Pacific Islander
6. Other DO NOT READ

RACEAS
^ASKORVERIFY
You may choose one or more Asian groups. ^C_AREISWAS ^TEMPNAME Chinese, Filipino,
Asian Indian, Vietnamese, Korean, Japanese, or of some other Asian origin?
Mark all that apply.
1. Chinese
2. Filipino
3. Asian Indian
4. Vietnamese
5. Korean
6. Japanese
7. Other Asian

RACEPI
You may choose one or more Pacific Islander groups. ^C_AREISWAS ^TEMPNAME Native
Hawaiian, Samoan, Chamorro, or of some other Pacific Islander origin?
Mark all that apply.
1. Native Hawaiian
2. Samoan
3. Chamorro
4. Other Pacific Islander
Page 41 of 537

PWAVE_RACE
PWAVE_RACEAS
PWAVE_RACEPI
PWAVE_RACEOT
HHSPEAK1
Do not read to the respondent.
So far, has any part of this interview been conducted in a language other than English?
Count American Sign Language as an English Language.
1. Yes
2. No, all in English

HHSPEAK2
? [F1]
^INTROFIL_HHSPEAK2 speak a language other than English at home?
Count American Sign Language as an English Language.
1. Yes
2. No, only English

WHOSPEAK
? [F1]
Who ^OTHERTHANFIL_WHOSPEAK speaks a language other than English at home?
Anyone else?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
2. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
3. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
4. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
5. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
6. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
7. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
8. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
Page 42 of 537

9. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
10. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
11. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
12. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
13. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
14. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
15. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
16. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
17. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
18. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
19. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5
20. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 5

AF_HHLD
Did ^YOUANYONE ever serve on active duty in the U.S. Armed Forces?
1. Yes
2. No

AF_WHO
Who?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
2. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
3. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
4. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
5. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
6. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
7. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
8. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
9. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
10. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
11. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
12. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
13. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
14. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
Page 43 of 537

15. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
16. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
17. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
18. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
19. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1
20. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 17 and PEOPLE_TO_ROSTER = 1

FALLOUT
^FALLOUT
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

MARITAL_STATUS
? [F1]
^C_AREIS ^TEMPNAME currently...
Read answer categories.
1. Married?
2. Married, spouse absent DO NOT READ
3. Widowed?
4. Divorced?
5. Separated?
6. Never Married?

WHO_SPOUSE
Ask if necessary:
Who is ^PTEMPNAME spouse?
Page 44 of 537

0. Person's spouse is not a member of the household
1. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
2. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
3. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
4. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
5. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
6. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
7. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
8. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
9. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
10. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
11. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
12. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
13. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
14. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
15. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
16. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
17. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
18. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
19. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15
20. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PAR1HHLD
^DODOES ^NAMEFIL2 have a parent in the household?
Please include biological, step and adoptive parents.
1. Yes
2. No
Page 45 of 537

PAR1_WHO
Ask or verify:
Who is that? (Who is ^PNAMEFIL2 parent?)

1. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

2. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

3. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

4. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

5. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

6. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

7. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

8. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

9. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

10. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

11. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

12. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

13. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

14. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

15. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

16. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

17. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

18. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

19. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

20. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

PAR1TYPE
? [F1]
^C_AREISWAS ^NAMEFIL2 ^PPAR1NAME biological, step, or adopted child?
1. Biological child
2. Stepchild
3. Adopted child
4. Foster child

PAR2HHLD
Ask or verify:
^DODOES ^NAMEFIL2 have another parent in the household?
Page 46 of 537

Please include biological, step and adoptive parents.
1. Yes
2. No

PAR2_WHO
Ask or verify:
Who is that? (Who is ^PNAMEFIL2 other parent?)

1. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

2. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

3. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

4. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

5. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

6. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

7. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

8. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

9. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

10. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

11. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

12. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

13. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

14. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

15. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

16. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

17. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

18. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

19. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

20. Display the LNO ROST_FNAME ^ROST_MNAME ROST_LNAME where AGE >= 15 and not equal WHO_SPOU

PAR2TYPE
? [F1]
^C_AREISWAS ^NAMEFIL2 ^PPAR2NAME biological, step, or adopted child?
1. Biological child
2. Stepchild
Page 47 of 537

3. Adopted child
4. Foster child

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

I_BORNUS
BORNUS
^ASKORVERIFY
^C_WASWERE ^TEMPNAME born in the United States?
1. Yes
2. No

I_BORNST
BORNST
^ASKORVERIFY
In what state ^WEREWAS ^TEMPNAME born?
1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
Page 48 of 537

13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
Page 49 of 537

52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming

BORNSTATE
^ASKORVERIFY
In what state ^WEREWAS ^TEMPNAME born?
1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
Page 50 of 537

28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming

I_BORNCOUNTRY
BORNCOUNTRY
BORNCNTRY
? [F1]
^ASKORVERIFY
In what country ^WEREWAS ^TEMPNAME born?
Page 51 of 537

1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
Page 52 of 537

40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
Page 53 of 537

79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other

I_CITIZEN
Page 54 of 537

CITIZEN
^ASKORVERIFY
^C_AREISWAS ^TEMPNAME a citizen of the United States?
1. Yes
2. No

I_NATCIT
NATCIT
D, ? [F1]
^ASKORVERIFY
How did ^TEMPNAME become a U.S. citizen?
1. Naturalized
2. Through ^HISHER or spouse's military service in the Armed Forces
3. Adopted by U.S. citizen parent or parents
4. Born in a U.S. Island Area or born in the United States
5. Born abroad of U.S. citizen parent or parents

I_YRENTRY
YRENTRY
^ASKORVERIFY
What year did ^TEMPNAME first come to live in the United States?

I_IMSTAT
IMSTAT
E
^ASKORVERIFY
When ^TEMPNAME first moved to the United States to live, what was ^HISHER immigration
status?
1. Relative or family sponsored
2. Employment-based
Page 55 of 537

3. Other permanent
4. Refugee or asylum
5. Non-immigrant (e.g., student, tourist, etc.)
6. Other

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

LANG1
? [F1]
What language ^DODOES ^TEMPNAME speak at home?
If more than one, mark the 'main' other language.
1. Spanish or Spanish Creole
2. Chinese
3. French (including Patois, Cajun)
4. French Creole
5. Tagalog, Filipino
6. Vietnamese
7. German
8. Korean
9. Russian
10. Italian
11. Hindi, Urdu
12. Arabic
13. Portuguese or Portuguese Creole
14. Polish
15. Persian
16. Gujarati
17. Other

HOWWELL
Page 56 of 537

^INTROFIL_HOWWELL
How well ^DODOES ^TEMPNAME speak English - would you say very well, well, not well, or not
at all?
1. Very well
2. Well
3. Not well
4. Not at all

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

EDUC
F, ? [F1]
EDUC_FILL1
31. Less than 1st grade
32. 1st, 2nd, 3rd or 4th grade
33. 5th or 6th grade
34. 7th or 8th grade
35. 9th grade
36. 10th grade
37. 11th grade
38. 12th grade, no diploma
39. High School Graduate (diploma or GED or equivalent)
40. Some college credit, but less than 1 year (regular Jr.coll./coll./univ.)
41. 1 or more years of college, no degree (regular Jr.coll./coll./univ.)
42. Associate's degree (2-year college)
43. Bachelor's degree (for example: BA, AB, BS)
44. Master's degree (for example: MA, MS, MBA, MSW)
45. Professional School degree (for example: MD (doctor), DDS (dentist), JD (lawyer))
46. Doctorate degree (for example: Ph.D., Ed.D.)

Page 57 of 537

GED_TEST
Had ^TEMPNAME completed high school by means of a GED or other equivalency test or
program?
1. Yes
2. No

HSGRAD_GED
? [F1]
Ask or verify.
Did ^TEMPNAME get ^HISHER high school diploma by graduating from high school, or by
passing a GED exam or other equivalent?
1. Graduated from high school
2. GED or other test
3. No diploma or GED

PWAVE_GED_TEST
PWAVE_HSGRAD_GED
PWAVE_EDUC
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

AFWHEN
When did ^TEMPNAME serve on active duty?
Any other times?
Mark all that apply.
1. September 2001 to present
2. August 1990 to August 2001 (including Persian Gulf War)
3. May 1975 to July 1990
Page 58 of 537

4. Vietnam Era (August 1964 to April 1975)
5. Februrary 1955 to July 1964
6. Korean War (July 1950 to January 1955)
7. January 1947 to June 1950
8. World War II or earlier (December 1946 or earlier)

AFNOW
^C_AREIS ^TEMPNAME now on active duty?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HHSPEAK3
? [F1]
C_DODOES ^TEMPNAME speak a language other than English at home?
Count American Sign Language as an English Language.
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**
Page 59 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

HHSTAT2NUM
LNO
**NON-DISPLAYED ITEM**

LNO_HHSTAT
**NON-DISPLAYED ITEM**

HHSTAT2_REL
BB
^HHSTAT2_RELATIONSHIPQFILL2. When you lived together, ^HHSTAT2_ROSTNAMEFIL was
^PTEMPNAME ______________.
If more than one relationship is applicable, enter the relationship that applied for most of the time spent
living together between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL.
If relationship is parent/child, probe for biological, step or adoptive.
If the exact relationship is unknown, mark 'Other Relatives' if the person is related or mark 'Other
Non-Relatives' if the person is not related.
1. Opposite sex husband/wife/spouse
2. Opposite sex unmarried partner
3. Same sex husband/wife/spouse
4. Same sex unmarried partner
5. Biological parent/child
6. Step parent/child
7. Adoptive parent/child
8. Grandparent/Grandchild
9. Brother/Sister
10. Parent/Child in-law
11. Brother/Sister in-law
12. Aunt/Uncle, Niece/Nephew
13. Other relative (cousin, etc.)
14. Foster parent/child
15. Other non-relative
16. Not in the household with this person
Page 60 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

LFPGINTRO
Since ^TEMPNAME is no longer in the household, I have a couple of questions about ^HISHER
circumstances before ^HESHE ^DIEDMOVEDOUT.
1. Enter 1 to continue

LFPARTPTN
Last time we interviewed ^TEMPNAME, ^HESHE was working for Provisional Job fill. When did
^HESHE stop working for Provisional Job fill?
For persons who have been institutionalized or working outside the country, they may still be employed
or working for the same company. In this instance, select the month in which they left the household.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
Page 61 of 537

13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
19. Person still working for same company DO NOT READ

LFPRT_AMT
What would you guess was ^HISHER total gross income from Provisional Job fill between
^BMONTHFILL 1st ^CALENDAR_YRFIL and LVMONTHYR?
1. Less than $20,000?
2. Between $20,000 and $34,999?
3. Between $35,000 and $49,999?
4. $50,000 or more?

NOWORKJOB
Did ^TEMPNAME work for pay at all between ^MONTH1 1st ^CALENDAR_YRFIL and
LVMONTHYR?
1. Yes
2. No

NWKJBAMT
What would you guess was ^HISHER gross income from ^HISHER job between ^MONTH1 1st
^CALENDAR_YRFIL and LVMONTHYR?
If respondent reports former household member held multiple jobs during the reference period, please
collect amount for the main or highest grossing job.
1. Less than $20,000?
2. Between $20,000 and $34,999?
3. Between $35,000 and $49,999?
4. $50,000 or more?

NOPROGRAM
Between ^MONTH1 1st ^CALENDAR_YRFIL and LVMONTHYR, did ^TEMPNAME receive income
Page 62 of 537

from Social Security?
1. Yes
2. No

NOPGMAMT
What was ^HISHER average monthly income from Social Security between ^MONTH1 1st
^CALENDAR_YRFIL and LVMONTHYR?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

HIPRTCPTN
I'm showing that when we last interviewed ^TEMPNAME, ^HESHE
(read list)
HI insurance fill.
Did ^HESHE have this coverage when ^HESHE ^DIEDMOVEDOUT?
1. Yes
2. No

HICVGENO
Did ^TEMPNAME have any health insurance coverage when ^HESHE ^DIEDMOVEDOUT?
1. Yes
2. No

HICVGETYP
What type of coverage did ^TEMPNAME have?
Mark all that apply.
1. Private health insurance
2. Medicare
3. Medicaid
Page 63 of 537

4. Military or VA health coverage

DCPRTCPTN
Before ^HESHE ^DIEDMOVEDOUT, did anyone in the household pay for care or hospitalization
for ^TEMPNAME?
1. Yes
2. No

DPCAREAMT
What was the total cost of these care arrangements between ^MONTH1 1st ^CALENDAR_YRFIL
and LVMONTHYR?

CTRLNUM
**NON-DISPLAYED ITEM**

INLIST
**NON-DISPLAYED ITEM**

BCHILD_INTRO
PWAVE_RIP
RIP
? [F1]
^RIPINTRO_W2_FIL
We Wave 4 RIP Introduction recontact this household in the future to update information. We
would like to ^RIPYES_FIL use some of the information you have provided today to make that
interview shorter and more efficient. RIPWAVE4 we speak to you or someone else you are living
with, is it OK if we use some of your answers as a starting point?
(Only a limited amount of information, such as whether you attended school and whether you are
married, is passed forward into the next interview.)
To see a comprehensive list of content that would be passed forward, see the Help Screen.
1. Yes
Page 64 of 537

2. No

BPROGINCOME_INTRO
RIPCONTINUE
EHC_PGM_SCRN
**NON-DISPLAYED ITEM**
1. Yes
2. No

INC_SCRN
**NON-DISPLAYED ITEM**
1. Yes
2. No

SCREENER_CLUMP
**NON-DISPLAYED ITEM**
1. Yes
2. No

PWAVE_SCREENER_CLUMP
PREV_HHRESP_INCLUMP
AGESALL
*** NON-DISPLAYED ITEM ***

AGEUNDER15T2
PCNTFEGE15T2
**NON-DISPLAYED ITEM**

PCNTLT5T2
**NON-DISPLAYED ITEM**

Page 65 of 537

PCNTLT7T2
**NON-DISPLAYED ITEM**

PCNTLT18T2
**NON-DISPLAYED ITEM**

PCNTLT22T2
**NON-DISPLAYED ITEM**

PLPCNT_TYPE2
**NON-DISPLAYED ITEM**

PCNTGE15T2
*** NON-DISPLAYED ITEM ***

PLPCNTLE18T2
**NON-DISPLAYED ITEM**

PCNTGE18T2
**NON-DISPLAYED ITEM**

PCNTTOTGE15
**NON-DISPLAY ITEM**

BEHCSCREEN
LNDCUPT
**NON-DISPLAYED ITEM**

HASDOMPART
HASSPDPT2SP
GAPMSGCOUNT
RESCOPY
CARICON_ARRAY
Page 66 of 537

? [F1]
This interview may be recorded for quality control purposes. Is that okay?
1. Yes
2. No

CARICON2_FLG
***NON-DISPLAYED ITEM***

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CLUMPALL
This is a survey about people's economic situation since ^MONTH1 1st ^CALENDAR_YRFIL. The
picture would be incomplete if we didn't get a little information about people ^TEMPNAME used
to live with.
Did ^TEMPNAME and Read name(s) ^BOTHALL continuously live together
^DURATION_REFPERDFIL?
"Continuously" means separations not longer than one month. This question is used to cluster all
listed household members together.
Display the first and last name of all people on the final household roster
(excluding the HH respondent).
1. Yes
2. No

CLUMPANY
^CLUMPANY_INTROFIL
Did ^TEMPNAME live together ^ENTIRE_TIMEFIL with ^EITHERANY of the people ^HESHE
currently ^LIVE_LIVESFIL with?
Page 67 of 537

1. Yes
2. No

CLUMPWHO
Who was that? (Which of these people did ^TEMPNAME live with the entire time between ^MONTH1
1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?)
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

T2_ALLYR
Page 68 of 537

T2_YN
^OTHERWAS there anyone else who lived with ^TEMPNAME for one month or more, either here
or at any other previous address, at any time between ^MONTH1 1st and the end of
^LASTMONTH ^CALENDAR_YRFIL?
Prechart all partial period people (HHSTAT=5) and movers (HHSTAT=2 and not
URE) people here (If no one on the roster is HHSTAT=5 or a mover then
prechart should be blank).
(This is a survey about people's economic situation between ^MONTH1 1st and the end of
^LASTMONTH ^CALENDAR_YRFIL. The picture would be incomplete if we didn't get a little information
about people ^TEMPNAME used to live with.)
'One month or more' must be CONTINUOUS time, not a day or week here or there.
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

T2SLOT
**NON-DISPLAY ITEM**

T2LNO
**NON-DISPLAYED ITEM**

T2SLOTCP
T2_ROST_NUM
T2 Who question text (That is, the people who lived with ^TEMPNAME^OTHERADD_COMMA at any
time between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL.)
As each name is added, consider whether this is a duplicate name to one previously entered and
probe to make sure the responses are consistent.
Enter 0 to add a new person.
Page 69 of 537

Enter 999 for none or no more.
Display the first and last name of the people already entered.

T2_ROST_FNAME
^T2FNAMETEXT

T2_ROST_LNAME
^T2LNAMETEXT

T2_RELEXP
BB
^T2_REL_RELATIONSHIPQFILL
Text to fill when limiting to only the first five type 2 people identified
If more than one relationship is applicable, enter the relationship that applied for most of the time spent
living together between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL.
If relationship is parent or child, probe for biological, step or adoptive.
If the exact relationship is unknown, mark 'Other Relatives' if the person is related or mark 'Other
Non-Relatives' if the person is not related.
1. Opposite sex husband/wife/spouse
2. Opposite sex unmarried partner
3. Same sex husband/wife/spouse
4. Same sex unmarried partner
5. Biological parent/child
6. Step parent/child
7. Adoptive parent/child
8. Grandparent/Grandchild
9. Brother/Sister
10. Parent/Child in-law
11. Brother/Sister in-law
12. Aunt/Uncle, Niece/Nephew
13. Other relative (cousin, etc.)
14. Foster parent/child
Page 70 of 537

15. Other non-relative
16. Not in the household with this person

T2_REL
**NON-DISPLAYED ITEM**
1. Spouse (Husband/Wife)
2. Unmarried Partners
3. Biological Parent/Child
4. Step-parent/child
5. Adoptive parent/child
6. Grandparent-grandchild
7. Siblings (e.g. brother/sister)
8. Other Relatives (e.g., aunt/uncle, niece/nephew, cousins, parent/child-in-laws, etc.)
9. Foster Parent/Child
10. Friends, Roommates or Other Non-Relatives

T2_1_MONTHS
In which months, between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME and ^T2_ROSTNAMEFIL live together?
Mark all that apply.
Mark all months in which these people lived together for at least half of the month.
1. ^MONTH1 ^CALENDAR_YR
2. ^MONTH2 ^CALENDAR_YR
3. ^MONTH3 ^CALENDAR_YR
4. ^MONTH4 ^CALENDAR_YR
5. ^MONTH5 ^CALENDAR_YR
6. ^MONTH6 ^CALENDAR_YR
7. ^MONTH7 ^CALENDAR_YR
8. ^MONTH8 ^CALENDAR_YR
9. ^MONTH9 ^CALENDAR_YR
10. ^MONTH10 ^CALENDAR_YR
11. ^MONTH11 ^CALENDAR_YR
12. ^MONTH12 ^CALENDAR_YR

Page 71 of 537

T2_SEX
Is ^T2_ROSTNAMEFIL male or female?
Response selected should be based on the respondent's answer to the question.
1. Male
2. Female

T2_AGE
What was ^T2HISHER age as of the beginning of last year (^MONTH1 1st, ^CALENDAR_YEAR)?
(Your best guess is fine.)

T2_AGERANGE
Was ^HESHE...
Read answer categories.
1. Under 5 years old?
2. 5 - 14 years old?
3. 15 - 19 years old?
4. 20 - 29 years old?
5. 30 - 49 years old?
6. 50 - 69 years old?
7. 70 years old or over?

T2_HIED
What is the highest level of school that ^T2_ROSTNAMEFIL has completed, or the highest degree
^T2HESHE has received?
1. Did NOT graduate from high school
2. Graduated from high school (Diploma or GED)
3. College graduate (Bachelor's degree or higher)

T2_WORK
Did ^T2_ROSTNAMEFIL work for pay at any time when ^TEMPNAME and ^T2HESHE lived
together?
Display the months selected in the field T2_1_MONTHS underneath the heading:
Page 72 of 537

Months Lived Together. If T2_1_MONTHS = Don't Know or Refuse, nothing should
be displayed here.
1. Yes
2. No

T2_INC
Including all income sources, what would you guess was ^T2HISHER annual income?
(We don't expect an exact amount. Your best guess is fine.)
If a specific time is asked for, use ^MONTH1 1st, ^CALENDAR_YEAR.
If the person's income is $1 million or more, enter 999,999.
Round the amount to the nearest dollar.

T2_INCDK1
Was it more than $25,000?
If a specific time is asked for, use ^MONTH1 1st, ^CALENDAR_YEAR.
1. Yes, more than $25,000
2. No

T2_INCDK2A
Was it more than $50,000?
If a specific time is asked for, use ^MONTH1 1st, ^CALENDAR_YEAR.
1. Yes, more than $50,000
2. No

T2_INCDK2B
Was it more than $10,000?
If a specific time is asked for, use ^MONTH1 1st, ^CALENDAR_YEAR.
1. Yes, more than $10,000
2. No
Page 73 of 537

TYPE2_COMP
The Type 2 section is complete.
Enter 1 to continue.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PROCERT
? [F1]
Now I have some preliminary questions about ^TEMPNAME that will help streamline the
interview.
^C_DODOESDID ^TEMPNAME have a professional certification or a state or industry license?
A professional certification or license shows you are qualified to perform a specific job and includes
things like Licensed Realtor, Certified Medical Assistant, Certified Construction Manager, a Project
Management Professional (PMP) certification, or an IT Certification.
1. Yes
2. No

WHOCERT
Who issued this certification or license?
Mark all that apply.
1. Federal, state, or local government

2. Professional or trade association (for example, Pediatric Nursing Certification Board, National Exercise and Spor
3. Business or company (for example, Microsoft, 3M Company, Xerox)
4. Other group or organization

Page 74 of 537

CERT
? [F1]
Some people decide to enroll at a college, university, community college, or trade school to earn
a certificate rather than a degree. ^C_HAVHASDID ^TEMPNAME ever ^EARN_FIL this type of
certificate?
An educational certificate is typically earned by completing a program of study offered by a college or
university, a community college, or a trade school, but it does not lead to an Associate's, Bachelor's, or
graduate degree. Sometimes these are called vocational diplomas (for example, a cosmetology or
mechanic's diploma), which differs from a high school diploma.
1. Yes
2. No

PWAVE_MS
**NON-DISPLAYED ITEM**

PWAVE_XMAR
**NON-DISPLAYED ITEM**

PW_CURRMAR
**NON-DISPLAYED ITEM**

TIMES_MARRIED
How many times ^HAVEHAS ^TEMPNAME been married?
If the person has been married but the marriage was annulled, consider the marriage never to have
occurred.
1. Once
2. Twice
3. Three times
4 or more. Four or more times
0. Never Married

CTRLNUM
**NON-DISPLAYED ITEM**
Page 75 of 537

LNO
**NON-DISPLAYED ITEM**

MSFLAG
**NON-DISPLAYED ITEM**

MAR_MO
^MARMO_FIL
Enter month.

1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

MAR_YR
^MARYR_FIL
Enter year.

WIDIV
Did ^PTEMPNAME ^12CUR_FIL marriage end in widowhood or divorce?
^WIDIV_FRNOTEFIL
1. Widowhood
2. Divorce
Page 76 of 537

END_MO
^ENDMO_FIL
Enter month.
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

END_YR
^ENDYR_FIL
Enter year.

STOPLIV_MO
^STOPLIVMO_FIL actually stop living together?
Enter month.
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
Page 77 of 537

12. December

STOPLIV_YR
^STOPLIVYR_FIL actually stop living together?)
Enter year.

YR_CURR_MARR
**NON-DISPLAYED ITEM**

EVRWID
^C_HAVHAS ^TEMPNAME ever been widowed?
1. Yes
2. No

PWAVE_EVRWID
EVRDIV
^C_HAVHAS ^TEMPNAME ever been divorced?
1. Yes
2. No

PWAVE_EVRDIV
PARFLAG
*********** NON-DISPLAYED ITEM ****************
1. Yes
2. No

PARENT_SCRN
^DEMO_Q_INTRO2
C_DODOES ^TEMPNAME have any children?

Page 78 of 537

Please include biological, step or adopted children, both living and deceased.
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HHINCSCR_YR
I also have a couple of preliminary questions about income. In ^CALENDAR_YEAR was
^PINCPER_FILL gross or net annual income below $^INCYR_FILL?
1. Yes
2. No

HHINCSCR_MTH
During any month in ^CALENDAR_YEAR, was ^PINCPER_FILL gross or net monthly income ever
below $^INCMTH_FILL?
1. Yes
2. No

HHPGMSCR
Just to be sure nothing is missed, at any time since ^MONTH1 ^CALENDAR_YRFIL, did
^PPROGRAM_FILL receive assistance such as Food Stamps or SNAP, WIC, Medicaid,
^TANFFIL1, ^TANFFIL2, ^TANFFIL3, or State GA Program Names, State GA Program Names, or
State GA Program Names from a federal, state, or local agency?
1. Yes
2. No

EHC_INTRO
Page 79 of 537

In this section of the interview, we are interested in ^YOURHISHER residence, INCOREDUC, and
other circumstances since ^MONTH1 1st ^CALENDAR_YRFIL.
Enter 1 to continue.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

BRESIDENCY_SCREENER
^RESSCREENERTEXT
1. Yes
2. No

BRESIDENCY_SCREENER2
BRESIDENCY_DESC
BRESIDENCY_RETURNING
**NON-DISPLAYED ITEM**

BMARITAL_HISTORY_DESC
BMARITAL_HISTORY_RETURNING
**NON-DISPLAYED ITEM**

BEDUC_ENROLLMENT_SCREENER
^C_AREIS ^YOUHESHE currently attending ^ENROLLSCREENERTEXT?
1. Yes
2. No

BEDUC_ENROLLMENT_SCREENER2
Page 80 of 537

^ENROLLSCREENER2TEXT
1. Yes
2. No

BEDUC_ENROLLMENT_RETURNING
**NON-DISPLAYED ITEM**

BEDUC_ENROLLMENT_DESC
BJOB_SCREENER
^JOBSCREENER
1. Yes
2. No

BJOB_SCREENER2
^JOBSCREENER2
1. Yes
2. No

BJOB_DESC
BJOB_RETURNING
**NON-DISPLAYED ITEM**

BNOJOB_SCREENER
Read if necessary:
I have recorded that ^YOUHESHE AREIS currently NOT working for pay.
Is that correct?"
1. Yes
2. No

BNOJOB_SCREENER2
"I have recorded that there were times ^YOUHESHE WASWERE NOT working for pay since
Page 81 of 537

^MONTH1 1st ^CALENDAR_YRFIL. Is that correct?"
1. Yes
2. No

BNOJOB_DESC
BNOJOB_RETURNING
BSSI_SCREENER
AREIS ^YOUHESHE currently receiving SSI?
Do NOT include disability, retirement, or survivor income from Social Security.
1. Yes
2. No

BSSI_SCREENER2
Did ^YOUHESHE receive SSI ^SCREENER2TEXT?
Do NOT include disability, retirement, or survivor income from Social Security.
1. Yes
2. No

BSSI_DESC
BSSI_RETURNING
**NON-DISPLAYED ITEM**

BFS_SCREENER
^C_AREIS ^YOUHESHEFAM currently receiving Food Stamps or SNAP benefits?
1. Yes
2. No

BFS_SCREENER2
Did ^YOUHESHEFAM receive Food Stamps or SNAP benefits ^SCREENER2TEXT?
1. Yes
Page 82 of 537

2. No

BFS_DESC
BFS_RETURNING
**NON-DISPLAYED ITEM**

BTANF_SCREENER
^C_AREIS ^YOUHESHEFAM currently receiving TANF benefits, or any other cash assistance
from a state or local welfare program^TANFLE18FIL?
1. Yes
2. No

BTANF_SCREENER2
Did ^YOUHESHEFAM receive TANF benefitsClosing text for the second TANF screener?
1. Yes
2. No

BTANF_DESC
BTANF_RETURNING
**NON-DISPLAYED ITEM**

BGENASSIS_SCREENER
^C_AREIS ^YOUHESHEFAM currently receiving General Assistance (either for
^YOURHIMHERSELF or on behalf of a child)?
1. Yes
2. No

BGENASSIS_SCREENER2
Did ^YOUHESHEFAM receive General Assistance ^GASCREENER2TEXT?
1. Yes
2. No
Page 83 of 537

BGENASSIS_DESC
BGENASSIS_RETURNING
**NON-DISPLAYED ITEM**

BWIC_SCREENER
^C_AREIS ^YOUHESHE currently receiving WIC benefits^WICLT5FIL?
1. Yes
2. No

BWIC_SCREENER2
Did ^YOUHESHE receive WIC benefits Closing text for the second WIC screener?
1. Yes
2. No

BWIC_DESC
BWIC_RETURNING
**NON-DISPLAYED ITEM**

BPRIVATE_SCREENER
^C_AREIS ^YOUHESHE currently covered by a private health insurance plan?
Do NOT include Military or VA coverage, or coverage through a Medicare Supplement, Medigap, or
Medicare Advantage (Part C) plan.
1. Yes
2. No

BPRIVATE_SCREENER2
^PRIVATE_SCREENER2QTEXT
1. Yes
2. No

BPRIVATE_DESC
Page 84 of 537

BPRIVATE_RETURNING
**NON-DISPLAYED ITEM**

BMEDICARE_SCREENER
^C_AREIS ^YOUHESHE currently covered by Medicare?
Include coverage through any type of Medicare plan, such as a Medicare Supplement, Medigap, or
Medicare Advantage (Part C).
1. Yes
2. No

BMEDICARE_SCREENER2
BMEDICARE_DESC
BMEDICARE_RETURNING
**NON-DISPLAYED ITEM**

BMEDICAID_SCREENER
^C_AREIS ^YOUHESHE currently covered by Medicaid, or CHIP, or any other government
program that helps pay health care costs for low-income people?
1. Yes
2. No

BMEDICAID_SCREENER2
Were ^YOUHESHE covered by Medicaid, or CHIP, or any other government program that helps
pay health care costs for low-income people ^SCREENER2TEXT?
1. Yes
2. No

BMEDICAID_DESC
BMEDICAID_RETURNING
**NON-DISPLAYED ITEM**

BMILITARY_SCREENER
Page 85 of 537

^C_AREIS ^YOUHESHE currently covered by any health insurance through one of those
sources?
1. Yes
2. No

BMILITARY_SCREENER2
Were ^YOUHESHE covered by health insurance provided by the military or Department of
Veterans Affairs ^SCREENER2TEXT?
1. Yes
2. No

BMILITARY_DESC
BMILITARY_RETURNING
**NON-DISPLAYED ITEM**

BOTHERCOVERAGE_SCREENER
(Other than what we've already talked about,) AREIS ^YOUHESHE currently covered by any other
type of health insurance plan? (Perhaps a government program, Indian Health Services, or a policy
through a parent, a foreign government, or any other source?)
1. Yes
2. No

BOTHERCOVERAGE_SCREENER2
^C_WASWERE ^YOUHESHE covered by any other type of health insurance plan at any time since
^MONTH1 1st ^CALENDAR_YRFIL? (Perhaps a government program, Indian Health Services, or a
policy through a parent, a foreign government, or any other source?)
1. Yes
2. No

BOTHERCOVERAGE_DESC
BOTHERCOVERAGE_RETURNING
BNOCOVERAGE_DESC
BNOCOVERAGE_RETPERNUM
Page 86 of 537

BNOCOVERAGE_SCREENER
NOCOVINDEX
HEALTHGAPCTR
BRESIDENCY_RETPERNUM
BMARITAL_HISTORY_RETPERNUM
BEDUC_ENROLLMENT_RETPERNUM
BEDUC_ENROLLMENT_PWAVEGRADE_INT
BJOB_RETPERNUM
BNOJOB_RETPERNUM
BSSI_RETPERNUM
BFS_RETPERNUM
BTANF_RETPERNUM
BGENASSIS_RETPERNUM
BWIC_RETPERNUM
BPRIVATE_RETPERNUM
BMEDICARE_RETPERNUM
BMEDICAID_RETPERNUM
BMILITARY_RETPERNUM
BOTHERCOVERAGE_RETPERNUM
PROVIS_MS_EHC
PROVIS_WHO_SPOUSE_EHC
BJOB_AT_EMPNAME
JOB1INDEX
JOB2INDEX
JOB3INDEX
JOB4INDEX
JOB5INDEX
JOB6INDEX
JOB7INDEX
JOB8INDEX
JOB9INDEX
PRIV1INDEX
PRIV2INDEX
MEDCINDEX
MEDDINDEX
Page 87 of 537

MILINDEX
OTCINDEX
RESINDEX
EDUINDEX
FSINDEX
TANFINDEX
GENINDEX
WICINDEX
SSIINDEX
NOJOBCOUNT
MIL_COVFLAG
*Non-Displayed Field*

MED_COVFLAG
*Non-Displayed Field*

PRIV1_COVFLAG
*Non-Displayed Field*

PRIV2_COVFLAG
*Non-Displayed Field*

HINS_COVFLAG
JOB1FLG
JOB2FLG
JOB3FLG
JOB4FLG
JOB5FLG
JOB6FLG
JOB7FLG
JOB8FLG
MIL_FLAG
MED_FLAG
PRIV1_FLAG
Page 88 of 537

PRIV2_FLAG
TANF_BLKLNFLG
*** NON-DISPLAYED ITEM ***

FS_BLKLNFLG
*** NON-DISPLAYED ITEM ***

GA_BLKLNFLG
*** NON-DISPLAYED ITEM ***

NUMBER_OF_JOBS
***NON-DISPLAYED ITEM***

JOBS_EMONTH
NJOB_FLG
NOJOBRET_FLG
SITNOW_FLG
REL_FLG
** NON-DISPLAY ITEM **

EHC_Incomplete
The interview for ^TEMPNAME cannot be continued. The following sections have not been completed
in the EHC:
Incomplete EHC items
Either go back and finish the EHC, OR Enter 1 to continue to another person's interview.
1. Enter 1 to continue

ctrlnum
**NON-DISPLAYED ITEM**

Page 89 of 537

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

bmonth
^RESFROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

emonth
^RESTOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
Page 90 of 537

3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

RESIDENCECODE
**NON-DISPLAYED ITEM**

pick_address_old
INTRO
^RESINTROTEXT

pick_address_ehc
pick_address
? [F1]
What was the address where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH?
Select from below list of previously entered addresses OR select 'Add new address' to enter a new
address.

INFO
All months of the reference period must be accounted for; this includes both ^YR_FIL PLUS any months
to date in ^INTYEARFIL.
A maximum of 5 addresses is collected per household member for the reference period.
Page 91 of 537

When recording changes in residences, FROM and TO months should be selected for the residence
where the respondent lived for the majority of the month.

ehc_cntry_scrn
Was the address ^TEMPNAME lived at ^BETWEEN_BMONTH_EMONTH located in the United
States?
1. Yes
2. No

ehc_cntry
? [F1]
In what country did ^TEMPNAME live ^BETWEEN_BMONTH_EMONTH?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
Page 92 of 537

25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
Page 93 of 537

64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
Page 94 of 537

103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other

ehc_hno
What was the house number where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH?

ehc_hnosuf
What was the house number suffix (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
(For example, did this address have an apartment and a unit number?)

ehc_strname
What was the street name (where ^TEMPNAME lived ^BETWEEN_BMONTH_EMONTH)?

ehc_noncityadd
? [F1]
What was the non-city address (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
(For example, any description you can add to the address to make it more specific.)

ehc_po
What was the city (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?

EHC_COUNTRY
ehc_cnty
What was the county (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?

Page 95 of 537

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

ehc_state
What was the state (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
Page 96 of 537

33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming

ehc_st
What was the state (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?
1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
Page 97 of 537

11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
Page 98 of 537

50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming

ehc_zip
What was the zip code (where ^YOUHESHE lived ^BETWEEN_BMONTH_EMONTH)?

temp_livewith
ehc_livewith
? [F1]
Ask or verify
During this period, (^BETWEEN_BMONTH_ALTEMONTH,) did ^TEMPNAME live with any of the
following people...
Read answer categories.
Mark all that apply.
1. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
2. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
3. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
4. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
5. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
6. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
7. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
8. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
9. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
10. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
11. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
12. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
13. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
14. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
Page 99 of 537

15. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
16. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
17. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
18. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
19. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
20. LNO ^FNAME ^LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER =
26. Did not live with any of these people or lived alone?

prvlvqrt
^ASKORVERIFY
What type of living quarters ^ISWAS ^EHCRES_FIL?
1. House, apartment, flat
2. Unit in rooming house, hotel, motel, etc.
3. Mobile home or trailer
4. Other housing unit
5. Correctional institution
6. Medical institution/nursing home
7. Military quarters (barracks, ship at sea)
8. Student quarters
9. Other group quarters unit
10. Emergency or transitional shelter
11. Tent or trailer site
12. Car, van, or other non-permanent accommodations

ehc_ten
^ASKORVERIFY
C_ISWAS ^EHCRES_FIL...
Read answer categories.
1. Owned or being bought by someone in the household?
2. Rented?
3. Occupied without payment of rent?

ehc_rentsub
Page 100 of 537

^ASKORVERIFY
^EHCRENTSUBQTEXT
Include respondents who live in a building owned by a Public Housing Authority (i.e., the housing
authority is the respondent's landlord) as receiving a rent subsidy.
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Yes
2. No

ehc_voucher
^ASKORVERIFY
C_DOESDID ^PTEMPNAME household receive a housing voucher for

Read address?

A housing voucher gives a renter the right to choose where to live AND it helps pay the rent.
Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP
1. Yes
2. No

ehc_why
W, ? [F1]

What was the main reason ^TEMPNAME moved to

Read address?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. Change in marital/relationship status
2. To move into own apartment or house
3. Other family-related reason
Page 101 of 537

4. New job or job transfer
5. To look for work or lost job
6. To be closer to work or school
7. Other job-related reason
8. Wanted to own home, not rent
9. Wanted a better quality apartment or house
10. Wanted a better neighborhood
11. Cheaper housing
12. Other housing-/neighborhood-related reason
13. Disaster loss (fire, flood, hurricane, etc.)
14. Eviction/foreclosure
15. Always lived here (never moved)
16. Other reason (specify)

ehc_whyot
What was the other reason ^TEMPNAME moved?

ehc_mvyr
What year did ^TEMPNAME move to

Read address?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

ehc_mvmo
What month did ^TEMPNAME move to

Read address?

Address:
^HNO ^STRNM ^HNOSUF
^CITY ^NONCITYADD, ^STATE ^ZIP

1. January
2. February
3. March
4. April
5. May
6. June
Page 102 of 537

7. July
8. August
9. September
10. October
11. November
12. December

ehc_pvten
? [F1]
Thinking about the address ^TEMPNAME lived at prior to ^EHCRES_FIL, was it...
Read answer categories.
1. Owned or being bought by someone in the household?
2. Rented?
3. Occupied without payment of rent?

residencycontinue
Enter 1 to continue.
1. Continue

residenceid
*** NON-DISPLAYED ITEM ***

resid
*** NON-DISPLAYED ITEM ***

rescopied
i_ehc_country
i_ehc_hno
i_ehc_strname

Page 103 of 537

i_ehc_hnosuf
i_ehc_po
i_ehc_noncityadd
i_ehc_state
i_ehc_cnty
i_ehc_zip
anymorespells
Now let's talk about the other places ^TEMPNAME lived since ^MONTH1 1st
^CALENDAR_YRFIL.
Enter 1 to return to calendar and enter a new residence spell.
1. Continue

howmany
We've talked about five residences. In how many more residences did ^TEMPNAME live since
^MONTH1 1st ^CALENDAR_YRFIL?

nomorespells
The residences topic is complete.
Enter 1 to continue.
1. Continue

pwave_complete
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
Page 104 of 537

**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
Let's talk about ^YOURHISHER marital history since ^MONTH1 1st ^CALENDAR_YRFIL.

INFO
All people age 15 and over should complete the marital status section since it also asks about
cohabitation during the reference period.
Edit or extend the provisional spell by either moving the cursor to the Period box and typing 1, or
pressing tab 2 times.

BMONTH
When did that start?
If prior to ^MONTH1 ^CALENDAR_YRFIL, select ^MONTH1 ^CALENDAR_YRFIL
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 105 of 537

EMONTH
^MARITALTOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

MS_EHC
? [F1]
What ^ISWAS ^PTEMPNAME marital status ^BETWEEN_BMONTH_EMONTH...
Read answer categories.
1. Married?
2. Married, spouse absent - DO NOT READ
3. Widowed?
4. Divorced?
5. Separated?
6. Never Married?

WHO_SPOUSE_EHC
Who ^ISWAS ^PTEMPNAME spouse (^BETWEEN_BMONTH_EMONTH)?

1. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe
Page 106 of 537

2. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

3. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

4. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

5. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

6. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

7. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

8. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

9. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

10. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

11. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

12. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

13. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

14. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

15. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

16. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

17. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

18. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

19. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

20. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

21. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

22. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

23. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

24. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

25. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe
26. Someone not listed

GOT_PARTNER
? [F1]
Ask or verify
During this period, (^BETWEEN_B_EMONTH,) did ^TEMPNAME have a boyfriend, girlfriend, or
partner who lived in the household?
1. Yes
2. No

WHO_PARTNER_EHC
Who ^ISWAS_MH ^PTEMPNAME boyfriend, girlfriend, or partner?
Page 107 of 537

1. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

2. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

3. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

4. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

5. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

6. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

7. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

8. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

9. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

10. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

11. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

12. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

13. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

14. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

15. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

16. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

17. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

18. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

19. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

20. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

21. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

22. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

23. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

24. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

25. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe
26. Someone not listed

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

Page 108 of 537

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

IN_GRADE
INTRO
^ENROLLINTROTEXT

INFO
(Include only nursery or preschool, kindergarten, elementary school, home school, and schooling that
leads to a high school diploma, a college or graduate degree, or an educational certificate.)

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
Page 109 of 537

^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EDGRADE1
**NON-DISPLAYED ITEM**

EDGRADE2
**NON-DISPLAYED ITEM**

GRADE
? [F1]
What level of school ISAREWASWERE ^TEMPNAME enrolled in
^BETWEEN_BMONTH_EMONTH?
1. 1st
2. 2nd
3. 3rd
4. 4th
5. 5th
Page 110 of 537

6. 6th
7. 7th
8. 8th
9. 9th
10. 10th
11. 11th
12. 12th
13. College year 1 (Freshman)
14. College year 2 (Sophomore)
15. College year 3 (Junior)
16. College year 4 (Senior)
17. College year 5 (First year graduate or professional school)
18. College year 6+ (Second year or higher in graduate or professional school)
19. Enrolled in college, but not working towards degree
20. Vocational, technical, or business school beyond high school level
21. Nursery school or preschool
22. Kindergarten

EDTYPE
What type of school ISAREWASWERE ^TEMPNAME enrolled in...
Read answer categories.
If the respondent ^ISWAS enrolled in more than one type of school, select the type of school in which
he or she was enrolled for the most time.
1. Public?
2. Private?
3. Charter school?
4. Home school?

CRED
What degree or certificate ISAREWASWERE ^TEMPNAME working on?
1. Associate's Degree
2. Bachelor's Degree
3. Master's Degree
4. Doctoral or Professional Degree (Including JD)
5. Undergraduate certificate or diploma leading to a license (for example: nursing, mechanics, cosmetology)
Page 111 of 537

6. Undergraduate certificate or diploma, NOT including those leading to a license
7. Post-baccalaureate certificate
8. Post-master's certificate
9. Not enrolled for a degree or certificate

EDHEADST
Some preschool programs are federally sponsored and are primarily for children from
low-income families. Some examples of these are Head Start, Even Start and Fair Start.
C_ISWAS ^TEMPNAME enrolled in a federally-sponsored program like this?
1. Yes
2. No

GRADEREP
You said that ^TEMPNAME WASWERE enrolled in the same grade at the beginning and end
^CALENDAR_YRFIL. Was this because ^YOUHESHE had to repeat a grade or WASWERE held
back for any reason?
1. Yes - repeated grade or was held back
2. No - enrolled in same grade
3. No - grade entered for ^BMONTHFILL to ^EMONTHFILL is incorrect
4. No - grade entered in previously recorded spell is incorrect
5. Other, specify DO NOT READ

GRADEREP_OTH
What was the reason you said ^TEMPNAME WASWERE enrolled in the same grade at the
beginning and end ^CALENDAR_YRFIL?

PREV_GRADE
What is the correct grade?
This refers to the grade of the previous spell.
1. 1st
2. 2nd
3. 3rd
Page 112 of 537

4. 4th
5. 5th
6. 6th
7. 7th
8. 8th
9. 9th
10. 10th
11. 11th
12. 12th
13. College year 1 (Freshman)
14. College year 2 (Sophomore)
15. College year 3 (Junior)
16. College year 4 (Senior)
17. College year 5 (First year graduate or professional school)
18. College year 6+ (Second year or higher in graduate or professional school)
19. Enrolled in college, but not working towards degree
20. Vocational, technical, or business school beyond high school level
21. Nursery school or preschool
22. Kindergarten

FTPT
C_ISAREWASWERE ^TEMPNAME enrolled full-time or part-time?
1. Full-time
2. Part-time

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME attend ^EDUCLEVEL at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of school enrollment. How many other times WASWERE
^TEMPNAME enrolled in school since ^MONTH1 1st ^CALENDAR_YRFIL?
Page 113 of 537

NOMORESPELLS
The enrollment topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

jobid
**NON-DISPLAYED ITEM**

jobnum
**NON-DISPLAYED ITEM**

periodnum
**NON-DISPLAYED ITEM**

bmonth_wave
pvjobblank
cpyspell
bmonth
^FROMTEXT

Page 114 of 537

INTRO
^JOBINTROTEXT

emonth
^TOTEXT

INFO
If necessary probe with additional question: Did ^YOUHESHE have a paid job, or do any work at all,
no matter how small, that earned some money?

jborse
? [F1]
C_DIDDODOES ^TEMPNAME work for an employer, or ISAREWASWERE ^YOUHESHE
self-employed, or DIDDODOES ^YOUHESHE have some other work arrangement?
1. Employer
2. Self-employed (owns a business)
3. Other work arrangement

conchk1
?[F1]
C_DIDDODOES ^TEMPNAME have a definite arrangement with one or more employers to work on
an ongoing basis?
1. Yes
2. No

startjan
Did ^TEMPNAME begin this JOBBUS in ^MONTH1 ^CALENDAR_YRFIL?
1. Yes
2. No

startyear
? [F1]
Page 115 of 537

In what year did ^TEMPNAME begin this JOBBUS?

startmonth
In what month did ^TEMPNAME begin this JOBBUS?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

COPYJOB
Enter 1 to continue.

startweek
T
During which week did ^TEMPNAME begin this JOBBUS?
^ASKORVERIFY

endweek
T
During which week did ^TEMPNAME end this JOBBUS?

rsend
G, ? [F1]
What is the main reason ^YOUHESHE stopped working for ^YOURHISHER employer?
1. Plant or company closed down or moved
Page 116 of 537

2. Slack work or business conditions, such as due to coronavirus pandemic business closures
3. Position or shift abolished
4. Temporary or seasonal job completed
5. Discharged or fired
6. Other involuntary reason
7. Quit to take another job
8. Unsatisfactory work arrangements
9. Quit for some other reason
10. Retirement
11. Taking care of children, such as due to coronavirus pandemic school closures
12. Other family or personal obligations
13. Own health concerns or own illness
14. Own injury
15. School or training
16. Other personal reason

rendb
G
What is the main reason ^TEMPNAME gave up or ended this business?
1. Retirement
2. Taking care of children, such as due to coronavirus pandemic school closures
3. Other family or personal problems
4. Own health concerns or own illness
5. Own injury
6. School or training
7. Went bankrupt or business failed
8. Sold business or transferred ownership
9. To start other business or take a job
10. Season ended for a seasonal business
11. Quit for some other reason

empbsname
? [F1]
What ^ISWAS the name of ^PTEMPNAME Fill for Employer/Business?

Page 117 of 537

^EBSNAMEFILL

jbaddstrnum
? [F1]
What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?
Street Number

jbaddstrname
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Street Name

jbaddnumsuf
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Suite or Office Number

jbaddcity
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
City

jbaddst
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
State
AL. Alabama
AK. Alaska
Page 118 of 537

AZ. Arizona
AR. Arkansas
CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
NE. Nebraska
NV. Nevada
NH. New Hampshire
NJ. New Jersey
NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
Page 119 of 537

SD. South Dakota
TN. Tennessee
TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming

jbaddzip5
? [F1]
(What is the address of the main location where ^TEMPNAME WORKSWORKED at ^EMPNAME?)
Zip code

clwrk
? [F1]
^CUREMONTH ^ISWAS ^EMPNAME...
Read answer categories.
1. A government organization, including the Armed Forces?
2. A private, for-profit company?
3. A non-profit organization, including tax-exempt and charitable organizations?

kindg
? [F1]
What type of government DIDDODOES ^TEMPNAME work for ^INEMONTHFILL...
Read answer categories.

1. Federal Military Departments (CIVILIAN ONLY) (ex. Dept. of Defense, Dept. of Army, and other military departme
2. All other Federal Departments (CIVILIAN ONLY)?
Page 120 of 537

3. State Government?
4. Local Government?
5. U.S. Armed Forces (ACTIVE DUTY ONLY)?

kindg2
What type of government DIDDODOES ^TEMPNAME work for ^INEMONTHFILL...
Read answer categories.

1. Federal Military Departments (CIVILIAN ONLY) (ex. Dept. of Defense, Dept. of Army, and other military departme
2. U.S. Armed Forces (ACTIVE DUTY ONLY)?

kndin
? [F1]
^CUREMONTH what kind of business, industry, or organization ^ISWAS this?
Read if necessary:
What do they make or do where ^TEMPNAME WORKSWORKED?

typin
? [F1]
C_ISWAS this kind of business, industry, or organization mainly...
Read answer categories.
Read if necessary:
^C_BETWEEN_BMONTH_EMONTH, when this JOBBUS was held, at the location where
^TEMPNAME WORKSWORKED, what ^ISWAS this ^EMPBUSPOS primary activity?
1. Manufacturing?
2. Wholesale trade?
3. Retail trade?
4. Service?
5. Or something else (agriculture, construction, government, etc.)?

kndwk
Page 121 of 537

? [F1]
What kind of work DIDDODOES ^TEMPNAME do ^INEMONTHFILL, that is, what ^ISWAS
^YOURHISHER occupation?
(For example: bookkeeper, plumber, registered nurse)

actvt
? [F1]
What ^AREWERE ^YOURHISHER usual activities at ^EMPNAME ^INEMONTHFILL?
(For example: keeping account books, repairing pipes, patient care)

union
? [F1]
At ^EMPNAME, ISAREWASWERE ^TEMPNAME a member of either a labor union or an employee
association like a union?

1. Yes
2. No

cntrc
? [F1]
C_ISAREWASWERE ^TEMPNAME covered by either a union contract or something like a union
contract?

1. Yes
2. No

emploc
Does ^EMPNAME operate in more than one location?
1. Yes
2. No
Page 122 of 537

empall
? [F1]
About how many people are employed by ^EMPNAME at ALL LOCATIONS together?
1. Less than 10
2. 10 to 25
3. 26 to 50
4. 51 to 100
5. 101 to 200
6. 201 to 500
7. 501 to 1000
8. Greater than 1000

empsize
? [F1]
About how many people ^AREWERE employed by ^EMPNAME at the location where
^TEMPNAME WORKSWORKED?
1. Less than 10
2. 10 to 25
3. 26 to 50
4. 51 to 100
5. 101 to 200
6. 201 to 500
7. 501 to 1000
8. Greater than 1000

empb
^C_BETWEEN_BMONTH_EMONTH, what ^ISWAS the maximum number of employees, including
^TEMPNAME, working for ^EMPNAME at any one time?
1. 1 (Only self)
2. 2 to 9
3. 10 to 25
4. 26 to 50
5. 51 to 100
6. 101 to 200
7. 201 to 500
8. 501 to 1000
Page 123 of 537

9. Greater than 1000

incpb
? [F1]
C_ISWAS ^EMPNAME incorporated?
1. Yes
2. No

propb
? [F1]
DIDDODOES ^TEMPNAME own ^EMPNAME Fill for SELF or ^ISWAS it a partnership?
1. Alone
2. Partnership

hprtb
C_ISWAS any other member of this household an owner or partner in ^EMPNAME?
1. Yes
2. No

partb
Who ^ISWAS that?
Mark all that apply.

1. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

2. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

3. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

4. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

5. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

6. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

7. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

8. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

9. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe
Page 124 of 537

10. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

11. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

12. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

13. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

14. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

15. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

16. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

17. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

18. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

19. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

20. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

21. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

22. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

23. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

24. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe

25. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 or AGE = DK or REF either on the T2 roster or whe
26. Someone not listed

bslryb
DIDDODOES ^YOUHESHE draw a regular salary from ^EMPNAME - that is, take a regular
paycheck, as opposed to just treating the profits as ^YOURHISHER income?
1. Yes
2. No

typpay
^TYPPAYINTRO_FIL Which of the following types of pay DIDDODOES ^TEMPNAME receive
^INEMONTHFILL?
Any other type of pay?
Read answer categories.
Mark all that apply.
If payment is given per service or per unit of production, enter commission and collect monthly total
amounts.
1. Salary or hourly rate?
2. Commission?
Page 125 of 537

3. Tips?
4. Overtime?
5. Bonus pay?

payhr1
H, ? [F1]
Ask or verify
The next questions are about ^PTEMPNAME gross income from ^EMPNAME before taxes and
other deductions. What is the easiest way for you to report ^YOURHISHER pay rate or salary
information...
Read answer categories.
1. Annual salary (pay rate for the year)?
2. Actual gross amount earned in the year?
3. Pay per hour?
4. Pay per week?
5. Pay every two weeks?
6. Pay per month?
7. Pay twice a month?
8. Some other way (report monthly average)?

pyrat1
? [F1]
^QSTNTXT_PYRAT1 ^ISWAS the gross dollar amount of ^PTEMPNAME PHRFILL1 before any
taxes and other deductions?
Extra Pay FR Note

PYRAT1_RANGEANN
C_ISWAS the annual amount...
Read answer categories.
1. Less than $20,000?
2. Between $20,000 and $34,999?
3. Between $35,000 and $49,999?
Page 126 of 537

4. $50,000 or more?

PYRAT1_RANGEHOUR
C_ISWAS this hourly wage...
Read answer categories.
1. Less than $9 per hour?
2. Between $9 and $11.99 per hour?
3. Between $12 and $16.99 per hour?
4. $17 Per hour or more?

PYRAT1_RANGEWKLY
C_ISWAS this weekly pay...
Read answer categories.
1. Less than $400 per week?
2. Between $400 and $599 per week?
3. Between $600 and $999 per week?
4. $1000 or more per week?

PYRAT1_RANGEBWKLY
C_ISWAS this PHRFILL1...
Read answer categories.
1. Less than $800 per period?
2. Between $800 and $1199 per period?
3. Between $1200 and $1999 per period?
4. $2000 or more per period?

PYRAT1_RANGEMTHLY
C_ISWAS this PHRFILL1...
Read answer categories.

Page 127 of 537

1. Less than $1500 per month?
2. Between $1500 and $2499 per month?
3. Between $2500 and $4499 per month?
4. $4500 or more per month?

takehome1
? [F1]
C_ISWAS this take-home pay, or ^ISWAS it gross pay before any taxes and other deductions
^AREWERE taken out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

jobhrs1
? [F1]
^QSTNTXT_JOBHRS1 How many hours per week DIDDODOES ^TEMPNAME usually work at
^EMPNAME ^INEMONTHFILL?
^JOBHRSFILL

ptyn1
? [F1]
C_DIDDODOES ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME?
1. Yes
2. No

ptresn1
I, ? [F1]
What ^ISWAS the main reason ^TEMPNAME WORKSWORKED less than 35 hours per week?
For those respondents who work part-time because they have multiple jobs, select option #2 (wanted
to work part-time).
Page 128 of 537

1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of own injury
4. Temporarily unable to work full-time because of own health concerns or own illness
5. Unable to work full-time because of chronic health condition or disability
6. Taking care of children or other persons, such as due to coronavirus pandemic school closures
7. Full-time work week is less than 35 hours
8. Slack work or business conditions, such as reduced hours due to coronavirus pandemic
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

chearn1
You said ^TEMPNAME ISAREWASWERE paid ^PYRAT1FIL ^PAYHR1FIL ^INEMONTHFILL. Did
^YOURHISHER pay rate change ^BETWEEN_BMONTH_ALTEMONTH?
1. Yes
2. No

chermnth1
In what month was ^PTEMPNAME most recent pay rate change?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
Page 129 of 537

16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

cherweek1
T
In which week did ^PTEMPNAME pay rate change?

payhr2
H, ? [F1]
What type of pay rate or salary did ^TEMPNAME have at ^EMPNAME ^CHERMNTH1...
Read answer categories.
1. Paid an annual salary?
2. Paid by the hour?
3. Paid by the week?
4. Paid once every 2 weeks?
5. Paid once a month?
6. Paid twice a month?
7. Paid some other way (report monthly average)?

pyrat2
? [F1]
What was the gross dollar amount of ^PTEMPNAME PHRFILL2 before any taxes and other
deductions at ^EMPNAME ^CHERMNTH1?

PYRAT2_RANGEANN
Was the annual salary amount...
Read answer categories.
1. Less than $20,000?
Page 130 of 537

2. Between $20,000 and $34,999?
3. Between $35,000 and $49,999?
4. $50,000 or more?

PYRAT2_RANGEHOUR
Was this hourly wage...
Read answer categories.
1. Less than $9 per hour?
2. Between $9 and $11.99 per hour?
3. Between $12 and $16.99 per hour?
4. $17 Per hour or more?

PYRAT2_RANGEWKLY
Was this weekly pay...
Read answer categories.
1. Less than $400 per week?
2. Between $400 and $599 per week?
3. Between $600 and $999 per week?
4. $1000 or more per week?

PYRAT2_RANGEBWKLY
Was this PHRFILL2...
Read answer categories.
1. Less than $800 per period?
2. Between $800 and $1199 per period?
3. Between $1200 and $1999 per period?
4. $2000 or more per period?

PYRAT2_RANGEMTHLY
Was this PHRFILL2...
Page 131 of 537

Read answer categories.
1. Less than $1500 per month?
2. Between $1500 and $2499 per month?
3. Between $2500 and $4499 per month?
4. $4500 or more per month?

takehome2
? [F1]
Was this take-home pay, or was it gross pay before any taxes and other deductions were taken
out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

chhour1
^CHHOUR1FILL
1. Yes
2. No

chhomon1
In what month did ^PTEMPNAME hours change?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
Page 132 of 537

10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

chhoweek1
T
In which week did ^PTEMPNAME hours change?

jobhrs2
? [F1]
How many hours per week did ^TEMPNAME usually work at ^EMPNAME before ^CHHOMON1?
^JOBHRSFILL

ptyn2
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME before this change?

1. Yes
2. No

ptresn2
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
Page 133 of 537

3. Temporarily unable to work full-time because of own injury
4. Temporarily unable to work full-time because of own health concerns or own illness
5. Unable to work full-time because of chronic health condition or disability
6. Taking care of children or other persons, such as due to coronavirus pandemic school closures
7. Full-time work week is less than 35 hours
8. Slack work or business conditions, such as reduced hours due to coronavirus pandemic
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

chearn2
You said ^TEMPNAME WASWERE paid ^PYRAT2FIL ^PAYHR2FIL ^CHERMNTH1. Did
^PTEMPNAME pay rate change Again ^BTWN_BMONTH_CHERMNTH1?
1. Yes
2. No

chermnth2
When did ^PTEMPNAME pay rate change ^BTWN_BMONTH_CHERMNTH1?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
Page 134 of 537

18. June ^INTYEARFIL

cherweek2
T
In which week did ^PTEMPNAME pay rate change?

payhr3
H, ? [F1]
What type of pay rate or salary did ^TEMPNAME have at ^EMPNAME ^CHERMNTH2...
Read answer categories.
1. Paid an annual salary?
2. Paid by the hour?
3. Paid by the week?
4. Paid once every 2 weeks?
5. Paid once a month?
6. Paid twice a month?
7. Paid some other way (report monthly average)?

pyrat3
? [F1]
What was the gross dollar amount of ^PTEMPNAME PHRFILL3 before any taxes and other
deductions ^CHERMNTH2?

PYRAT3_RANGEANN
Was the annual salary amount...
Read answer categories.
1. Less than $20,000?
2. Between $20,000 and $34,999?
3. Between $35,000 and $49,999?
4. $50,000 or more?

PYRAT3_RANGEHOUR
Page 135 of 537

Was this hourly wage...
Read answer categories.
1. Less than $9 per hour?
2. Between $9 and $11.99 per hour?
3. Between $12 and $16.99 per hour?
4. $17 Per hour or more?

PYRAT3_RANGEWKLY
Was this weekly pay...
Read answer categories.
1. Less than $400 per week?
2. Between $400 and $599 per week?
3. Between $600 and $999 per week?
4. $1000 or more per week?

PYRAT3_RANGEBWKLY
Was this PHRFILL3...
Read answer categories.
1. Less than $800 per period?
2. Between $800 and $1199 per period?
3. Between $1200 and $1999 per period?
4. $2000 or more per period?

PYRAT3_RANGEMTHLY
Was this PHRFILL3...
Read answer categories.
1. Less than $1500 per month?
2. Between $1500 and $2499 per month?
3. Between $2500 and $4499 per month?
4. $4500 or more per month?

Page 136 of 537

takehome3
? [F1]
Was this take-home pay, or was it gross pay before any taxes and other deductions were taken
out?
1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

chhour2
^CHHOUR2FILL
1. Yes
2. No

chhomon2
When did ^PTEMPNAME hours change CHHOMONFILL?

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 137 of 537

chhoweek2
T
In which week did ^PTEMPNAME hours change?

jobhrs3
? [F1]
How many hours per week did ^TEMPNAME usually work ^CHHOMON2?
^JOBHRSFILL

ptyn3
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME ^CHHOMON2?

1. Yes
2. No

ptresn3
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of own injury
4. Temporarily unable to work full-time because of own health concerns or own illness
5. Unable to work full-time because of chronic health condition or disability
6. Taking care of children or other persons, such as due to coronavirus pandemic school closures
7. Full-time work week is less than 35 hours
8. Slack work or business conditions, such as reduced hours due to coronavirus pandemic
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

Page 138 of 537

chhour3
^CHHOUR3FILL
1. Yes
2. No

chhomon3
When did ^PTEMPNAME hours change CHHOMON3FILL?

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

chhoweek3
T
In which week did ^PTEMPNAME hours change?

jobhrs4
? [F1]
Page 139 of 537

How many hours per week did ^TEMPNAME usually work ^CHHOMON3?
^JOBHRSFILL

ptyn4
Did ^TEMPNAME usually work 35 hours or more per week for ^EMPNAME before ^CHHOMON3?

1. Yes
2. No

ptresn4
I
What was the main reason ^TEMPNAME worked less than 35 hours per week?
1. Could not find full-time job
2. Wanted to work part-time
3. Temporarily unable to work full-time because of own injury
4. Temporarily unable to work full-time because of own health concerns or own illness
5. Unable to work full-time because of chronic health condition or disability
6. Taking care of children or other persons, such as due to coronavirus pandemic school closures
7. Full-time work week is less than 35 hours
8. Slack work or business conditions, such as reduced hours due to coronavirus pandemic
9. Participated in a job-sharing arrangement
10. On vacation
11. In school
12. Other

oincb
? [F1]
Besides what has already been reported, did ^TEMPNAME receive any other income for Fill for
SELF out of the money that ^EMPNAME brought in?
1. Yes
2. No
Page 140 of 537

oincamt
^QSTNTXT_OINCAMT In ^CALENDAR_YEAR, what was the average monthly amount of other
income ^YOUHESHE usually received from ^EMPNAME?

prftloss
? [F1]
Did ^EMPNAME make a net profit, net loss, or break even for the year ^CALENDAR_YRFIL?
1. Profit (positive)
2. Loss (negative)
3. No profit/break even

prftb
? [F1]
For ^EMPNAME, what was the dollar amount of ^PTEMPNAME share of the ^PRFTLOSSFIL for
the year ^CALENDAR_YRFIL?

prftb_range
Was the amount less than $7,000, between $7,000 and $20,000, between $20,000 and $40,000, or
more than $40,000?
1. Less than $7,000
2. $7,000 to $19,999
3. $20,000 to $39,999
4. $40,000 or more

prftbchk
C_ISWAS ^HISHER own income from ^EMPNAME (that we talked about earlier) reported in this
^PRFTLOSSFIL? Or do we need to subtract ^HISHER income to get a total ^PRFTLOSSFIL?
1. Salary/draw is included in the net profit/loss amount
2. Subtract salary/draw from net profit/loss amount to get total ^PRFTLOSSFIL

fpawopyn1
Page 141 of 537

? [F1]
^C_FPAWOPYN1FILL, did ^TEMPNAME have any time away without pay from ^EMPNAME for a
period of at least two weeks?
Examples include being furloughed due to coronavirus pandemic business closures, or taking care of
children due to school closures.
1. Yes
2. No

fpawopsm1
^C_BEMIN which month did the most recent period of leave without pay begin?
FR Note for FPAWOPSM
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

fpawopsw1
T
In which week did this period of leave without pay begin?
FR notes for FPAWOPSW
Page 142 of 537

fpawopem1
Between ^FPAWOPSM1 and ^EMONTHFILL, in which month did the most recent period of leave
without pay end?
FR note for FPAWOPEM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

fpawopew1
T
In which week did this period of leave without pay end?
FR note for FPAWOPEW

fpawopre1
J, ? [F1]
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff, such as furloughed due to coronavirus pandemic business closures
2. Slack work or business conditions
3. Vacation, scheduled time off, or personal days
Page 143 of 537

4. Teacher on an 8-, 9-, or 10-month contract
5. Own health concerns, injury, illness, or medical problems
6. Taking care of children, such as due to coronavirus pandemic school closures
7. Other family or personal obligations
8. Pregnancy, childbirth, maternity leave, or paternity leave
9. Labor dispute
10. Weather affected job
11. Civic, jury, or military duty
12. Other

fpawopch1
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No

fpawopyn2
? [F1]
^C_FPAWOPYN2FILL ^TEMPNAME have a second period of time away without pay from
^EMPNAME for at least two weeks?
Examples include being furloughed due to coronavirus pandemic business closures, or taking care of
children due to school closures.
1. Yes
2. No

fpawopsm2
^C_FPAWOPSM2FILL what month did the second period of leave without pay begin?
FR Note for FPAWOPSM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
Page 144 of 537

5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

fpawopsw2
T
In which week did the second period of leave without pay begin?
FR notes for FPAWOPSW

fpawopem2
^C_FPAWOPEM2FILL, in which month did the second period of leave without pay end?
FR note for FPAWOPEM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
Page 145 of 537

12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

fpawopew2
T
In which week did the second period of leave without pay end?
FR note for FPAWOPEW

fpawopre2
J, ? [F1]
What was the main reason that ^TEMPNAME did not get paid during this period?
1. On layoff, such as furloughed due to coronavirus pandemic business closures
2. Slack work or business conditions
3. Vacation, scheduled time off, or personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own health concerns, injury, illness, or medical problems
6. Taking care of children, such as due to coronavirus pandemic school closures
7. Other family or personal obligations
8. Pregnancy, childbirth, maternity leave, or paternity leave
9. Labor dispute
10. Weather affected job
11. Civic, jury, or military duty
12. Other

fpawopch2
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No
Page 146 of 537

fpawopyn3
? [F1]
^C_FPAWOPYN3FILL ^TEMPNAME have a third period of time away without pay from
^EMPNAME for at least two weeks?
Examples include being furloughed due to coronavirus pandemic business closures, or taking care of
children due to school closures.
1. Yes
2. No

fpawopsm3
^C_FPAWOPSM3FILL which month did the third period of leave without pay begin?
FR Note for FPAWOPSM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

fpawopsw3
T
In which week did the third period of leave without pay begin?
Page 147 of 537

FR notes for FPAWOPSW

fpawopem3
^C_FPAWOPEM3FILL, in which month did the third period of leave without pay end?
FR note for FPAWOPEM

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

fpawopew3
T
In which week did the third period of leave without pay end?
FR note for FPAWOPEW

fpawopre3
J, ? [F1]
What was the main reason that ^TEMPNAME did not get paid during this period?
Page 148 of 537

1. On layoff, such as furloughed due to coronavirus pandemic business closures
2. Slack work or business conditions
3. Vacation, scheduled time off, or personal days
4. Teacher on an 8-, 9-, or 10-month contract
5. Own health concerns, injury, illness, or medical problems
6. Taking care of children, such as due to coronavirus pandemic school closures
7. Other family or personal obligations
8. Pregnancy, childbirth, maternity leave, or paternity leave
9. Labor dispute
10. Weather affected job
11. Civic, jury, or military duty
12. Other

fpawopch3
Did this period of being away from work without pay reduce the earnings from the annual salary
reported for ^YOURSELF earlier?
1. Yes
2. No

spellcomplete
anymorespells
Did ^TEMPNAME work for ^EMPNAME2 at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

howmany
We've talked about two periods working for ^EMPNAME2. How many other times did
^TEMPNAME work for ^EMPNAME2 since ^MONTH1 1st ^CALENDAR_YRFIL?

anyotherwork
^OTHERWORK

Page 149 of 537

1. Yes
2. No

nojobscreener
I'm showing ^TEMPNAME WASWERE not working for pay during the following ^TIME_S since
^MONTH1 1st ^CALENDAR_YRFIL:
^LFGAPS_TEXTFIL
Have we talked about all times, since ^MONTH1 1st ^CALENDAR_YRFIL, when ^YOUHESHE
worked for pay?
1. Yes
2. No

nomorespells
The jobs and no job topics are complete. Enter 1 to continue.

pwave_complete
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

jobnum
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

periodnum
Page 150 of 537

**NON-DISPLAYED ITEM**

bmonth
**NON-DISPLAYED ITEM**

emonth
**NON-DISPLAYED ITEM**

pvworktran
U, ? [F1]
Let's talk about ^PTEMPNAME commuting expenses, job-related expenses and work schedule
with ^EMPNAME.
During a typical week, what modes of transportation DIDDODOES ^TEMPNAME use to get to
work?
Mark all that apply.
Include all work-related travel.
1. Drove own vehicle
2. Rider in someone else's vehicle/van pool
3. Bus
4. Rail
5. Other public transportation
6. Walked
7. Bicycled
8. Drove company vehicle
9. Worked at home
10. Other

pvtranprim
? [F1]
Which of these methods ^ACCOUNTSACCOUNTED for the greatest distance travelled as part of
^PTEMPNAME work commute?

Page 151 of 537

1. Drove own vehicle
2. Rider in someone else's vehicle/van pool
3. Bus
4. Rail
5. Other public transportation
6. Walked
7. Bicycled
8. Drove company vehicle
9. Worked at home
10. Other

pvtime
? [F1]
How many minutes ^DIDDOES it usually take ^TEMPNAME to get from home to work as part of
^YOURHISHER work commute?

pvmile
? [F1]
How many miles DIDDODOES ^TEMPNAME drive from home to work as part of ^YOURHISHER
work commute?

pvreimbmi
? [F1]
^DIDDOES ^EMPNAME reimburse ^TEMPNAME for the miles driven to work?
1. Yes
2. No

pvreimbmic
? [F1]
How many of those PVMILES miles ^AREWERE reimbursed by ^EMPNAME?

Page 152 of 537

pvpark
? [F1]
DIDDODOES ^TEMPNAME have to pay for parking or tolls as a part of ^YOURHISHER
work-commuting expenses?
Enter 1 for "yes" if ANY parking costs or tolls are out of pocket; enter 2 for "no" if ALL such costs are
reimbursed.
1. Yes
2. No

pvparkc
? [F1]
Typically, how much DIDDODOES^TEMPNAME spend per day for parking or tolls?
Include only costs that were NOT reimbursed.

pvothrc
? [F1]
In a typical day,PVOTHRCFILL about how much ^AREWERE ^PTEMPNAME PVOTHRCFILL2 work
commuting expensesPVOTHRCFILL3?
Enter 0 for "none." Include only work-commuting expenses that were NOT reimbursed.

pvoexpns
? [F1]
^C_BETWEEN_BMONTH_EMONTH, not counting expenses ^PTEMPNAME employer ^PAYSPAID,
DIDDODOES ^TEMPNAME have any work-related expenses such as licenses, permits, union
dues, special tools, or uniforms for ^YOURHISHER work at ^EMPNAME?

1. Yes
2. No

pvoexpnsc
Page 153 of 537

? [F1]
Altogether, ^PVOEXPNS_EMONTHFILL, how much ^AREWERE ^PTEMPNAME expenses for such
items?
Include only work-related expenses that were required for employment and were NOT reimbursed.

wswhdy
? [F1]
During a typical week at ^EMPNAME, which days DIDDODOES ^TEMPNAME work?
Mark all that apply.
If the days that the respondent ^WRKD varies, enter the days that ^HESHE most recently worked for
this job.
1. Monday through Friday
2. Sunday
3. Monday
4. Tuesday
5. Wednesday
6. Thursday
7. Friday
8. Saturday
9. All seven days (every day in a typical week)

wsbeg
? [F1]
(During a typical week at ^EMPNAME,) what time DIDDODOES ^TEMPNAME usually begin work?
Enter the time followed by a.m. or p.m.
12:00 a.m. is midnight and 12:00 p.m. is noon.
If the start time varies, enter the most common start time for this job.

wsend
? [F1]
Page 154 of 537

(During a typical week at ^EMPNAME,) what time DIDDODOES ^TEMPNAME usually end work?
Enter the time as well as a.m. or p.m.
12:00 a.m. is midnight and 12:00 p.m. is noon.
If the end time varies, enter the most common end time for this job.

wshmwrk
? [F1]
As part of ^PTEMPNAME typical work schedule for ^EMPNAME, ^AREWERE there any days
when ^TEMPNAME WORKSWORKED only at home?

1. Yes
2. No

wshomdy
? [F1]
Which days DIDDODOES ^TEMPNAME work only from home?
Mark all that apply.

1. Monday through Friday
2. Sunday
3. Monday
4. Tuesday
5. Wednesday
6. Thursday
7. Friday
8. Saturday
9. All seven days (every day in a typical week)

wsjob
M, ? [F1]

Page 155 of 537

Which of the following best describes ^PTEMPNAME work schedule at ^EMPNAME?
Mark variable work schedules as 6 ("Irregular").

1. Regular daytime schedule
2. Regular evening shift
3. Regular night shift
4. Rotating shift (one that changes regularly from days to evenings to nights)
5. Split shift (one that consists of two distinct periods each day)
6. Irregular schedule (one that changes from day to day)
7. Other - specify

wsoth
Please describe the 'other' type of work schedule.

wsmnr
What is the MAIN reason ^TEMPNAME WORKSWORKED this type of schedule?
DO NOT read answer categories.
1. Requirement of the job
2. Could not get any other job
3. Other involuntary reasons
4. Better pay
5. Better child care arrangements
6. Better arrangements for care of other family members
7. Allows time for school
8. Other voluntary reasons

Page 156 of 537

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

jobnum
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

periodnum
**NON-DISPLAYED ITEM**

bmonth
**NON-DISPLAYED ITEM**

emonth
**NON-DISPLAYED ITEM**

typexpay
Earlier you said ^TEMPNAME received ^TYPEXPAY_FILL while working at ^EMPNAME. Did
these ^TYPEXPAY_FILL ^PAYMENTS occur every month?
1. Yes
2. No

exearnamt1
^QSTNTXT_EXEARNAMT1 In ^CALENDAR_YEAR, ^L_EXEARNFILL much did ^TEMPNAME
usually earn per month in ^TYPEXPAY_FILL?

exearnmnth
^QSTNTXT_EXEARNMNTH During which ^PWEXEARNMNTH_FILL months did ^TEMPNAME earn
^TYPEXPAY_FILL while working for ^EMPNAME?
Page 157 of 537

One Month Spell Fill
Mark all that apply.
1. ^EXMNTH1_CALFIL
2. ^EXMNTH2_CALFIL
3. ^EXMNTH3_CALFIL
4. ^EXMNTH4_CALFIL
5. ^EXMNTH5_CALFIL
6. ^EXMNTH6_CALFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

exearnamt2
How much ^SPELL_AREWERE these ^TYPEXPAY_FILL ^PAYMENTS ^EXEARNMNTH_FILL?
Enter 0 if no ^TYPEXPAY_FILL ^PAYMENTS were earned this month.

typpaycode
**NON-DISPLAYED ITEM**

pwexearnamt1
pwexearnmnth
pwexearnamt2

Page 158 of 537

pwtyppay
pwpayhr1
pwpyrat1
pwpyrat1_rangeann
pwpyrat1_rangehour
pwpyrat1_rangewkly
pwpyrat1_rangebwkly
pwpyrat1_rangemthly
pwjobhrs1
pwptyn1
1. Yes
2. No

pwoincamt
ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
^OJINTRO_QTEXT

bmonth
INFO
This job line collects summary information about all remaining jobs and businesses beyond the 7 jobs
reported on lines 1-7. Ask respondent to think about and report all of ^HISHER work as a WHOLE rather
Page 159 of 537

than separately.
Record separate spells when ^HESHE reports disconnected time periods of employment for these
additional employers.

emonth

SCREENER2
Did ^YOUHESHE have any more time working for pay since ^MONTH1 1st ^CALENDAR_YRFIL
that you have not yet told me about?
1. Yes
2. No

startjan
Did ^TEMPNAME begin this work in ^MONTH1 ^CALENDAR_YRFIL?
1. Yes
2. No

startweek
T
During which week did ^TEMPNAME begin this other work?

endweek
T
During which week did ^TEMPNAME end this other work?

number_of_jobs
How many additional jobs, businesses, or other arrangements DIDDODOES ^TEMPNAME have
^BETWEEN_BMONTH_EMONTH?

jborseoth
Page 160 of 537

? [F1]
^OTHJBFIL you reported ^BETWEEN_BMONTH_EMONTH for ^EMPLOYER, was it
self-employment, was it some other kind of arrangement, or a combination of these?
Mark all that apply.
1. Employer
2. Self-employed (owns a business)
3. Other work arrangement

earn
Including all wages, salaries, tips, commissions, bonuses, and profits, what ^ISWAS the total
amount of ^YOURHISHER gross earnings from ^NOTHJOB ^BETWEEN_BMONTH_EMONTH?
Gross earnings are earnings before any taxes or other deductions.

takehome
C_ISWAS this a take-home amount or ^ISWAS it a gross amount before any taxes and
deductions ^AREWERE taken out?

1. Take-home pay (net, after deductions)
2. Gross (total) pay (before deductions)
3. No deductions (gross pay = net pay)

hours
^C_BETWEEN_BMONTH_EMONTH, DIDDODOES ^YOUHESHE usually work 35 hours or more per
week at ^NOTHJOB?
1. Yes
2. No

ptresn
What ^ISWAS the main reason ^TEMPNAME WORKSWORKED fewer than 35 hours per week at
^NOTHJOB?
1. Worked at one or more other jobs or businesses
Page 161 of 537

2. Could not find full-time job
3. Wanted to work part-time
4. Temporarily unable to work full-time because of injury
5. Temporarily unable to work full-time because of illness
6. Unable to work full-time because of chronic health condition/disability
7. Taking care of children/other persons
8. Full-time work week is less than 35 hours
9. Slack work or material shortage
10. Participated in a job-sharing arrangement
11. On vacation
12. In school
13. Other

spellcomplete
anymorespells
Did ^TEMPNAME work at ^NOTHJOB at any other times since ^MONTH1 1st ^CALENDAR_YRFIL
that you have not yet told me about?
1. Yes
2. No

howmany
We've talked about three periods of employment at ^NOTHJOB. How many other times, since
^MONTH1 1st ^CALENDAR_YRFIL, WASWERE ^YOUHESHE employed at ^NOTHJOB?

anyotherwork
nojobscreener
nomorespells
The job and no job topics are complete. Enter 1 to continue.
1. Continue

pwave_complete
nojobscreener
I'm showing ^TEMPNAME WASWERE not working for pay during the following ^TIME_S since
^MONTH1 1st ^CALENDAR_YRFIL:
Page 162 of 537

^LFGAPS_TEXTFIL
Have we talked about all times, since ^MONTH1 1st, when ^YOUHESHE worked for pay?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PSLOT
SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
Now I'm going to talk to you about time when ^YOUHESHE WASWERE not working for pay.

BMONTH
When did this period of not working for pay start?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
Page 163 of 537

9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
When did the period ^YOUHESHE did not work for pay end?
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

NOWRK_1
K
Why This is the fill for DIDDODONT ^TEMPNAME work for pay
^NWBETWEEN_BMONTH_EMONTH?
Page 164 of 537

Read or show the respondent the answer list.
After each response, ask: Any other reason?
1. Temporarily unable to work because of own injury?
2. Temporarily unable to work because of own health concerns or own illness?
3. Unable to work because of chronic health condition or disability?
4. Retired?
5. Pregnancy or childbirth?
6. Taking care of children or other persons, such as due to coronavirus pandemic school closures?
7. Going to school?
8. Unable to find work?
9. On layoff, such as furloughed due to coronavirus pandemic business closures?
10. Not interested in working at a job?
11. Usually worked 15 or more hours per week without pay in a family business or farm?
12. Other DO NOT READ

UNPDWRKYN
? [F1]
^C_BETWEEN_BMONTH_EMONTH_NOW did ^TEMPNAME work 15 or more hours per week
without pay in a related household member's family business or farm?
1. Yes
2. No

FAM_BUS_KNDIN_1
? [F1]
What kind of business or enterprise is the family business?
(What do they make or do?)

FAM_BUS_TYPIN_1
Is it mainly...
Read answer categories.
1. Manufacturing?
2. Wholesale trade?
Page 165 of 537

3. Retail trade?
4. Service?
5. Or something else (agriculture, construction, government, etc.)?

FAM_BUS_KNDWK_1
What kind of work DIDDODOES ^TEMPNAME do? That is, what ^ISWAS ^YOURHISHER
occupation?
(For example: bookkeeper, plumber, registered nurse)

FAM_BUS_ACTVT_1
What ^AREWERE ^YOURHISHER usual work activities?
(For example: Keeping account books, repairing pipes, patient care)

LAYOFF_1
? [F1]
^LAYOFFFILL ^TEMPNAME spend any time on layoff from a job?
Examples include being forced to leave a job due to slack work, shortages, or business closures such
as those due to the coronavirus pandemic (rather than personal misconduct or the completion of a
temporary job).

1. Yes
2. No

LAYOFF_TYPE_1
When ^TEMPNAME WASWERE laid off, WASWERE ^YOUHESHE either informed that
^YOUHESHE would be recalled to work within 6 months, or given a date to return to work?
Answer YES if the respondent was told to come back to work after government-ordered coronavirus
pandemic business closures are lifted.
1. Yes
2. No

Page 166 of 537

LAYOFF_DURATION
^C_WASWERE ^TEMPNAME on layoff for the entire period?
1. Yes
2. No

LAYOFF_ENDMNTH
In which month did the layoff end?
FR note for ENDMONTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

LAYOFF_ENDWEEK
T
In which week did the layoff end?
FR note for ENDWEEK

LKWRK_1
? [F1]
Page 167 of 537

^LKWRKFILL ^TEMPNAME ACTIVELY look for work in one or more weeks?
1. Yes
2. No

FROM_LKMNTH_11
^C_BEMIN what month did ^TEMPNAME FIRST begin looking for work?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_11
T
In which week did ^TEMPNAME first begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_11
From ^FROM11FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
Page 168 of 537

FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_11
T
In which week did ^TEMPNAME stop looking for work?
^TO_LKWEEKFRNOTE

MORE_STRETCH_12
^C_BTWN_TO11_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No

FROM_LKMNTH_12
^C_LKMNTH12 what month did ^TEMPNAME begin looking for work for the second time?
Page 169 of 537

FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_12
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_12
From ^FROM12FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 170 of 537

6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_12
T
In which week did ^TEMPNAME stop looking for work?
^TO_LKWEEKFRNOTE

MORE_STRETCH_13
^C_BTWN_TO12_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No

FROM_LKMNTH_13
^C_LKMNTH13 what month did ^TEMPNAME begin looking for work for the third time?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 171 of 537

6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_13
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_13
From ^FROM13FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
Page 172 of 537

13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TO_LKWEEK_13
T
In which week did ^TEMPNAME stop looking for work?
^TO_LKWEEKFRNOTE

MORE_STRETCH_14
^C_BTWN_TO13_EMONTH there any more time periods when ^TEMPNAME WASWERE looking
for work?
1. Yes
2. No

FROM_LKMNTH_14
^C_LKMNTH14 what month did ^TEMPNAME begin looking for work for the fourth time?
FR note for FROM_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
Page 173 of 537

13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FROM_LKWEEK_14
T
In which week did ^TEMPNAME begin looking for work?
FR note for FROM_LKWEEK

TO_LKMNTH_14
From ^FROM14FILL to ^EMONTHFILL, in what month did ^TEMPNAME stop looking for work?
FR Note for TO_LKMNTH
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 174 of 537

TO_LKWEEK_14
T
In which week did ^TEMPNAME stop looking for work?
^TO_LKWEEKFRNOTE

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME have any other times not working for pay since ^MONTH1 1st
^CALENDAR_YRFIL?

HOWMANY
We've talked about six periods of time not working for pay. How many other times, since
^MONTH1 1st ^CALENDAR_YRFIL, did ^YOUHESHE spend not working for pay?

ANYOTHERWORK
NOJOBSCREENER
NOMORESPELLS
The no jobs topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
Page 175 of 537

**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

R_SSIWHY
SSI_FLG
INTRO
(Next are some questions about assistance programs for people in need.) ^SSIINTROTEXT

INFO
(SSI is not the same as Social Security. Income from Social Security is asked about later.
SSI provides assistance to low-income children and adults who are blind or disabled, as well as
low-income people over age 65 who are not blind or disabled.)
Do NOT include SSI received on behalf of someone else.

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
Page 176 of 537

18. June ^INTYEARFIL

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving SSI
continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

SSI_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving SSI
continuously?
1. January
2. February
3. March
Page 177 of 537

4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

SSI_WHY
Why did ^TEMPNAME begin receiving SSI^SSI_BMONTHFIL?
Mark all that apply.
1. Disabled
2. Blind
3. Aged (65 and over)
4. Other

SSI_STOP
? [F1]
What were the reasons ^TEMPNAME stopped receiving SSI in ^EMONTHFILL?
1. Increased earned income (wages from a job)
2. Increased unearned income (benefits from a program, such as Social Security)
3. Increased resources (assets, such as a car)
4. No longer disabled
5. Other program requirements not met
6. Chose not to collect/the money is not worth it
7. Other

SSI_PAYMENT
C_DIDDODOES ^TEMPNAME receive ^PTEMPNAME monthly SSI benefit in one or two
payments?
1. One
Page 178 of 537

2. Two

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 179 of 537

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT
(Let's talk about the first payment you reported.)
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

SSI1_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

Page 180 of 537

SSI1_AMT1_START
When did ^TEMPNAME start receiving ^SSIAMT1_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT2
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

SSI1_AMT2_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
Page 181 of 537

5. $800 or more

SSI1_AMT2_START
When did ^TEMPNAME start receiving ^SSIAMT2_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT3
How much did ^TEMPNAME receive before ^SSI_AMT2_STARTFIL?

SSI1_AMT3_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
Page 182 of 537

3. $400-599
4. $600-799
5. $800 or more

SSI1_AMT3_START
When did ^TEMPNAME start receiving ^SSIAMT3_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_AMT4
How much did ^TEMPNAME receive before ^SSI_AMT3_STARTFIL?

SSI1_AMT4_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
Page 183 of 537

1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI1_AMT4_START
When did ^TEMPNAME start receiving ^SSIAMT4_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI1_STARTAMT
How much did ^TEMPNAME receive in ^BMONTHFILL?

SSI1_SRC
^SSISRC
Page 184 of 537

Read answer categories.
1. Federal Government?
2. State Government?
3. Combined (both federal and state)?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
Page 185 of 537

14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT
Let's talk about the second payment you reported earlier.
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

SSI2_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
Page 186 of 537

$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT1_START
When did ^TEMPNAME start receiving ^SSIAMT1_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT2
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

SSI2_AMT2_GUESS
Page 187 of 537

L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT2_START
When did ^TEMPNAME start receiving ^SSIAMT2_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT3
How much did ^TEMPNAME receive before ^SSI_AMT2_STARTFIL?

Page 188 of 537

SSI2_AMT3_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT3_START
When did ^TEMPNAME start receiving ^SSIAMT3_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_AMT4
How much did ^TEMPNAME receive before ^SSI_AMT3_STARTFIL?

Page 189 of 537

SSI2_AMT4_GUESS
L
What would you estimate the monthly amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

SSI2_AMT4_START
When did ^TEMPNAME start receiving ^SSIAMT4_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

SSI2_STARTAMT
How much did ^TEMPNAME receive in ^BMONTHFILL?

Page 190 of 537

SSI2_SRC
^SSISRC
Read answer categories.
1. Federal Government?
2. State Government?
3. Combined (both federal and state)?

SSI_OWNER
Who received payments on behalf of ^TEMPNAME?

1. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

2. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

3. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

4. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

5. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

6. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

7. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

8. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

9. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

10. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

11. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

12. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

13. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

14. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

15. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

16. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

17. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

18. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

19. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

20. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

21. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

22. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

23. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

24. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=

25. LNO ^FNAME ^LNAME of all people on final household roster 18 years and older (and PEOPLE_TO_ROSTER=
26. Someone not listed

Page 191 of 537

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME receive SSI at any other times since the ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of SSI receipt. How many other times did ^YOUHESHE receive
SSI since ^MONTH1 1st ^CALENDAR_YRFIL?

NOMORESPELLS
The SSI topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
Page 192 of 537

(Next are some questions about assistance programs for people in need.) ^FSINTROTEXT

INFO
(The Food Stamp Program, or Supplemental Nutrition Assistance Program - SNAP, was created to
assist low-income households in buying the food they need for good health and nutrition. The benefit
amount allowed to a household varies by the household's size and monthly cash income. Benefits are
generally provided through plastic electronic card called an Electronic Benefit Transfer (EBT).)

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 193 of 537

6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving Food
Stamps or SNAP continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

FS_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving Food
Stamps or SNAP continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

FS_BEGIN
Page 194 of 537

What changed in ^PTEMPNAME life to cause ^YOUHIMHER to receive Food Stamps or
SNAP^FS_BMONTHFIL?
Mark all that apply.
1. New child (or other dependent) or pregnancy
2. Separation, divorced or widowed
3. Job loss/layoff or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

FS_STOP
What were the reasons ^TEMPNAME stopped receiving Food Stamps or SNAP ^SPELLEND?
Mark all that apply.
1. Became ineligible because of an increase in income
2. Became ineligible because of family changes (family member left, over age limit, etc)
3. Still eligible but could not / chose not to collect
4. Became ineligible because program requirements were not met (did not attend school, job training, etc)
5. Eligibility ran out because of time limits
6. The money/benefits were not worth the trouble to continue enrollment
7. Other

FS1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

FS1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
Page 195 of 537

2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT1_START
When did ^TEMPNAME start receiving ^FSAMT1_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

FS2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
Page 196 of 537

1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT2_START
When did ^TEMPNAME start receiving ^FSAMT2_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?

FS3_GUESS
L

Page 197 of 537

What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT3_START
When did ^TEMPNAME start receiving ^FSAMT3_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?

FS4_GUESS
Page 198 of 537

L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

FS_AMT4_START
When did ^TEMPNAME start receiving ^FSAMT4_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

FS_COV
Please list everyone (including yourself) who ^ISWAS_COV covered by ^YOURHISHER benefits at
any time ^BETWEEN_BMONTH_EMONTH.
Page 199 of 537

Mark all that apply.

1. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

2. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

3. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

4. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

5. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

6. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

7. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

8. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

9. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

10. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

11. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

12. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

13. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

14. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

15. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

16. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

17. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

18. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

19. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

20. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

21. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

22. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

23. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

24. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

25. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_
26. Someone not listed

FS_OWNER
In whose name ^AREWERE benefits received?
1. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 200 of 537

7. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
26. Someone not listed

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME receive Food Stamps or SNAP benefits at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of Food Stamps or SNAP benefit receipt. How many other times
did ^YOUHESHE receive Food Stamps or SNAP benefits since ^MONTH1 1st
^CALENDAR_YRFIL?

NOMORESPELLS
The Food Stamps or SNAP topic is complete.

Page 201 of 537

Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^TANFINTROTEXT.

INFO
(In this area you may know this as ^TANFFIL1 or ^TANFFIL2 or ^TANFFIL3. Pass-through child support
is also called called bonus child support and disregard payments.)

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
Page 202 of 537

6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving
Page 203 of 537

payments continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

TANF_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving
payments continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

TANF_BEG
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need
assistance^TANF_BMONTHFIL?
Mark all that apply.
1. New child (or other dependent) or pregnancy
2. Separation, divorce, or widowed
3. Job loss or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

TANF_STOP
Page 204 of 537

What were the reasons ^TEMPNAME stopped receiving payments ^SPELLEND?
Mark all that apply.
1. Got a job or earnings increased
2. Family situation changed
3. Others in the household earned enough money
4. Penalized or sanctioned for non-cooperation
5. Time limit expired
6. Didn't want to use up time limit
7. Chose not to participate
8. The money is not worth it
9. Other

TANF1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

TANF1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT1_START
When did ^TEMPNAME start receiving ^TANFAMT1_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
Page 205 of 537

4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

TANF2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT2_START
When did ^TEMPNAME start receiving ^TANFAMT2_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
Page 206 of 537

2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?

TANF3_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT3_START
When did ^TEMPNAME start receiving ^TANFAMT3_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
Page 207 of 537

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?

TANF4_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

TANF_AMT4_START
When did ^TEMPNAME start receiving ^TANFAMT4_FIL?

Page 208 of 537

If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

TANF_ADULT_KID
Do these benefits cover children only, both children and adults, or only a pregnant woman?
1. Only children
2. Both children and adults
3. Only a pregnant woman

TANF_COV
Please list Coverage roster fill for TANF_COV question who ^ISWAS_COV covered by
^YOURHISHER benefits at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply.

1. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

2. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

3. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

4. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_
Page 209 of 537

5. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

6. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

7. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

8. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

9. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

10. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

11. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

12. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

13. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

14. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

15. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

16. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

17. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

18. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

19. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

20. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

21. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

22. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

23. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

24. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

25. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_
26. Someone not listed

TANF_OWNER
In whose name ^AREWERE benefits received?
1. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 210 of 537

12. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
18. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
26. Someone not listed

PASSTHRU_YN
? [F1]
Now I am going to ask you questions about receipt of pass-through child support
^BETWEEN_BMONTH_EMONTH.
At any time during this period, DIDDODOES ^TEMPNAME receive any child support as a bonus
or pass-through from a state or county welfare program, or any disregard payment?
Pass-through child support may also be known as "bonus child support" or "disregard payments."
1. Yes
2. No

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME receive TANF at any other times since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
Page 211 of 537

We've talked about three periods of TANF receipt. How many other times did ^TEMPNAME
receive TANF since ^MONTH1 1st ^CALENDAR_YRFIL?

NOMORESPELLS
The TANF topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^GAINTROTEXT.

INFO
(Fill containing sentence for the state GA program Names on the info screen These benefits may help
the disabled, elderly, or unemployed, as well as families with children. This may be a one-time
emergency payment or regular monthly payments.)

BMONTH
Page 212 of 537

^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
Page 213 of 537

16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving General
Assistance continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

GA_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving
General Assistance continuously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

GA_BEG
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need
assistance^GA_BMONTHFIL?
Mark all that apply.
1. New child (or other dependent) or pregnancy
2. Separation, divorce, or widowed
3. Job loss or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
Page 214 of 537

6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

GA_STOP
What were the reasons ^TEMPNAME stopped receiving General Assistance ^SPELLEND?
Mark all that apply.
1. Got a job or earnings increased
2. Family situation changed
3. Others in the household earned enough money
4. Penalized or sanctioned for non-cooperation
5. Time limit expired
6. Didn't want to use up time limit
7. Chose not to participate
8. The money is not worth it
9. Other

GA1_AMT
How much DIDDODOES ^TEMPNAME receive ^IN_EMONTHFIL?

GA1_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

GA_AMT1_START
When did ^TEMPNAME start receiving ^GAAMT1_FIL?
Page 215 of 537

If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA2_AMT
How much did ^TEMPNAME receive before ^AMT1_STARTFIL?

GA2_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

Page 216 of 537

GA_AMT2_START
When did ^TEMPNAME start receiving ^GAAMT2_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA3_AMT
How much did ^TEMPNAME receive before ^AMT2_STARTFIL?

GA3_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
Page 217 of 537

GA_AMT3_START
When did ^TEMPNAME start receiving ^GAAMT3_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA4_AMT
How much did ^TEMPNAME receive before ^AMT3_STARTFIL?

GA4_GUESS
L
What would you estimate the monthly amount to be - less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more
Page 218 of 537

GA_AMT4_START
When did ^TEMPNAME start receiving ^GAAMT4_FIL?
If the respondent began receiving this amount prior to January ^CALENDAR_YRFIL,
enter January ^CALENDAR_YRFIL.
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

GA_COV
Please list everyone (including yourself) who ^ISWAS_COV covered by ^YOURHISHER benefits
at any time ^BETWEEN_BMONTH_EMONTH.
Mark all that apply.

1. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

2. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

3. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

4. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

5. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

6. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

7. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

8. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

9. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

10. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_
Page 219 of 537

11. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

12. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

13. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

14. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

15. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

16. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

17. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

18. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

19. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

20. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

21. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

22. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

23. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

24. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_

25. LNO ROST_FNAME ROST_LNAME of all people regardless of age on (the final HH roster where PEOPLE_TO_
26. Someone not listed

GA_OWNER
In whose name ^AREWERE benefits received?
1. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
2. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
3. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
4. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
5. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
6. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
7. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
8. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
9. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
10. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
11. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
12. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
13. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
14. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
15. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
16. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
17. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
Page 220 of 537

18. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
19. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
20. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
21. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
22. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
23. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
24. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
25. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older
26. Someone not listed

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME receive General Assistance benefits at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of General Assistance benefit receipt. How many other times
did ^TEMPNAME receive General Assistance benefits since ^MONTH1 1st ^CALENDAR_YRFIL?

NOMORESPELLS
The General Assistance topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

Page 221 of 537

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
(Next are some questions about assistance programs for people in need.) ^WICINTROTEXT.

INFO
(The WIC program serves low-income pregnant or nursing women, and infants and children up to age 5,
by providing nutritious foods to supplement diets.)

BMONTH
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL
Page 222 of 537

EMONTH
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

WIC_LC_YEAR
Prior to ^MONTH1 ^CALENDAR_YRFIL, what YEAR did ^TEMPNAME first start receiving WIC
continuously?
If receipt began in ^MONTH1 ^CALENDAR_YRFIL, enter ^YR_FIL.

WIC_LC_MONTH
Prior to ^MONTH1 ^CALENDAR_YRFIL, what MONTH did ^TEMPNAME first start receiving WIC
continously?
1. January
2. February
3. March
4. April
5. May
6. June
7. July
Page 223 of 537

8. August
9. September
10. October
11. November
12. December

WIC_BEGIN
What changed in ^PTEMPNAME life to cause ^YOUHIMHER to need
assistance^WIC_BMONTHFIL?
Mark all that apply.
1. New child (or other dependent) or pregnancy
2. Separation, divorced or widowed
3. Job loss/layoff or wages reduced
4. Loss or reduction of other income
5. Became disabled or otherwise unable to work
6. No change - just decided it was time
7. No change - just heard about the program
8. Needed to re-certify
9. Other

WIC_STOP
What were the reasons ^TEMPNAME stopped receiving WIC ^SPELLEND?
1. Became ineligible because of an increase in income
2. Became ineligible because of family changes (family member left, over age limit, etc)
3. Still eligible but could not / chose not to collect
4. Became ineligible because program requirements were not met (did not attend school, job training, etc)
5. Eligibility ran out because of time limits
6. The money/benefits were not worth the trouble to continue enrollment
7. Other

WIC_COV
^DIDDO these benefits cover only children, only pregnant or nursing women aged 15 or older, or
both?
1. Only children
Page 224 of 537

2. Only a pregnant or nursing woman
3. Both a woman and children

WIC_ADULT_COV
Ask or verify
Which woman ^DIDDOES ^PTEMPNAME benefits cover?

1. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

2. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

3. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

4. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

5. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

6. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

7. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

8. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

9. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

10. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

11. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

12. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

13. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

14. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

15. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

16. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

17. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

18. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

19. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

20. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

21. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

22. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

23. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

24. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP

25. LNO ^FNAME ^LNAME of all women AGE >= 15 on (the final HH roster, excluding the respondent, where PEOP
26. Someone not listed

WIC_KID_COV
Which child or children DODID ^PTEMPNAME benefits cover?
Mark all that apply.
Page 225 of 537

1. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

2. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

3. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

4. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

5. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

6. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

7. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

8. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

9. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

10. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

11. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

12. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

13. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

14. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

15. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

16. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

17. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

18. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

19. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

20. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

21. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

22. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

23. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

24. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE

25. LNO ^FNAME ^LNAME of all children AGE < 7 on (the final HH roster, excluding the respondent, where PEOPLE
26. Other child not listed

SPELLCOMPLETE
ANYMORESPELLS
Did ^TEMPNAME receive WIC at any other times since ^MONTH1 1st ^CALENDAR_YRFIL?
1. Yes
2. No

HOWMANY
We've talked about three periods of WIC receipt. How many other times did ^TEMPNAME receive
WIC since ^MONTH1 1st ^CALENDAR_YRFIL?
Page 226 of 537

NOMORESPELLS
The WIC topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SPELLNUMBER
**NON-DISPLAYED ITEM**

PRIVNUMBER
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

INTRO
^PRIVATE_INTROQTEXT

bmonth
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
Page 227 of 537

4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

emonth
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

Page 228 of 537

ownins
? [F1]
(Health insurance plans are usually obtained in one person's name even if other family members are
covered. That person is called the policyholder.) Who ^ISWAS the policyholder for this plan?

1. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

2. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

3. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

4. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

5. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

6. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

7. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

8. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

9. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

10. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

11. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

12. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

13. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

14. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

15. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

16. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

17. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

18. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

19. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

20. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

21. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

22. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

23. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

24. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

25. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=
26. Someone outside of the household

privtype
? [F1]
What ^ISWAS the source of ^HIPHOLDER coverage? C_ISWAS it through...
Read answer categories.
If the respondent obtained this insurance from a job that ended during the reference period, select
Page 229 of 537

Option 1 (an employer or job).

1. an Employer or Job Fill used to specify type (current or former) of Employer or Union Private Health Insurance c
2. a Former Employer ?
3. a Union or Association ?
4. bought it directly?
5. school?
6. or something else?

privoth
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.

hicost
CC,? [F1]
C_DOESDID ^HIPHOLDER ^EMPUNION pay all, part, or none of the premium of the plan?
1. All
2. Part
3. None

INFO
(Private health insurance includes comprehensive medical insurance plans provided through an
employer or union, as well as plans purchased directly from an insurance company individually or as part
of a group.)
DO NOT include plans that contain only one type of coverage, like dental-only or vision-only plans.

privunit
Other than ^TEMPNAME, who else ^ISWAS covered by this plan Health Insurance fill used to
specify the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered
2 or more month?
Mark all that apply.
0. Nobody

1. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

2. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

3. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo
Page 230 of 537

4. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

5. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

6. LNO FNAMEL NAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

7. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

8. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

9. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

10. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

11. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

12. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

13. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

14. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

15. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

16. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

17. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

18. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

19. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

20. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

21. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

22. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

23. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

24. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

25. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 f
26. Someone outside of the household
27. All household members

hiothr
C_DOESDID this plan also cover anyone else who ^DIDDOES NOT live in this household?
1. Yes
2. No

hiwho
Who outside of this household ^DIDDOES the plan cover?
Read answer categories.
Mark all that apply.
1. Child under 18
Page 231 of 537

2. Child 18-25
3. Child 26 or over
4. Spouse/partner
5. Other

privplan
? [F1]
C_ISWAS this plan...
Read answer categories.
Ask if necessary: (Please check ^YOURHISHER insurance card for type of coverage plan).
1. An HMO (Health Maintenance Organization) or IPA (Individual Practice Association)?
2. A PPO (Preferred Provider Organization)?
3. A POS (Point-of-service)?
4. A fee-for-service or indemnity?
5. Some other kind of plan?

hdedpln
CC,? [F1]
Is the ^HDEDFILL1 annual deductible for medical care for this plan ^HDEDFILL2 or more?
1. Yes (^HDEDFILL2 or more)
2. No (Less than ^HDEDFILL2)

hlthsav
? [F1]
As part of this plan, ^ISWAS there a special account or fund used to pay for medical expenses?
(These accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement
Accounts (HRAs), Personal Care Accounts, Personal Medical Funds, or Choice Funds and are different
from Flexible Spending Accounts.)
1. Yes
2. No

Page 232 of 537

PRIEXCH
CC
C_ISWAS this coverage through EXCHSHOP? In ^STATE, this is known as
Read List:
[Display list of program names as defined in 'SIPP State Fills.txt' for the appropriate state (i.e. where
^STATE=column 1 of input document). If PRIVTYPE=(1 or 2), use columns 16-19; Else, use columns
12-15.]
1. Yes
2. No

PRIPREM
CC
C_ISWAS there a monthly premium for this plan?
A monthly premium is a fixed amount of money people pay each month to have health coverage. It
does not include copays or other expenses such as prescription costs.

1. Yes
2. No

PRISUBS
CC
C_ISWAS the cost of the premium subsidized based on Fill to determine if Health Exchange
premium was subsidized. income?
A monthly premium is a fixed amount of money people pay each month to have health coverage. It
does not include copays or other expenses such as prescription costs.

1. Yes
2. No

privend
Page 233 of 537

? [F1]
What was the reason this insurance plan coverage ended?
Mark all that apply.
1. Fill for Reasons Uninsured Answer list
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. Fill for Reasons Uninsured Answer list
6. Other

spellcomplete
anymorespells
^C_WASWERE ^TEMPNAME covered by another private health insurance plan since ^MONTH1
1st ^CALENDAR_YRFIL?
^PRIVATE_ANYMOREFIL

1. Yes
2. No

howmany
^PRIVATE_HOWMANYQTEXT

nomorespells
^PRIVATE_NOMOREFRNOTE

1. Continue

pwave_complete
**NON-DISPLAYED ITEM**

Page 234 of 537

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

bmonth
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

emonth
^MEDICARE_TOTEXT
Page 235 of 537

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

INTRO
^MEDICAREINTROTEXT

mcpart
AA
The Medicare Program contains a number of different kinds of plans. Please tell me which of
these plan types ^YOUHESHE ISAREWASWERE covered by...
Read answer categories.
Mark all that apply.
1. Part A (Hospital Insurance)?
2. Part B?
3. A Supplement?
4. Part C or Medicare Advantage?
5. Part D (Prescription Drug Coverage)?

Page 236 of 537

INFO
Respondents may confuse MediCAID, the health insurance program for low-income people, with
MediCARE. Medicare is mostly for the elderly, and it is NOT based on income. Respondents may have
both Medicare and Medicaid. Please report Medicare here, and Medicaid on the Medical Assistance
line.

spellcomplete
anymorespells
howmany
nomorespells
The Medicare topic is complete.
Enter 1 to continue.
1. Continue

PWAVE_COMPLETE
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

bmonth
^FROMTEXT

Page 237 of 537

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

emonth
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
Page 238 of 537

17. May ^INTYEARFIL
18. June ^INTYEARFIL

mdunit
Other than ^TEMPNAME, who else had this kind of coverage Health Insurance fill used to specify
the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered 2 or
more month?
Mark all that apply.
Include persons even if they were covered by different Medicaid, S-CHIP, or Medical Assistance
programs.
0. Nobody

1. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

2. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

3. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

4. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

5. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

6. LNO FNAMEL NAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

7. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

8. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

9. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

10. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

11. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

12. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

13. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

14. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

15. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

16. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

17. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

18. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

19. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

20. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

21. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

22. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

23. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

24. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

25. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 f
26. Someone outside of the household
Page 239 of 537

27. All household members

INTRO
^MEDICAIDINTROTEXT

mdplan
? [F1]
C_ISWAS this plan...
Read answer categories.
1. An HMO (Health Maintenance Organization)?
2. A fee-for-service plan?
3. Another managed-care type program?
4. Some other kind of plan?

INFO
For example, Medical Assistance programs in ^STATE are called
Read list:

Respondents may have both Medicare and Medicaid. Please report Medicaid here, and Medicare
plans on the Medicare line above.

MDEXCH
CC
C_ISWAS this coverage through the Health Insurance Marketplace? In ^STATE, this is known as
Read list:
Display list of program names as defined in 'SIPP State Fills.txt' for the
appropriate state (i.e. where ^STATE=column 1 of the input document), using
columns 12-15.
1. Yes
2. No

Page 240 of 537

MDPREM
CC
C_ISWAS there a monthly premium for this plan?
A monthly premium is a fixed amount of money people pay each month to have health coverage. It
does not include copays or other expenses such as prescription costs.
1. Yes
2. No

MDSUBS
CC
C_ISWAS the cost of the premium subsidized based on Fill to determine if Health Exchange
premium was subsidized. income?
A monthly premium is a fixed amount of money people pay each month to have health coverage. It
does not include copays or other expenses such as prescription costs.

1. Yes
2. No

mdend
? [F1]
What was the reason this coverage ended?
Mark all that apply.
1. Fill for Reasons Uninsured Answer list
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. Fill for Reasons Uninsured Answer list
6. Other

spellcomplete
Page 241 of 537

anymorespells
WASWERE ^TEMPNAME covered by Medicaid, or CHIP, or any other government program that
helps pay health care costs for low-income people at any other times since ^MONTH1 1st
^CALENDAR_YRFIL?
1. Yes
2. No

howmany
We've talked about six periods of Medicaid coverage. How many other times WASWERE
^TEMPNAME covered by Medicaid since ^MONTH1 1st ^CALENDAR_YRFIL?

nomorespells
The Medicaid topic is complete.
Enter 1 to continue.
1. Continue

pwave_complete
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**
Page 242 of 537

bmonth
^FROMTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

emonth
^TOTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
Page 243 of 537

15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

militype
What type of military or VA health coverage DIDDODOES ^YOUHESHE have? C_ISWAS it ...
Read answer categories.
1. TRICARE or CHAMPUS?
2. CHAMPVA?
3. VA?
4. Other?

INTRO
^MILIINTROTEXT

milioth
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.

INFO
("CHAMPVA" is the civilian health and medical program of the Department of Veterans Affairs.)

mownins
? [F1]
Who ^ISWAS the policyholder or sponsor for this plan?

1. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

2. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

3. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

4. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

5. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

6. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=
Page 244 of 537

7. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

8. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

9. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

10. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

11. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

12. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

13. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

14. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

15. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

16. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

17. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

18. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

19. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

20. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

21. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

22. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

23. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

24. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=

25. LNO ^FNAME ^LNAME of all people on final household roster 15 years and older (and PEOPLE_TO_ROSTER=
26. Someone outside of the household

miliunit
Other than ^TEMPNAME, who else ^ISWAS covered by this plan Health Insurance fill used to
specify the specific month(s) of coverage (during, if covered 1 month) (from...through, if covered
2 or more month?
Mark all that apply.
0. Nobody

1. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

2. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

3. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

4. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

5. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

6. LNO FNAMEL NAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

7. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

8. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

9. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

10. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo
Page 245 of 537

11. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

12. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

13. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

14. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

15. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

16. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

17. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

18. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

19. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

20. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

21. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

22. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

23. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

24. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 fo

25. LNO FNAME LNAME of all people on final household roster regardless of age (and PEOPLE_TO_ROSTER=1 f
26. Someone outside of the household
27. All household members

mhioth
C_DOESDID this plan also cover anyone else who ^DIDDOES NOT live in this household?
1. Yes
2. No

MHIWHO
Who outside of this household ^DIDDOES the plan cover?
Read answer categories.
Mark all that apply.
1. Child under 18
2. Child 18-25
3. Child 26 or over
4. Spouse/partner
5. Other

miliend
Page 246 of 537

? [F1]
What was the reason this Military-based health coverage ended?
Mark all that apply.
1. Fill for Reasons Uninsured Answer list
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. Fill for Reasons Uninsured Answer list
6. Other

spellcomplete
anymorespells
Did ^TEMPNAME have military or VA health coverage at any other time since ^MONTH1 1st
^CALENDAR_YRFIL?

1. Yes
2. No

howmany
We've talked about four periods of military health care coverage. How many other times
WASWERE ^TEMPNAME covered by military health care coverage since ^MONTH1 1st
^CALENDAR_YRFIL?

nomorespells
The military insurance topic is complete.
Enter 1 to continue.
1. Continue

pwave_complete
**NON-DISPLAYED ITEM**

Page 247 of 537

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

spellnumber
**NON-DISPLAYED ITEM**

PERIODNUM
**NON-DISPLAYED ITEM**

bmonth
^FROMTEXT
1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

INFO
DO NOT include plans that contain only one type of coverage, like dental-only or vision-only plans.
Page 248 of 537

emonth
^TOTEXT

1. January ^CALENDAR_YRFIL
2. February ^CALENDAR_YRFIL
3. March ^CALENDAR_YRFIL
4. April ^CALENDAR_YRFIL
5. May ^CALENDAR_YRFIL
6. June ^CALENDAR_YRFIL
7. July ^CALENDAR_YRFIL
8. August ^CALENDAR_YRFIL
9. September ^CALENDAR_YRFIL
10. October ^CALENDAR_YRFIL
11. November ^CALENDAR_YRFIL
12. December ^CALENDAR_YRFIL
13. January ^INTYEARFIL
14. February ^INTYEARFIL
15. March ^INTYEARFIL
16. April ^INTYEARFIL
17. May ^INTYEARFIL
18. June ^INTYEARFIL

othcovtype
? [F1]
What type of health coverage is this...
Read answer categories.
1. Government or public assistance?
2. Through someone else (parent, relative)?
3. Indian Health Services?
4. Some other source?

othcovoth
You said ^TEMPNAME HADHASHAVE some other type of coverage. Please explain.

OTHEXCH
Page 249 of 537

CC
C_ISWAS this coverage through the Health Insurance Marketplace? In ^STATE, this is known as
Read list:
Display list of program names as defined in 'SIPP State Fills.txt' for the
appropriate state (i.e. where ^STATE=column 1 of input document), using
columns 12-15.
1. Yes
2. No

OTHPREM
CC
C_ISWAS there a premium for this plan?
A monthly premium is a fixed amount of money people pay each month to have health coverage. It
does not include copays or other expenses such as prescription costs.

1. Yes
2. No

OTHSUBS
CC
C_ISWAS the cost of the premium subsidized based on Fill to determine if Health Exchange
premium was subsidized. income?
A monthly premium is a fixed amount of money people pay each month to have health coverage. It
does not include copays or other expenses such as prescription costs.

1. Yes
2. No

othend
What was the reason this insurance plan coverage ended?
Page 250 of 537

Mark all that apply.
1. Fill for Reasons Uninsured Answer list
2. ^JOBLOSS
3. No longer eligible
4. Unhappy with plan
5. Fill for Reasons Uninsured Answer list
6. Other

spellcomplete
anymorespells
WASWERE ^TEMPNAME covered by another health insurance plan at any other times since
^MONTH1 1st ^CALENDAR_YRFIL? (Perhaps a government program, Indian Health Services, or a
policy through a parent, a foreign government, or any other source?)
1. Yes
2. No

howmany
We've talked about four periods of other health care coverage. How many other times
WASWERE ^TEMPNAME covered by other health insurance since ^MONTH1 1st
^CALENDAR_YRFIL?

nomorespells
The other health insurance topic is complete.
Enter 1 to continue.
1. Continue

pwave_complete

CTRLNUM
**NON-DISPLAYED ITEM**

Page 251 of 537

LNO
**NON-DISPLAYED ITEM**

EXCH
**NON_DISPLAYED ITEM**

NOESI
**NON-DISPLAYED ITEM**

NOPRIVCOV
**NON-DISPLAYED ITEM**

NOHICOV
**NON-DISPLAYED ITEM**

HIFU_INTRO
? [F1]
The next section of the interview includes a few follow-up questions based on the health
insurance information you have already provided.
1. Enter 1 to continue

EMPNOESI
During ^CALENDAR_YEAR, there was a time when ^TEMPNAME ^WEREWAS employed, but did
not have health coverage through ^HISHER job. Did ^HISHER employer offer health insurance to
any of its employees then?
If a respondent had more than one employer during this time, and at least one employer offered health
insurance to any of its employees, then answer Yes.
1. Yes
2. No

WHYNOESI
X, ? [F1]

Page 252 of 537

Why didn't ^TEMPNAME sign up for this insurance?
Mark all that apply.
If a respondent had more than one employer that offered health insurance to its employees during this
time, then mark all reasons the respondent did not sign up for health insurance through both or all of
these employers.
1. Fill for Reasons Uninsured Answer list
2. Haven't worked for this employer long enough
3. Part-Time, Temporary, or Contract employee
4. Fill for Reasons Uninsured Answer list
5. Healthy (haven't needed health insurance)
6. Able to get care elsewhere (such as a health clinic)
7. Fill for Reasons Uninsured Answer list
8. Dissatisfied or don't believe in insurance
9. Fill for Reasons Uninsured Answer list
10. Fill for Reasons Uninsured Answer list
11. Other

NOESIOTH
(What was that "other" reason?)

WHYNOPRI
Y, ? [F1]
Fill for WHYNOPRI based on coverage
Fill for WHYNOPRI based on coverage18
Mark all that apply.
Health Insurance exchange information
1. Fill for Reasons Uninsured Answer list
2. Haven't worked for this employer long enough
3. Part-Time, Temporary, or Contract employee
4. Fill for Reasons Uninsured Answer list
5. Healthy (haven't needed health insurance)
6. Able to get care elsewhere (such as a health clinic)
7. Fill for Reasons Uninsured Answer list
Page 253 of 537

8. Dissatisfied or don't believe in insurance
9. Fill for Reasons Uninsured Answer list
10. Fill for Reasons Uninsured Answer list
11. Other

NOPRIOTH
(What was that "other" reason?)

WHYNOPUB
Z, ? [F1]
Why didn't ^TEMPNAME get Medicaid or Medical Assistance?
Mark all that apply.
1. Fill for Reasons Uninsured Answer list
2. Haven't worked for this employer long enough
3. Part-Time, Temporary, or Contract employee
4. Fill for Reasons Uninsured Answer list
5. Healthy (haven't needed health insurance)
6. Able to get care elsewhere (such as a health clinic)
7. Fill for Reasons Uninsured Answer list
8. Dissatisfied or don't believe in insurance
9. Fill for Reasons Uninsured Answer list
10. Fill for Reasons Uninsured Answer list
11. Other

NOPUBOTH
(What was that "other" reason?)

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

Page 254 of 537

INFANTC
**NON-DISPLAYED ITEM**

INFANTINS_INTRO
These next questions will ask about health insurance coverage for the CHILD0INF in the
household. You may have reported some health insurance already but we want to make sure we
have not missed any insurance coverage.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HVARINFANT
**NON-DISPLAY ITEM**

INFANTLNO
**NON-DISPLAYED ITEM**

LGINS
^LGINS_FILL
1. Yes
2. No

LGINSTYPE
^LGINSTYPE_FILL
Read answer categories.
Mark all that apply.

Page 255 of 537

1. Private health insurance?
2. Medical assistance?
3. Military or VA?
4. Other health coverage?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

NOWRK_0
K
Next, I'll ask some follow-up questions based on the employment information you have already
provided.
Why ^DONTDOESNT ^TEMPNAME work for pay now...
Read answer categories.
After each response, ask: Any other reason?
1. Temporarily unable to work because of own injury?
2. Temporarily unable to work because of own health concerns or own illness?
3. Unable to work because of chronic health condition or disability?
4. Retired?
5. Pregnancy or childbirth?
6. Taking care of children or other persons, such as due to coronavirus pandemic school closures?
7. Going to school?
8. Unable to find work?
9. On layoff, such as furloughed due to coronavirus pandemic business closures?
10. Not interested in working at a job?
11. Usually worked 15 or more hours per week without pay in a family business or farm?
12. Some other reason?
13. Error: Currently working DO NOT READ

Page 256 of 537

LKWRK_0
? [F1]
Between January ^REFYEAR and now, did ^TEMPNAME ACTIVELY look for work in one or more
weeks?
1. Yes
2. No

PROGINCOME_INTRO
? [F1]
Next I'll ask some questions about additional ways money may enter or leave your household.
(This includes income from other sources such as Social Security, Unemployment Compensation,
Worker's Compensation, disability payments, and survivor's benefits.) I'll also ask you about This is
the fill if the respondent has children or has ever divorced any payments ^TEMPNAME might
have made for the support or care of non-household members.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

VA_ANY
Earlier you indicated ^TEMPNAME served in the military.
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME receive any payments from the VA Page 257 of 537

that is, the Department of Veterans Affairs?
1. Yes
2. No

VA_TYPE
N
^QSTNTXT_VATYPE What type of VA payments did ^TEMPNAME receive since ^MONTH1
^CALENDAR_YRFIL?
If necessary, read response choices 1, 2, and 3. Do not read response choice 4, 5, or 6.
Mark all that apply.
1. Service-connected disability compensation
2. Veterans' pension
3. Other VA payments
4. G.I. Bill benefits
5. Insurance proceeds
6. Did not receive any VA benefits

VADISRATE
^QSTNTXT_VADISRATE. What was ^PTEMPNAME total service-connected disability rating since
^MONTH1 ^CALENDAR_YRFIL?
1. 0 percent
2. 10 - 20 percent
3. 30 - 40 percent
4. 50 - 60 percent
5. 70+ percent

VATYPE_SP
What was that other type of VA payment?

VAQUES
^C_WASWERE ^TEMPNAME required to fill out an Eligibility Verification Report, or EVR, since
^MONTH1 ^CALENDAR_YRFIL in order to receive VA benefits?
Page 258 of 537

1. Yes
2. No

PWAVE_VA_NOW
PWAVE_VA_TYPE
PWAVE_VADISRATE
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

VABENEFITCODE
***NON-DISPLAYED ITEM***

VA_NOW
C_DODOES ^TEMPNAME receive ^TYPEVAPMTFIL now?
1. Yes
2. No

VA_LAST_REC
When did ^TEMPNAME last receive ^TYPEVAPMTFIL?
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
Page 259 of 537

12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

VA_START_REC
When did ^TEMPNAME start receiving ^TYPEVAPMTFIL?
Enter 0 if the person started receiving ^TYPEVAPMTFIL prior to the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

VA_1STAMT
How much ^DIDDO ^TEMPNAME receive in ^TYPEVAPMTFIL ^VACURAMT_FIL?

VA_GUESS
What would you estimate the monthly amount to be?
Page 260 of 537

VA_1STSTART
When did ^TEMPNAME start receiving ^VAAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

VA_2NDAMT
How much did ^TEMPNAME receive in ^TYPEVAPMTFIL ^VASTART1_FIL?

VA_2NDSTART
When did ^TEMPNAME start receiving ^VAAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
Page 261 of 537

10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

VA_3RDAMT
How much did ^TEMPNAME receive in ^TYPEVAPMTFIL ^VASTART2_FIL?

VA_3RDSTART
When did ^TEMPNAME start receiving ^VAAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

VA_4THAMT
Page 262 of 537

How much did ^TEMPNAME receive in ^TYPEVAPMTFIL ^VASTART3_FIL?

VA_4THSTART
When did ^TEMPNAME start receiving ^VAAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

VA_STARTAMT
How much did ^TEMPNAME receive in ^TYPEVAPMTFIL in ^VASTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

WC_ANY
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME receive any money from Workers'
Page 263 of 537

Compensation as a result of any kind of job-related injury or illness?
1. Yes
2. No

UC_ANY
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME receive any money from
Unemployment Compensation?
1. Yes
2. No

UC_TYPE
^QSTNTXT_UCTYPE What type of Unemployment Compensation payments did ^TEMPNAME
receive since ^MONTH1 ^CALENDAR_YRFIL?
Mark all that apply.
1. Regular, government-provided
2. Supplemental, employer-provided
3. Other, including union benefits
4. Did not receive Unemployment Compensation

UC_CVD
Did ^TEMPNAME have a period of unemployment since January 1, 2022 due to the coronavirus
pandemic?
1. Yes
2. No

PWAVE_WC_NOW
PWAVE_UC_NOW
PWAVE_UC_TYPE
CTRLNUM
**NON-DISPLAYED ITEM**

Page 264 of 537

LNO
**NON-DISPLAYED ITEM**

WC_NOW
C_DODOES ^TEMPNAME receive any money from Workers' Compensation (as a result of any kind
of job-related injury or illness) now?
1. Yes
2. No

WC_LAST_REC
When did ^TEMPNAME last receive money from Workers' Compensation (as a result of any kind of
job-related injury or illness)?
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR
19. ^FEEDBACKWRONG

WC_START_REC
When did ^TEMPNAME start receiving money from Workers' Compensation (as a result of any kind
of job-related injury or illness)?
Enter 0 if the person started receiving money from Workers' Compensation prior to the start of the
Page 265 of 537

reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

WC_1STAMT
How much ^DIDDO ^TEMPNAME receive in Workers' Compensation ^WCCURAMT_FIL?

WC_GUESS
What would you estimate the monthly amount to be?

WC_1STSTART
When did ^TEMPNAME start receiving ^WCAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
Page 266 of 537

7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

WC_2NDAMT
How much did ^TEMPNAME receive in Workers' Compensation ^WCSTART1_FIL?

WC_2NDSTART
When did ^TEMPNAME start receiving ^WCAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR
Page 267 of 537

WC_3RDAMT
How much did ^TEMPNAME receive ^WCSTART2_FIL?

WC_3RDSTART
When did ^TEMPNAME start receiving ^WCAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

WC_4THAMT
How much did ^TEMPNAME receive ^WCSTART3_FIL?

WC_4THSTART
When did ^TEMPNAME start receiving ^WCAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
Page 268 of 537

6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

WC_STARTAMT
How much did ^TEMPNAME receive ^WCSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

UEMP_COMP_CODE
**NON-DISPLAYED ITEM**

UC_NOW
C_DODOES ^TEMPNAME receive any money from ^TYPEUCFIL now?
1. Yes
2. No

UC_LAST_REC
When did ^TEMPNAME last receive money from ^TYPEUCFIL?
Page 269 of 537

1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR
19. ^FEEDBACKWRONG

UC_START_REC
When did ^TEMPNAME start receiving money from ^TYPEUCFIL?
Enter 0 if the person started receiving money from Unemployment Compensation prior to the start of
the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
Page 270 of 537

13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

UC_1STAMT
How much ^DIDDO ^TEMPNAME receive in ^TYPEUCFIL?

UC_GUESS
What would you estimate the monthly amount to be?

UC_1STSTART
When did ^TEMPNAME start receiving UCAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

UC_2NDAMT
Page 271 of 537

How much did ^TEMPNAME receive in ^TYPEUCFIL UCSTART_FIL?

UC_2NDSTART
When did ^TEMPNAME start receiving UCAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

UC_3RDAMT
How much did ^TEMPNAME receive in ^TYPEUCFIL UCSTART2_FIL?

UC_3RDSTART
When did ^TEMPNAME start receiving UCAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
Page 272 of 537

7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

UC_4THAMT
How much did ^TEMPNAME receive in ^TYPEUCFIL UCSTART3_FIL?

UC_4THSTART
When did ^TEMPNAME start receiving UCAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR
Page 273 of 537

UC_STARTAMT
How much did ^TEMPNAME receive in ^TYPEUCFIL UCSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

UTILITIES
^DIDFIL_UTILYN pay ^SEPARATE_UTILYN for water, electricity, gas, or oil?
1. Yes
2. No

ENERGY_ASST
? [F1]
^HAVEYOUFIL_EGYASSYN received any energy assistance from the Federal, State, or Local
government at any time between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL?
1. Yes
2. No

ENERGY_PMT1
? [F1]
Was this assistance received in the form of...
...checks sent to the household?
(...coupons or vouchers sent to the household?)
(...payments sent directly to the utility company, fuel provider, or landlord?)
1. Yes
2. No

Page 274 of 537

ENERGY_PMT2
? [F1]
(Was this assistance received in the form of...)
(...checks sent to the household?)
...coupons or vouchers sent to the household?
(...payments sent directly to the utility company, fuel provider, or landlord?)
1. Yes
2. No

ENERGY_PMT3
? [F1]
(Was this assistance received in the form of...)
(...checks sent to the household?)
(...coupons or vouchers sent to the household?)
...payments sent directly to the utility company, fuel provider, or landlord?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SCHOOL_LUNCH
? [F1]
Since the beginning of the current academic school year, ^DIDFIL_SCHOOLMEALS usually get
the lunch that ^THEIRFIL_SCHOOLMEALS school provides?
Display the first and last name(s) of all children where LNGD_MEALS=LNO.
1. Yes
2. No
Page 275 of 537

WHO_LUNCH
? [F1]
Which children usually got the school lunch?
Mark all that apply.

1. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

2. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

3. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

4. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

5. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

6. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

7. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

8. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

9. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

10. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

11. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

12. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

13. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

14. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

15. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

16. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

17. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

18. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

19. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

20. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

21. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

22. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

23. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

24. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

25. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS
26. Child not listed

FREE_LUNCH
? [F1]
Were these lunches...
Read answer categories.

Page 276 of 537

1. Free?
2. Reduced-price?
3. Full price (did not qualify)?

SCHOOL_BREAKFAST
? [F1]
Since the beginning of the current academic school year, ^DIDFIL_SCHOOLMEALS usually get
the breakfast that ^THEIRFIL_SCHOOLMEALS school provides?
Display the first and last name(s) of all children where LNGD_MEALS=LNO.
1. Yes
2. No

WHO_BREAKFAST
? [F1]
Which children usually got the school breakfast?
Mark all that apply.

1. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

2. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

3. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

4. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

5. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

6. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

7. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

8. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

9. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

10. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

11. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

12. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

13. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

14. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

15. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

16. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

17. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

18. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS
Page 277 of 537

19. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

20. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

21. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

22. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

23. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

24. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS

25. Display the LNO, ^FNAME, ^LNAME where AGE >= 5 and AGE <= 18 and EDUC <= 38 (and PEOPLE_TO_ROS
26. Child not listed

FREE_BREAKFAST
? [F1]
Were these breakfasts...
Read answer categories.
1. Free?
2. Reduced-price?
3. Full price (did not qualify)?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SSC_ANY
Since ^MONTH1 ^CALENDAR_YRFIL, did ^TEMPNAME receive any Social Security on behalf of a
child?
Page 278 of 537

1. Yes
2. No

SSKIDCOV
^QSTNTXT_SSKIDCOV Who was covered by the Social Security income you received since
^MONTH1 ^CALENDAR_YRFIL?
Mark all that apply.

1. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

2. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

3. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

4. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

5. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

6. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

7. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

8. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

9. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

10. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

11. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

12. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

13. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

14. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

15. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

16. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

17. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

18. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

19. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

20. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

21. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

22. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

23. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

24. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE

25. Display the LNO, ^FNAME, ^LNAME where AGE<18 and the resondent is the child's parent or guardian (and PE
26. Someone not listed
27. Did not receive Social Security on behalf of a child

REASON_CHILD
Page 279 of 537

What are the reasons ^TEMPNAME AREIS receiving Social Security on behalf of
since ^MONTH1 ^CALENDAR_YRFIL?

Read name(s)

Display the first and last name of all children selected in SSKIDCOV under
the heading Children. If SSKIDCOV=26, display "this child" instead of
nothing.
Mark all that apply.
1. Surviving child
2. Dependent child

PWAVE_SSC_NOW
PWAVE_SSKIDCOV
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SSC_NOW
C_DODOES ^TEMPNAME receive Social Security on behalf of

Read name(s) now?

Display the first and last name of the children identified in SSKIDCOV under
the heading "Child(ren)". Display "this child" if SSKIDCOV=26.
1. Yes
2. No

SSC_LAST_REC
When did ^TEMPNAME last receive Social Security on behalf of ^THISTHESECHILDREN?
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
Page 280 of 537

7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSC_START_REC
When did ^TEMPNAME start receiving Social Security on behalf of ^THISTHESECHILDREN?
Enter 0 if the person starting receiving Social Security on behalf of ^THISTHESECHILDREN prior to
the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

Page 281 of 537

SSC_1STAMT
How much ^DIDDO ^TEMPNAME receive in Social Security, before any deductions ^AREWERE
taken out, on behalf of ^THISTHESECHILDREN ^SSCCURAMT_FIL?

SSC_GUESS
What would you estimate the monthly amount to be?

1. $0
2. $1-350
3. $350-700
4. $700-850
5. $850 or greater

SSC_1STSTART
When did ^TEMPNAME start receiving ^SSCAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

Page 282 of 537

SSC_2NDAMT
How much did ^TEMPNAME receive in Social Security before any deductions were taken out on
behalf of ^THISTHESECHILDREN ^SSCSTART1_FIL?

SSC_2NDSTART
When did ^TEMPNAME start receiving ^SSCAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSC_3RDAMT
How much did ^TEMPNAME receive in Social Security before any deductions were taken out on
behalf of ^THISTHESECHILDREN ^SSCSTART2_FIL?

SSC_3RDSTART
When did ^TEMPNAME start receiving ^SSCAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
Page 283 of 537

3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSC_4THAMT
How much did ^TEMPNAME receive in Social Security before any deductions were taken out on
behalf of ^THISTHESECHILDREN ^SSCSTART3_FIL?

SSC_4THSTART
When did ^TEMPNAME start receiving ^SSCAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
Page 284 of 537

14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSC_STARTAMT
How much did ^TEMPNAME receive in Social Security before any deductions were taken out on
behalf of ^THISTHESECHILDREN ^SSCSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SSS_ANY
? [F1]
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME receive any Social Security income
for ^HIMHERSELF?
1. Yes
2. No

SSI_SS_CHK
Some people receive Supplemental Security Income (SSI) and Social Security at the same time.
Earlier ^TEMPNAME reported getting SSI payments. Just to be sure, did ^TEMPNAME receive
both SSI and Social Security?
Given their similar names, these programs are often confused. One difference is that many Social
Security recipients have Medicare, while SSI recipients often
have Medicaid.
1. Yes, both SSI and Social Security were received
2. No, only Social Security was received
Page 285 of 537

3. No, only SSI was received

REASON_SELF
^QSTNTXT_REASONSELF What are the reasons ^HESHE received Social Security since
^MONTH1 ^CALENDAR_YRFIL?
Mark all that apply.
1. Retired
2. Disabled
3. Widowed
4. Spouse
5. Other reason
6. Did not receive Social Security

REASON_SP
What was the other reason ^TEMPNAME received Social Security?

AGESS
At what age did ^TEMPNAME begin receiving Social Security (for ^HIMHERSELF)?
Report age in years.

PWAVE_SSS_NOW
PWAVE_REASONSELF
PWAVE_AGESS
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SSS_NOW
C_DODOES ^TEMPNAME receive Social Security for ^HIMHERSELF now?
Page 286 of 537

1. Yes
2. No

SSS_LAST_REC
When did ^TEMPNAME last receive Social Security (for ^HIMHERSELF)?
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSS_START_REC
When did ^TEMPNAME start receiving Social Security (for ^HIMHERSELF)?
Enter 0 if the person started receiving Social Security prior to the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
Page 287 of 537

8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSS_1STAMT
How much ^DIDDO ^TEMPNAME receive in Social Security, before any deductions ^AREWERE
taken out, ^SSSCURAMT_FIL?

SSS_GUESS
What would you estimate the monthly amount to be?
Ask respondent to please report the gross amount, that is before any deductions are taken out, within
the following ranges.
Read answer categories.
1. $0
2. $1-1000
3. $1001-1400
4. $1401-1900
5. $1901 or greater

SSS_1STSTART
When did ^TEMPNAME start receiving ^SSSAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
Page 288 of 537

5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSS_2NDAMT
How much did ^TEMPNAME receive in Social Security, before any deductions were taken out,
^SSSSTART1_FIL?

SSS_2NDSTART
When did ^TEMPNAME start receiving ^SSSAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
Page 289 of 537

16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSS_3RDAMT
How much ^DIDDO ^TEMPNAME receive in Social Security, before any deductions were taken
out, ^SSSSTART2_FIL?

SSS_3RDSTART
When did ^TEMPNAME start receiving ^SSSAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSS_4THAMT
How much did ^TEMPNAME receive in Social Security, before any deductions were taken out,
^SSSSTART3_FIL?

SSS_4THSTART
Page 290 of 537

When did ^TEMPNAME start receiving ^SSSAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SSS_STARTAMT
How much did ^TEMPNAME receive in Social Security, before any deductions were taken out, in
^SSSSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SSPARTB
? [F1]
Earlier ^TEMPNAME stated ^HESHE ^HAVHAS Medicare medical insurance, also called Part B.
Page 291 of 537

C_DODOES ^TEMPNAME have the premium taken out of ^HISHER Social Security benefit before
it reaches HIMHER?
1. Yes
2. No

SSPARTBAMT
How much is deducted from ^PTEMPNAME monthly Social Security benefits?

SSPARTC
? [F1]
Earlier ^TEMPNAME stated ^HESHE ^HAVHAS a Medicare Advantage Plan, also called Part C.
C_DODOES ^TEMPNAME have the premium taken out of ^HISHER Social Security benefit before
it reaches HIMHER?
1. Yes
2. No

SSPARTCAMT
How much is deducted from ^PTEMPNAME monthly Social Security benefits?

SSPARTCAMT_PD
How much did ^TEMPNAME pay per month for Medicare Part C?

SSPARTD
? [F1]
Earlier ^TEMPNAME stated ^HESHE ^HAVHAS prescription drug coverage through Medicare,
also called Medicare Part D.
C_DODOES ^TEMPNAME have the premium taken out of ^HISHER Social Security benefit before
it reaches HIMHER?
1. Yes
2. No

Page 292 of 537

SSPARTDAMT
How much is deducted from ^PTEMPNAME monthly Social Security benefits?

SSPARTDAMT_PD
How much did ^TEMPNAME pay per month for Medicare Part D?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

DISABL
C_DODOES ^TEMPNAME have a physical, mental, or other health condition that limits the kind or
amount of work ^HESHE can do at a job or business?
1. Yes
2. No

TAX_RETURNS_FLAG
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

LMPNOW
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME
receive any severance pay or lump sum payments from a pension or retirement plan?
1. Yes
2. No
Page 293 of 537

LUMPTYP
What type of payment was that?
Anything else?
Mark all that apply.
1. Lump sum from a pension/retirement plan
2. Severance pay
3. Deferred payment/final paycheck
4. Something else

LUMPTYP_SP
What was the other type?

LUMPAMT
What was the total amount of lump sum payments ^TEMPNAME received between ^MONTH1 1st
and the end of ^LASTMONTH ^CALENDAR_YRFIL?
Round the amount to the nearest dollar.

ROLLOVR1
Did ^HESHE re-invest or roll-over any of the money into an IRA or some other kind of retirement
plan?
1. Yes
2. No

ROLLOVR2
C_DODOES ^HESHE plan to re-invest or roll-over any of the money?
1. Yes
2. No

ROLLAMT
How much ^PLANFIL_ROLLAMT roll-over into another retirement account?
Round the amount to the nearest dollar.
Page 294 of 537

DEFERAMT
What was the amount of the deferred payment or final paycheck ^TEMPNAME received between
^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?
Round the amount to the nearest dollar.

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

DIS_ANY
Since ^MONTH1 1st ^CALENDAR_YRFIL ^OTHERTHAN_DISANY, did ^TEMPNAME receive any
income because of ^HISHER health condition?
1. Yes
2. No

DIS_TYPE
N, ? [F1]
^QSTNTXT_DISTYPE What type of disability income did ^TEMPNAME receive since ^MONTH1
^CALENDAR_YRFIL?
Mark all that apply.
1. Payments from a sickness, accident, or disability insurance policy
2. Employer disability payments
3. Pension from a company or union including income from a profit-sharing plan
4. Federal Civil Service or other Federal civilian employee pension
5. State government pension
6. Local government pension
7. U.S. Military retirement pay
8. U.S. Government Railroad Retirement
9. Black Lung benefits
10. Other disability income
Page 295 of 537

11. Did not receive disability payments

DIS_TYPETWO
Did ^TEMPNAME purchase that policy on ^HISHER own?
1. Yes
2. No

DISTYPE_SP
What was that other type of disability income?

PWAVE_DIS_NOW
**NON-DISPLAYED ITEM**

PWAVE_DIS_TYPE
PWAVE_DISTYPE_SP
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

DISABLECODE
**NON-DISPLAYED ITEM**

DIS_NOW
C_DODOES ^TEMPNAME receive ^DISABILITY_TYPE now?
1. Yes
2. No

DIS_LAST_REC
When did ^TEMPNAME last receive ^DISABILITY_TYPE?
Page 296 of 537

1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

DIS_START_REC
When did ^TEMPNAME start receiving ^DISABILITY_TYPE?
Enter 0 if the person started receiving ^DISABILITY_TYPE prior to the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
Page 297 of 537

15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

DIS_1STAMT
How much ^DIDDO ^TEMPNAME receive in ^DISABILITY_TYPE ^DISCURAMT?

DIS_GUESS
What would you estimate the monthly amount to be?

DIS_1STSTART
When did ^TEMPNAME start receiving ^DISAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

DIS_2NDAMT
How much did ^TEMPNAME receive in ^DISABILITY_TYPE ^DISSTART1_FIL?
Page 298 of 537

DIS_2NDSTART
When did ^TEMPNAME start receiving ^DISAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

DIS_3RDAMT
How much did ^TEMPNAME receive in ^DISABILITY_TYPE ^DISSTART2_FIL?

DIS_3RDSTART
When did ^TEMPNAME start receiving ^DISAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
Page 299 of 537

9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

DIS_4THAMT
How much did ^TEMPNAME receive in ^DISABILITY_TYPE ^DISSTART3_FIL?

DIS_4THSTART
When did ^TEMPNAME start receiving ^DISAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

Page 300 of 537

DIS_STARTAMT
How much did ^TEMPNAME receive in ^DISABILITY_TYPE in ^DISSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SUR_ANY
^OTHERTHANFIL_SURANY ^SSHLTHRETFIL_SURANY ^DIDFIL_SURANY ^TEMPNAME receive
any ^OTHERFIL_SURANY income as a result of being a ^WIDOWFIL_SURANY?
1. Yes
2. No

SUR_TYPE
N
^QSTNTXT_SURTYPE What type of survivor income did ^TEMPNAME receive since ^MONTH1
^CALENDAR_YRFIL?
Mark all that apply.
1. Pension from a company or union, including income from a profit-sharing plan
2. Veterans' compensation or pension
3. Federal Civil Service or other Federal civilian employee pension
4. U.S. Government Railroad Retirement
5. State government pension
6. Local government pension
7. Income from a paid-up life insurance policy or annuity
8. Military retirement pay
9. Black Lung benefits
10. Workers' Compensation
11. Payments from an estate or trust
12. National Guard or Reserve Forces retirement
13. Other survivor income
Page 301 of 537

14. Did not receive survivor income

SURTYPE_SP
What was that other type of survivor income?

PWAVE_SUR_NOW
PWAVE_SUR_TYPE
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SURVRCODE
**NON-DISPLAYED ITEM**

SUR_NOW
C_DODOES ^TEMPNAME receive ^SURVIVOR_TYPE now?
1. Yes
2. No

SUR_LAST_REC
When did ^TEMPNAME last receive ^SURVIVOR_TYPE?
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
Page 302 of 537

10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUR_START_REC
When did ^TEMPNAME start receiving ^SURVIVOR_TYPE?
Enter 0 if the person starting receiving ^SURVIVOR_TYPE prior to the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUR_1STAMT
How much ^DIDDO ^TEMPNAME receive in ^SURVIVOR_TYPE ^SURCURAMT_FIL?

Page 303 of 537

SUR_GUESS
What would you estimate the monthly amount to be?

SUR_1STSTART
When did ^TEMPNAME start receiving ^SURAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUR_2NDAMT
How much did ^TEMPNAME receive in ^SURVIVOR_TYPE ^SURSTART1_FIL?

SUR_2NDSTART
When did ^TEMPNAME start receiving ^SURAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
Page 304 of 537

6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUR_3RDAMT
How much did ^TEMPNAME receive in ^SURVIVOR_TYPE ^SURSTART2_FIL?

SUR_3RDSTART
When did ^TEMPNAME start receiving ^SURAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
Page 305 of 537

17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUR_4THAMT
How much did ^TEMPNAME receive in ^SURVIVOR_TYPE ^SURSTART3_FIL?

SUR_4THSTART
When did ^TEMPNAME start receiving ^SURAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUR_STARTAMT
How much did ^TEMPNAME receive in ^SURVIVOR_TYPE ^SURSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**
Page 306 of 537

LNO
**NON-DISPLAYED ITEM**

PWAVE_FCC_ANY
FCC_ANY
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME receive any foster child care
payments?
1. Yes
2. No

CSAGREE
Have child support payments ever been court-ordered, or informally agreed to, for
name(s)?

Read

Display the first and last name of children under the age of 21 from both the
HH and T2 rosters where either one or both parents are not household members
and the child(ren) are NOT foster child(ren) and the respondent is the
'guardian' as specified by the question universe (NOTE: because of the age
range, this does not necessarily conform to usual guardianship flag; see
question universe)
1. Yes
2. No

CS_ANY
? [F1]
Fill to acknowledge what we know about pass-through child support ^MONTH1 1st
^CALENDAR_YRFIL, did ^TEMPNAME receive any child support payments or other financial help
from the ^PARFIL_CSANY of Read name(s)?
Do not include alimony.
Display the first and last name of children under the age of 21 on both the
HH and T2 rosters where either one or both parents are not household members
and the child(ren) are NOT foster child(ren) and for whom the Respondent is
the guardian as specified in question universe for CSAGREE.
1. Yes
2. No
Page 307 of 537

3. No - absent parent deceased (volunteered)

PWAVE_ALI_ANY
ALI_ANY
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME receive any payments from
^FORMERFIL_ALI_ANY spouse, such as alimony or spousal support?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SUPPORTPMTCODE
**NON-DISPLAYED ITEM**

SUP_NOW
C_DODOES ^TEMPNAME receive any ^FMLY_SUP_TYPE now?
1. Yes
2. No

SUP_LAST_REC
When did ^TEMPNAME last receive ^FMLY_SUP_TYPE?
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
Page 308 of 537

8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR
19. ^FEEDBACKWRONG

SUP_START_REC
When did ^TEMPNAME start receiving ^FMLY_SUP_TYPE?
Enter 0 if the person starting receiving ^FMLY_SUP_TYPE prior to the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUP_1STAMT
Page 309 of 537

How much ^DIDDO ^TEMPNAME receive in ^FMLY_SUP_TYPE?

SUP_GUESS
What would you estimate the monthly amount to be?

SUP_1STSTART
When did ^TEMPNAME start receiving SUPAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUP_2NDAMT
How much did ^TEMPNAME receive in ^FMLY_SUP_TYPE SUPSTART1_FIL?

SUP_2NDSTART
When did ^TEMPNAME start receiving SUPAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
Page 310 of 537

3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUP_3RDAMT
How much did ^TEMPNAME receive in ^FMLY_SUP_TYPE SUPSTART2_FIL?

SUP_3RDSTART
When did ^TEMPNAME start receiving SUPAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
Page 311 of 537

15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUP_4THAMT
How much did ^TEMPNAME receive in ^FMLY_SUP_TYPE SUPSTART3_FIL?

SUP_4THSTART
When did ^TEMPNAME start receiving SUPAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

SUP_STARTAMT
How much did ^TEMPNAME receive in ^FMLY_SUP_TYPE SUPSTARTAMT_FIL?

CTRLNUM
**NON-DISPLAYED ITEM**
Page 312 of 537

LNO
**NON-DISPLAYED ITEM**

SUP_REC_INKND
There are some ways a parent (who doesn't live with a child) may provide support that are different
than a child support payment. This is known as in-kind support. It may include things for the
child such as groceries, clothes, or diapers. It can also include payments for things such as
medical expenses or childcare.

Between ^MONTH1 and ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME receive any in-kind
support from the ^PARFIL_CSANY of Read name(s)? (outside of child support payments)
Display the first and last name of children under the age of 21 on both the
HH and T2 rosters where either one or both parents are not household members
and the child(ren) are NOT foster child(ren) and for whom the Respondent is
the guardian as specified in question universe for CSAGREE.
1. Yes
2. No

REC_INKNDAMT
What is your estimate of the total value of all in-kind support provided by the ^PARFIL_CSANY
between ^MONTH1 and ^LASTMONTH ^CALENDAR_YRFIL (other than child support payments)?

Read answer categories.

1. Under $100
2. $100 to $499
3. $500 to $999
4. $1000 to $1999
5. $2000 or more

CTRLNUM
**NON-DISPLAYED ITEM**

Page 313 of 537

LNO
**NON-DISPLAYED ITEM**

ANYKID
Did ^TEMPNAME have any children under 21 years of age who lived elsewhere with their other
parent or guardian at any time between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL?
Do not include children who were away at school and were considered part of this household. On the
other hand, if a child is away at school and was considered part of the other parent or guardian's
household, then they should be included.
1. Yes
2. No

NUMKIDS
How many children?

SUPPORTPAY
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME
make any payments for the support of ^CHILDCHILDREN_CS_SUPPORTPAY (who lived
elsewhere)?
Include any payments:
... made directly to the other parent or guardian,
... made through a court or agency, or
... withheld from this person's paycheck.
1. Yes
2. No

AMOUNTPAID
What was the total amount of support payments ^TEMPNAME made for
^CHILDCHILDREN_CS_AMTPAY between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL?
Count all forms of child support payments, including:
... payments made directly to the other parent or guardian,
... payments made through a court or agency, or
... payments withheld from this person's paycheck.

Page 314 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SUP_PAID_INKND
There are some ways a parent (who doesn't live with a child) may provide support that are different
than a child support payment. This is known as in-kind support. It may include things for the
child such as groceries, clothes, or diapers. It can also include payments for things such as
medical expenses or childcare.

Between ^MONTH1 and ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME provide any in-kind
support for ^CHILDCHILDREN_CS_SUPPORTPAY (outside of child support payments)?

1. Yes
2. No

SUP_PAID_AMT
What is the estimate of the total value of all in-kind support ^TEMPNAME provided between
^MONTH1 and ^LASTMONTH ^CALENDAR_YRFIL (other than child support payments) ?

Read answer categories.

1. Under $100
2. $100 to $499
3. $500 to $999
4. $1000 to $1999
5. $2000 or more

TIMESPENT
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, about how often did
^TEMPNAME see ^CS_THISCHILDYOUNGESTCHILD (who lived elsewhere)?
0. Not at all
Page 315 of 537

1. About once a year
2. Several times a year
3. One to three times a month
4. About once a week
5. Several times a week

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

OTHERSUPPORT
The following questions are about regular or lump sum support payments ^TEMPNAME might
have made between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL to people
living outside ^HISHER household.
To which people who lived outside ^HISHER household did ^TEMPNAME make support
payments: Read answer categories.
Mark all that apply.
Payments can be either mandatory or voluntary.
Do not include people who were away at school and who were considered part of this household.
Supported parents who are not the respondent's own (i.e., in-laws) should be classified as "Someone
else not related to HIMHER".
Supported children who are not the respondent's own should be classified as either "Someone else
related to HIMHER" or "Someone else not related to HIMHER".
1. ^C_PTEMPNAME parent or parents?
2. ^C_PTEMPNAME child 21 years old or older who lived elsewhere?
3. Someone else related to ^TEMPNAME (excluding ^HISHER children under 21 living elsewhere)?
4. ^C_PTEMPNAME ex-spouse or ex-partner (Or current spouse or partner living elsewhere)?
5. Someone else not related to ^TEMPNAME?
6. Did not make support payments?

Page 316 of 537

NUMPARSUP
How many parents did ^TEMPNAME make support payments for (between ^MONTH1 1st and the
end of ^LASTMONTH ^CALENDAR_YRFIL)?

PARTOTAMT
What was the total amount ^TEMPNAME paid in support for ^HISHER Displays between
^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?

NUMKIDSUP
How many of ^PTEMPNAME children 21 years old and older who lived elsewhere did
^TEMPNAME make support payments for (between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL)?

KIDTOTAMT
What was the total amount ^TEMPNAME paid in support for ^HISHER children 21 years old or
older who lived elsewhere between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL?

NUMORSUP
How many relatives other than parents and children did ^TEMPNAME make support payments for
(between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?

ORTOTAMT
What was the total amount ^TEMPNAME paid in support for ^THISTHESE_ORSUP between
^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?

NUMEXSUP
How many current or ex-spouses or partners who lived elsewhere did ^TEMPNAME make
support payments for (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?
This support includes payments such as alimony or spousal support.

EXTOTAMT
What was the total amount ^TEMPNAME paid in support for ^HISHER current or ex-spouse(s) (or
partner(s)) between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?

Page 317 of 537

NUMNRSUP
How many non-relatives did ^TEMPNAME make support payments for (between ^MONTH1 1st and
the end of ^LASTMONTH ^CALENDAR_YRFIL)?

NRTOTAMT
What was the total amount ^TEMPNAME paid in support for ^THISTHESE_NRSUP between
^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

FILING
Did ^TEMPNAME file a federal income tax return during ^CALENDAR_YEAR for tax year
^CALENDAR_YEAR-1 ?
1. Yes
2. No

WILLFILE
C_DODOES ^TEMPNAME plan to file a federal income tax return for tax year
^CALENDAR_YEAR-1?
1. Yes
2. No

FSTATUS
What ^WASWILL ^PTEMPNAME filing status on ^HISHER tax year ^CALENDAR_YEAR-1 federal
income tax return...
Read answer categories.
Respondents should report their filing status for their ^CALENDAR_YEAR-1 tax return.
To file as a head of household, you must be unmarried and have dependents.
Page 318 of 537

1. Single?
2. Married filing jointly?
3. Married filing separately?
4. Head of household?

DEPCLM
^C_FILED_WASWERE claimed as a dependent on ^PTEMPNAME parent's or someone else's
income tax return for tax year ^CALENDAR_YEAR-1?
1. Yes
2. No

EITC
^C_DIDWILL ^TEMPNAME claim an Earned Income Tax Credit (EITC) on ^HISHER tax year
^CALENDAR_YEAR-1 federal income tax return?
The EITC is a benefit for people who work and have low to moderate wage earnings. The EITC
reduces the amount of taxes you may owe and often results in an income benefit to the eligible federal
tax filer.
This is different from the Expanded Child Tax Credit, which provides a monthly payment to families with
children.
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

INCOME_TYPE
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME
receive any money or income from any of the following sources...
Read answer categories.
Page 319 of 537

Do not include any money or income received from the government due to the coronavirus pandemic.
Mark all that apply.
1. A community or religious charity?
2. Family or friends?
3. Roomers or boarders?
4. Estates?
5. Incidental or casual earnings?
6. Miscellaneous cash income (such as lottery winnings)?
7. ntlguard_FIL
8. Did not receive money from any of these sources?

AMOUNT_TOTAL
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL), how much did you
receive from ^THISTHESE_MISC?
Read list:
Display all selections from INCOME_TYPE.

AMOUNT_GUESS
L
What would you estimate the annual amount to be- less than $200, $200 to $400, $400 to $600,
$600 to $800, or more than $800?
1. Less than $200
2. $200-399
3. $400-599
4. $600-799
5. $800 or more

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
Page 320 of 537

**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

TRANS_TYPE1
Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME receive any of the
following types of transportation assistance...
... gas vouchers?
(... bus or subway tokens or passes?)
(... help registering, repairing, or insuring a car?)
(... rides to a doctor's office or medical appointment?)
(... some other kind of transportation assistance?)
Do not include any assistance previously reported (such as commuting expenses paid by an
employer).
1. Yes
2. No

TRANS_TYPE2
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME receive any of the following
types of transportation assistance...)
(... gas vouchers?)
... bus or subway tokens or passes?
(... help registering, repairing, or insuring a car?)
(... rides to a doctor's office or medical appointment?)
(... some other kind of transportation assistance?)
Do not include any assistance previously reported (such as commuting expenses paid by an
employer.)
1. Yes
2. No

Page 321 of 537

TRANS_TYPE3
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME receive any of the following
types of transportation assistance...)
(... gas vouchers?)
(... bus or subway token or passes?)
... help registering, repairing, or insuring a car?
(... rides to a doctor's office or medical appointment?)
(... some other kind of transportation assistance?)
Do not include any assistance previously reported (such as commuting expenses paid by an
employer).
1. Yes
2. No

TRANS_TYPE4
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME receive any of the following
types of transportation assistance...)
(... gas vouchers?)
(... bus or subway tokens or passes?)
(... help registering, repairing, or insuring a car?)
... rides to a doctor's office or medical appointment?
(... some other kind of transportation assistance?)
Do not include any assistance previously reported (such as commuting expenses paid by an
employer).
1. Yes
2. No

TRANS_OTH
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME receive any of the following
types of transportation assistance...)
(... gas vouchers?)
(... bus or subway tokens or passes?)
(... help registering, repairing, or insuring a car?)
(... rides to a doctor's office or medical appointment?)
... some other kind of transportation assistance?
Do not include any assistance previously reported (such as commuting expenses paid by an
employer).
Page 322 of 537

1. Yes
2. No

TRANSOTH_SP
What was the other kind of transportation assistance ^TEMPNAME received?

GAS_SOURCE
Did ^TEMPNAME receive the gas vouchers through a government social service agency?
1. Yes
2. No

GAS_SOURCE_SP
What was the source of the gas voucher?

TOKEN_SOURCE
Did ^TEMPNAME receive the bus or subway tokens or passes through a government agency?
1. Yes
2. No

TOKEN_SOURCE_SP
What was the source of the bus or subway tokens or passes?

TRANS_WHEN
During which months did ^TEMPNAME receive transportation assistance?
Mark all that apply.
1. ^MONTH1 ^CALENDAR_YEAR
2. ^MONTH1 ^CALENDAR_YEAR
3. ^MONTH1 ^CALENDAR_YEAR
4. ^MONTH1 ^CALENDAR_YEAR
5. ^MONTH1 ^CALENDAR_YEAR
6. ^MONTH1 ^CALENDAR_YEAR
7. ^MONTH1 ^CALENDAR_YEAR
Page 323 of 537

8. ^MONTH1 ^CALENDAR_YEAR
9. ^MONTH1 ^CALENDAR_YEAR
10. ^MONTH1 ^CALENDAR_YEAR
11. ^MONTH1 ^CALENDAR_YEAR
12. ^MONTH1 ^CALENDAR_YEAR
13. All months

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

FOOD_TYPE1
Do not include any assistance previously reported (such as ^FOODFIL).
Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME receive any of the
following types of food assistance...
... Money, vouchers, or certificates to buy groceries or food (Other than Food Stamps) ?
(... Bags of groceries or packaged foods?)
(... Any meals from a shelter, soup kitchen, Meals-on-Wheels, or other charity?)
(... Any other food assistance?)

1. Yes
2. No

FOOD_TYPE2
Do not include any assistance previously reported (such as ^FOODFIL).
(Between ^MONTH1 and December ^CALENDAR_YEAR, did ^TEMPNAME receive any of the following
types of food assistance...)
(... Money, vouchers, or certificates to buy groceries or food (Other than Food Stamps)?)
... Bags of groceries or packaged foods?
(... Any meals from a shelter, soup kitchen, Meals-on-Wheels, or other charity?)
(... Any other food assistance?)

Page 324 of 537

1. Yes
2. No

FOOD_TYPE3
Do not include any assistance previously reported (such as ^FOODFIL).
(Between ^MONTH1 and December ^CALENDAR_YEAR, did ^TEMPNAME receive any of the following
types of food assistance...)
(... Money, vouchers, or certificates to buy groceries or food (Other than Food Stamps)?)
(... Bags of groceries or packaged foods?)
... Any meals from a shelter, soup kitchen, Meals-on-Wheels, or other charity?
(... Any other food assistance?)

1. Yes
2. No

FOOD_OTH
Do not include any assistance previously reported (such as ^FOODFIL).
(Between ^MONTH1 and December ^CALENDAR_YEAR, did ^TEMPNAME receive any of the following
types of food assistance...)
(... Money, vouchers, or certificates to buy groceries or food (Other than Food Stamps)?)
(... Bags of groceries or packaged foods?)
(... Any meals from a shelter, soup kitchen, Meals-on-Wheels, or other charity?)
... Any other food assistance?
1. Yes
2. No

FOODOTH_SP
What was the other type of food assistance ^TEMPNAME received?

FOOD_SOURCE
Was this food assistance provided by...
Read answer categories.

Page 325 of 537

Mark all that apply.
1. A Government agency?
2. A community or religious charity?
3. Family or friends?
4. Someplace else?

FOOD_SOURCE_SP
What was the other source of food assistance?

FOOD_WHEN
During which months did ^TEMPNAME receive food assistance?
Mark all that apply.
1. ^MONTH1 ^CALENDAR_YEAR
2. ^MONTH1 ^CALENDAR_YEAR
3. ^MONTH1 ^CALENDAR_YEAR
4. ^MONTH1 ^CALENDAR_YEAR
5. ^MONTH1 ^CALENDAR_YEAR
6. ^MONTH1 ^CALENDAR_YEAR
7. ^MONTH1 ^CALENDAR_YEAR
8. ^MONTH1 ^CALENDAR_YEAR
9. ^MONTH1 ^CALENDAR_YEAR
10. ^MONTH1 ^CALENDAR_YEAR
11. ^MONTH1 ^CALENDAR_YEAR
12. ^MONTH1 ^CALENDAR_YEAR
13. All months

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CLTH_TYPE
Page 326 of 537

(Between ^MONTH1 and December ^CALENDAR_YRFIL,) Did ^TEMPNAME receive any of the
following types of clothing assistance...
Read answer categories.
Mark all that apply.
1. Free or reduced price clothes?
2. Money or vouchers for clothes?
3. (Did not receive clothing assistance.)

CLTH_SOURCE
Was this clothing assistance provided by...
Read answer categories.
Mark all that apply.
1. A Government agency?
2. A community or religious charity?
3. Family or friends?
4. An employer?
5. Someplace else?

CLTH_SOURCE_SP
What was the other source of clothing assistance?

HOUSE_ANY
(Since ^MONTH1 ^CALENDAR_YRFIL,) Did ^TEMPNAME receive any assistance to help pay for
housing^ENERGYFIL?
1. Yes
2. No

OTHASST_WHEN
During which months did ^TEMPNAME receive ^OTHASSTFIL assistance?
Mark all that apply.

Page 327 of 537

1. ^MONTH1 ^CALENDAR_YEAR
2. ^MONTH1 ^CALENDAR_YEAR
3. ^MONTH1 ^CALENDAR_YEAR
4. ^MONTH1 ^CALENDAR_YEAR
5. ^MONTH1 ^CALENDAR_YEAR
6. ^MONTH1 ^CALENDAR_YEAR
7. ^MONTH1 ^CALENDAR_YEAR
8. ^MONTH1 ^CALENDAR_YEAR
9. ^MONTH1 ^CALENDAR_YEAR
10. ^MONTH1 ^CALENDAR_YEAR
11. ^MONTH1 ^CALENDAR_YEAR
12. ^MONTH1 ^CALENDAR_YEAR
13. All months

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

WELACTV1
Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME attend any of the
following types of training...
...classes to improve basic reading or math skills?
(...job readiness training to learn about resume writing, job interviewing, or building self-esteem?)
(...job search programs or job clubs, or use any job resource centers to find out about jobs, to schedule
interviews, or to fill out applications?)
(...training to learn a specific job skill, such as computers, car repair, nursing, day care work, or some
other job skill?)
1. Yes
2. No

WELACTV2_1
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME attend any of the following
types of training...)
Page 328 of 537

(...classes to improve basic reading or math skills?)
...job readiness training to learn about resume writing, job interviewing, or building self-esteem?
(...job search programs or job clubs, or use any job resource centers to find out about jobs, to schedule
interviews, or to fill out applications?)
(...training to learn a specific job skill, such as computers, car repair, nursing, day care work, or some
other job skill?)
1. Yes
2. No

WELACTV2_2
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME attend any of the following
types of training...)
(...classes to improve basic reading or math skills?)
(...job readiness training to learn about resume writing, job interviewing, or building self-esteem?)
...job search programs or job clubs, or use any job resource centers to find out about jobs, to
schedule interviews, or to fill out applications?
(...training to learn a specific job skill, such as computers, car repair, nursing, day care work, or some
other job skill?)
1. Yes
2. No

WELACTV2_3
(Between ^MONTH1 and December ^CALENDAR_YRFIL, did ^TEMPNAME attend any of the following
types of training...)
(...classes to improve basic reading or math skills?)
(...job readiness training to learn about resume writing, job interviewing, or building self-esteem?)
(...job search programs or job clubs, or use any job resource centers to find out about jobs, to schedule
interviews, or to fill out applications?)
...training to learn a specific job skill, such as computers, car repair, nursing, day care work, or
some other job skill?
1. Yes
2. No

WELACTV4
Since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME participate in any work experience
programs, such as a community service job, in exchange for ^PTEMPNAME ^TANF_FIL?
Page 329 of 537

1. Yes
2. No

TRAIN_WHEN
During which months did ^TEMPNAME attend training?
Mark all that apply.
1. ^MONTH1 ^CALENDAR_YEAR
2. ^MONTH1 ^CALENDAR_YEAR
3. ^MONTH1 ^CALENDAR_YEAR
4. ^MONTH1 ^CALENDAR_YEAR
5. ^MONTH1 ^CALENDAR_YEAR
6. ^MONTH1 ^CALENDAR_YEAR
7. ^MONTH1 ^CALENDAR_YEAR
8. ^MONTH1 ^CALENDAR_YEAR
9. ^MONTH1 ^CALENDAR_YEAR
10. ^MONTH1 ^CALENDAR_YEAR
11. ^MONTH1 ^CALENDAR_YEAR
12. ^MONTH1 ^CALENDAR_YEAR
13. All months

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

N_DEC_JOBS
**NON-DISPLAYED ITEM**

RETIRE_INTRO
Next I'll ask some questions about ^RET_INTRO_FIL
1. Enter 1 to continue

Page 330 of 537

MAIN_JOB
Which of the following did ^YOUHESHE consider to be ^YOURHISHER main employer in
December ^REFYEAR?
Respondent must select one of the options below. If respondent is unsure, choose the job where
respondent has the most earnings.
If no main job can be identified or selected, enter CTRL+D.
1. ^JOB1_FILL
2. ^JOB2_FILL
3. ^JOB3_FILL
4. ^JOB4_FILL
5. ^JOB5_FILL
6. ^JOB6_FILL
7. ^JOB7_FILL

EVERET
^C_HAVHAS ^TEMPNAME ever retired, for any reason, from a job or business?
1. Yes
2. No

PWAVE_EVERET
**NON-DISPLAYED ITEM**

NOW_RET
**NON-DISPLAYED ITEM**

ECVD_RETIRE
^COVIDRET

1. Yes
2. No

ECVD_RET_HOW
^COVIDRET_HOW
Page 331 of 537

Read answer categories
1. postpone or delay retirement?
2. plan an earlier retirement date?
3. return to work from retirement?
4. retire later than planned?
5. retire earlier than planned?
6. Retired before pandemic began - (DO NOT READ)
7. Other reason (or no change in plans) - (DO NOT READ)

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

OWN_THR401
? [F1]
Next are a couple of questions about retirement accounts. At any time between ^MONTH1 1st and
the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME have a 401k, 403b, 503b, or thrift
plan?
1. Yes
2. No

OWN_IRAKEO
? [F1]
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL) Did ^TEMPNAME
^ALSOFIL_IRA own a retirement plan, such as an Individual Retirement Account (IRA) or a Keogh
account?
1. Yes
2. No

Page 332 of 537

OWN_PENSION
? [F1]
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL) ^C_WASWERE
^TEMPNAME included in a plan that provides regular payments for life based on earnings or
years on the job, such as a defined-benefit pension or cash balance plan?
1. Yes
2. No

PENSION_FUP
^DODOES ^TEMPNAME have a defined-benefit pension from a current or previous job which will
provide benefits in the future?
1. Yes
2. No

MULTI_RETIRE
***Non-displayed item***
1. Yes
2. No

RETIRE_INTRO2
Next, I'll ask more detailed questions about ^PTEMPNAME ^IRA401FIL
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

THR401VAL
? [F1]
Page 333 of 537

^THR401_MULT_FIL As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the total
balance or market value of the plan(s) ^TEMPNAME participated in?

THR401VAL_RAN
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $50,000, or more than $50,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $49,999
4. $50,000 or more

THR401_INC_YN
At any time in ^CALENDAR_YRFIL, did ^TEMPNAME receive any income or withdrawals from
^HISHER 401k, 403b, 503b, or thrift plan(s)^LUMP_FIL?
1. Yes
2. No

THR401_INC_AMT
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much income did
^TEMPNAME receive (from ^HISHER 401k, 403b, 503b, or thrift plan)^LUMP_FIL?

THR401_INC_RANGE
Was the annual amount less than $1,000, between $1,000 and $5,000, between $5,000 and
$20,000, or more than $20,000?
1. less than $1,000
2. $1,000 to $4,999
3. $5,000 to $19,999
4. $20,000 or more

MAIN_JOB_THR401
In ^CALENDAR_YRFIL, did ^TEMPNAME have a 401k, 403b, 503b, or thrift plan provided through
^MJBNAME_FIL?

Page 334 of 537

1. Yes
2. No

SCNTYN_401
In ^CALENDAR_YRFIL, did ^HESHE contribute any money to the plan with ^MJBNAME_FIL, for
example, through payroll deductions?
Exclude rollovers or cash-outs from other retirement accounts or pension plans as new contributions.
1. Yes
2. No

SCNTAMT_401
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much did
^TEMPNAME contribute toward this plan?
Enter 0 if the respondent made no contributions.
Exclude rollovers or cash-outs from other retirement accounts or pension plans as new contributions.

ECNTYN_401
In ^CALENDAR_YRFIL, did ^MJBNAME_FIL make contributions to this plan?
1. Yes
2. No

ECNTAMT_401
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much did
^MJBNAME_FIL contribute toward this plan?
Enter 0 if ^MJBNAME_FIL made no contributions.

PREV_JOB_THR401
^PREVJOB401_FIL
1. Yes
2. No
Page 335 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

IRAKEOVAL
? [F1]
^IRA_MULT_FIL As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the total
balance or market value of the account(s) ^TEMPNAME owned?

IRAVAL_RAN
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $50,000, or more than $50,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $49,999
4. $50,000 or more

IRA_INC_YN
At any time in ^CALENDAR_YRFIL, did ^TEMPNAME receive any income or withdrawals from
^HISHER IRA or Keogh account(s)^LUMP_FIL?
1. Yes
2. No

IRA_INC_AMT
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much income did
^TEMPNAME receive (from ^HISHER IRA or Keogh account)^LUMP_FIL?

IRA_INC_RANGE
Was the annual amount less than $1,000, between $1,000 and $5,000, between $5,000 and
$20,000, or more than $20,000?
1. less than $1,000
Page 336 of 537

2. $1,000 to $4,999
3. $5,000 to $19,999
4. $20,000 or more

MAIN_JOB_IRA
In ^CALENDAR_YRFIL, did ^TEMPNAME have an IRA or Keogh account(s) provided through
^MJBNAME_FIL?
1. Yes
2. No

SCNTYN_IRA
In ^CALENDAR_YRFIL, did ^HESHE contribute any money to the plan with ^MJBNAME_FIL, for
example, through payroll deductions?
Exclude rollovers or cash-outs from other retirement accounts or pension plans as new contributions.
1. Yes
2. No

SCNTAMT_IRA
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much did
^TEMPNAME contribute toward this plan?
Enter 0 if the respondent made no contributions.
Exclude rollovers or cash-outs from other retirement accounts or pension plans as new contributions.

ECNTYN_IRA
In ^CALENDAR_YRFIL, did ^MJBNAME_FIL make contributions to this plan?
1. Yes
2. No

ECNTAMT_IRA
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much did
^MJBNAME_FIL contribute toward this plan?
Page 337 of 537

Enter 0 if ^MJBNAME_FIL made no contributions.

PREV_JOB_IRA
^PREVJOBIRA_FIL
1. Yes
2. No

PENSION_INC_YN
^PENS_MULT_FIL. At any time in ^CALENDAR_YEAR, did ^TEMPNAME receive any income from
^HISHER pension or cash balance plan(s)?
1. Yes
2. No

RET_ANY
^OTHERTHANFIL_RETANY ^SSHLTHFIL_RETANY ^DIDFIL_RETANY ^TEMPNAME receive any
^OTHERFIL_RETANY retirement income?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

RET_TYPE
N
^QSTNTXT_RETTYPE What type of retirement income did ^TEMPNAME receive since ^MONTH1
^CALENDAR_YRFIL?
Mark all that apply.
Page 338 of 537

1. Pension from a company or union, including income from a profit-sharing plan
2. Federal Civil Service or other Federal Civilian employee pension
3. State government pension
4. Local government pension
5. Military retirement pay
6. U.S. Government Railroad Retirement
7. National Guard or Reserve Forces retirement
8. Other retirement income
9. Did not receive retirement income

RETTYPE_SP
What was that other type of retirement income?

LIFEYN
? [F1]
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME
receive any retirement income from a paid-up life insurance policy or annuity?
1. Yes
2. No

LIFEREG
Did that come as a single lump-sum?
1. Yes
2. No

LIFEWHEN
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, during which months
did ^TEMPNAME receive retirement income from a paid-up life insurance policy or annuity?
Mark all that apply.
1. ^MONTH1 ^CALENDAR_YEAR
2. ^MONTH1 ^CALENDAR_YEAR
3. ^MONTH1 ^CALENDAR_YEAR
4. ^MONTH1 ^CALENDAR_YEAR
Page 339 of 537

5. ^MONTH1 ^CALENDAR_YEAR
6. ^MONTH1 ^CALENDAR_YEAR
7. ^MONTH1 ^CALENDAR_YEAR
8. ^MONTH1 ^CALENDAR_YEAR
9. ^MONTH1 ^CALENDAR_YEAR
10. ^MONTH1 ^CALENDAR_YEAR
11. ^MONTH1 ^CALENDAR_YEAR
12. ^MONTH1 ^CALENDAR_YEAR
13. All months

LIFEAMT
What was the total amount of life insurance payments ^TEMPNAME received between ^MONTH1
1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?

PWAVE_RET_NOW
PWAVE_RET_TYPE
PWAVE_RETTYPE_SP
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

RETIRECODE
**NON-DISPLAYED ITEM**

RET_NOW
C_DODOES ^TEMPNAME receive ^RETIREMENT_TYPE now?
1. Yes
2. No

RET_LAST_REC
When did ^TEMPNAME last receive ^RETIREMENT_TYPE?
Page 340 of 537

1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

RET_START_REC
When did ^TEMPNAME start receiving ^RETIREMENT_TYPE?
Enter 0 if the person started receiving ^RETIREMENT_TYPE prior to the start of the reference period.
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
Page 341 of 537

15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

RET_1STAMT
How much ^DIDDO ^TEMPNAME receive in ^RETIREMENT_TYPE ^RETCURAMT_FIL?

RET_GUESS
What would you estimate the monthly amount to be?

RET_1STSTART
When did ^TEMPNAME start receiving ^RETAMT1_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

RET_2NDAMT
How much did ^TEMPNAME receive in ^RETIREMENT_TYPE ^RETSTART1_FIL?
Page 342 of 537

RET_2NDSTART
When did ^TEMPNAME start receiving ^RETAMT2_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

RET_3RDAMT
How much did ^TEMPNAME receive in ^RETIREMENT_TYPE ^RETSTART2_FIL?

RET_3RDSTART
When did ^TEMPNAME start receiving ^RETAMT3_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
Page 343 of 537

9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

RET_4THAMT
How much did ^TEMPNAME receive in ^RETIREMENT_TYPE ^RETSTART3_FIL?

RET_4THSTART
When did ^TEMPNAME start receiving ^RETAMT4_FIL?
0. Receipt started prior to ^MONTH1, ^CALENDAR_YEAR
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

Page 344 of 537

RET_STARTAMT
How much did ^TEMPNAME receive in ^RETIREMENT_TYPE ^RETSTARTAMT_FIL?

MAIN_JOB_PENSION
In ^CALENDAR_YRFIL, did ^TEMPNAME have a pension or cash balance plan provided through
^MJBNAME_FIL?
1. Yes
2. No

CASH_BAL
Was the plan(s) through ^MJBNAME_FIL a defined-benefit pension, a cash balance plan, or both?
1. Defined-benefit pension
2. Cash balance plan
3. Both a defined-benefit pension and cash balance plan

SCNTYN_PEN
In ^CALENDAR_YRFIL, did ^HESHE contribute any money to the ^PEN_CASH_FIL plan with
^MJBNAME_FIL, for example, through payroll deductions?
1. Yes
2. No

SCNTAMT_PEN
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much did
^TEMPNAME contribute toward this plan?
Enter 0 if the respondent made no contributions.

PREV_JOB_PENSION
^PREVJOBPEN_FIL
1. Yes
2. No

PENSNYN
Page 345 of 537

Even though ^TEMPNAME ^DODOES not have a retirement plan through ^MJBNAME_FIL, did
^MJBNAME_FIL have any kind of pension or retirement plans for anyone in ^PTEMPNAME
company or organization?
1. Yes
2. No

INCPENS
^C_WASWERE ^TEMPNAME included in such a plan?
1. Yes
2. No

EPREVPEN
Even though ^TEMPNAME ^DODOES not have a retirement plan through a previous job,
^HAVHAS ^TEMPNAME ever been covered by a pension or retirement plan on any previous job
or business?
Examples include a 401k you cashed out or leaving a job before you were vested.
1. Yes
2. No

PENTYP
Earlier you reported that ^TEMPNAME had ^PENTYP_FIL through ^MJBNAME_FIL. Which plan is
the most important to ^TEMPNAME?
1. The IRA or Keogh plan
2. The 401k, 403b, 503b, or thrift plan
3. The defined-benefit pension
4. The cash balance plan

N_MAIN_JOB_PLANS
***Non-displayed item***

CTRLNUM
**NON-DISPLAYED ITEM**
Page 346 of 537

LNO
**NON-DISPLAYED ITEM**

ASSET_INTRO
? [F1]
Next I'll ask some questions about the value of assets ^TEMPNAME ^OWNOWNSFIL_PR, income
received from those assets, and any debts ^TEMPNAME may have. This is the additional
sentence in the Assets intro to be included when someone has a spouse.
(The Census Bureau uses the data collected to create national estimates of wealth.) We know that
people aren't used to talking about their assets, but we ask these questions to get an overall
picture of your community and the nation -- NOT to find out about ^YOUANYONEFIL personally.
The types of assets I will be asking you about include checking and savings accounts, retirement
accounts, stocks, cars, motorcycles, and real estate.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

AST1A
O, ? [F1]
Please only include U.S. Government savings bonds or U.S. Government securities that were owned
separately from any mutual funds.
The next few questions are about assets and other investments, either individually or jointly
owned INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL, did ^TEMPNAME own, either individually or jointly...
...any U.S. Government savings bonds or U.S. Government securities?
(...a checking account?)
(...a savings account?)
(^RETIRE_FIL)
(...a money market deposit account or fund?)
(...any certificates of deposit (that is, CDs)?)
Page 347 of 537

(...mutual funds?)
(...stocks?)
1. Yes
2. No

AST2A
O, ? [F1]
(The next few questions are about assets and other investments, either individually or jointly owned
INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME own, either individually or jointly...)
(...any U.S. Government savings bonds or U.S. Government securities?)
...a checking account?
(...a savings account?)
(^RETIRE_FIL)
(...a money market deposit account or fund?)
(...any certificates of deposit (that is, CDs)?)
(...mutual funds?)
(...stocks?)
1. Yes
2. No

AST2B
O, ? [F1]
(The next few questions are about assets and other investments, either individually or jointly owned
INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME own, either individually or jointly...)
(...any U.S. Government savings bonds or U.S. Government securities?)
(...a checking account?)
...a savings account?
(^RETIRE_FIL)
(...a money market deposit account or fund?)
(...any certificates of deposit (that is, CDs)?)
(...mutual funds?)
(...stocks?)

Page 348 of 537

1. Yes
2. No

AST2C
O, ? [F1]
(The next few questions are about assets and other investments, either individually or jointly owned
INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME own, either individually or jointly...)
(...any U.S. Government savings bonds or U.S. Government securities?)
(...a checking account?)
(...a savings account?)
^RETIRE_FIL
...a money market deposit account or fund?
(...any certificates of deposit (that is, CDs)?)
(...mutual funds?)
(...stocks?)
1. Yes
2. No

AST2D
O, ? [F1]
(The next few questions are about assets and other investments, either individually or jointly owned
INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME own, either individually or jointly...)
(...any U.S. Government savings bonds or U.S. Government securities?)
(...a checking account?)
(...a savings account?)
^RETIRE_FIL
(...a money market deposit account or fund?)
...any certificates of deposit (that is, CDs)?
(...mutual funds?)
(...stocks?)
1. Yes
2. No

Page 349 of 537

AST3A
O, ? [F1]
(The next few questions are about assets and other investments, either individually or jointly owned
INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME own, either individually or jointly...)
(...any U.S. Government savings bonds or U.S. Government securities?)
(...a checking account?)
(...a savings account?)
^RETIRE_FIL
(...a money market deposit account or fund?)
(...any certificates of deposit (that is, CDs)?)
...mutual funds?
(...stocks?)
1. Yes
2. No

AST3B
O, ? [F1]
(The next few questions are about assets and other investments, either individually or jointly owned
INCLCHILDFIL. Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME own, either individually or jointly...)
(...any U.S. Government savings bonds or U.S. Government securities?)
(...a checking account?)
(...a savings account?)
^RETIRE_FIL
(...a money market deposit account or fund?)
(...any certificates of deposit (that is, CDs)?)
(...mutual funds?)
...stocks?
1. Yes
2. No

AST3C
P, ? [F1]
Read (or verify) all response options.
Page 350 of 537

^ASSET2_QSTNTXT
...any municipal or corporate bonds?
(...any life insurance policies (including employer-provided policies)?)
(...rental property?)
(...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?)
(...annuities and trusts?)
(...businesses as an investment only?)
(...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid to
HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.)
1. Yes
2. No

MUNCOR
Were these municipal or corporate bonds separate from the mutual funds you just told me
about?
Select 'Yes' if some municipal or corporate bonds are included in mutual funds, and some are not.
1. Yes
2. No

AST5A
P, ? [F1]
Read (or verify) all response options.
(^ASSET2_QSTNTXT)
(...any municipal or corporate bonds?)
...any life insurance policies (including employer-provided policies)?
(...rental property?)
(...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?)
(...annuities and trusts?)
(...businesses as an investment only?)
(...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid to
HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.)
1. Yes
2. No

Page 351 of 537

AST4A
P, ? [F1]
Read (or verify) all response options.
(^ASSET2_QSTNTXT)
(...any municipal or corporate bonds?)
(...any life insurance policies (including employer-provided policies)?)
...rental property?
(...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?)
(...annuities and trusts?)
(...businesses as an investment only?)
(...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid to
HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.)
1. Yes
2. No

AST5B
P, ? [F1]
Read (or verify) all response options.
Do not include right-to-use timeshares as 'other' real estate.
(^ASSET2_QSTNTXT)
(...any municipal or corporate bonds?)
(...any life insurance policies (including employer-provided policies)?)
(...rental property?)
...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?
(...annuities and trusts?)
(...businesses as an investment only?)
(...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid to
HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.)
1. Yes
2. No

AST5E
P, ? [F1]
Read (or verify) all response options.
Page 352 of 537

(^ASSET2_QSTNTXT)
(...any municipal or corporate bonds?)
(...any life insurance policies (including employer-provided policies)?)
(...rental property?)
(...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?)
...annuities and trusts?
(...businesses as an investment only?)
(...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid to
HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.)
1. Yes
2. No

AST5F
P, ? [F1]
Read (or verify) all response options.
(^ASSET2_QSTNTXT)
(...any municipal or corporate bonds?)
(...any life insurance policies (including employer-provided policies)?)
(...rental property?)
(...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?)
(...annuities and trusts?)
...businesses as an investment only?
(...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid to
HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.)
1. Yes
2. No

AST4C
P, ? [F1]
Read (or verify) all response options.
(^ASSET2_QSTNTXT)
(...any municipal or corporate bonds?)
(...any life insurance policies (including employer-provided policies)?)
Page 353 of 537

(...rental property?)
(...other real estate such as a vacation home, a deeded timeshare, or an undeveloped lot?)
(...annuities and trusts?)
(...businesses as an investment only?)
...or any other financial investments? Examples include coins, jewelry, artwork, mortgages paid
to HIMHER, other loans owed to HIMHER, royalties, or cryptocurrency.
1. Yes
2. No

AST4C_SP
? [F1]
What 'other' type of financial investment(s)?
Please separate individual 'other' financial investments by the use of a comma.

VERIFY_ASSETS
^QSTNTXT_VERIFYASSETS
Read list:
Display all of the assets reported by the respondent as defined in the
special instructions.
1. Yes
2. No

FIX_ASSETS
Which assets should not be included on the list?
4. U.S. Govt. savings bonds/securities
5. Checking account
7. Savings account
8. Money market deposit account
9. Certificates of deposit
11. Mutual funds
12. Stocks
13. Municipal or corporate bonds
Page 354 of 537

14. Life insurance
15. Rental property
16. Real estate
17. Annuities and trusts
18. Businesses as an investment only
19. Fill with response to item AST4C_SP

EDITRESULT
WHYSUPPRESS
QUESTIONCONTINUE

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ASTCODE
**NON-DISPLAYED ITEM**

JT
^JT_QSTNTXT
1. Yes
2. No

JTWHO1
With whom?
^JTWHOFRNOTE_FIL
Enter 50 if the person owns the asset(s) with a non-household member.
1. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
2. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
3. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
Page 355 of 537

4. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
5. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
6. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
7. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
8. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
9. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
10. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
11. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
12. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
13. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
14. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
15. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
16. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
17. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
18. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
19. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
20. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
21. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
22. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
23. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
24. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
25. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
50. Non-household member(s)

OAST1
^INADDITIONFIL_OAST1 ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME ^ALSOFIL_OAST1 own any in ^HISHER name only?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**
Page 356 of 537

astcode2
**NON-DISPLAYED**

ANYJNT
^ANYJNT_QSTNTXT
1. Yes
2. No

JTWHO2
With whom?
^JTWHOFRNOTE_FIL
Enter 50 if the respondent owns the mutual funds or stocks with a non-household member.
1. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
2. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
3. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
4. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
5. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
6. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
7. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
8. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
9. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
10. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
11. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
12. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
13. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
14. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
15. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
16. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
17. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
18. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
19. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
20. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
21. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
22. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
23. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
24. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
Page 357 of 537

25. Display the LNO, ^FNAME, ^LNAME (where PEOPLE_TO_ROSTER = 1 for people on the Hhld. roster)
50. Non-household member(s)

OAST2
^INADDITIONFIL_OAST2 ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME ^ALSOFIL_OAST2 ^FNDSTCK2FIL in ^HISHER name only?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

AST2F
? [F1]
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL was anyone in
^PTEMPNAME household the owner or the beneficiary of an educational or college savings
account (such as a 529 account)?
1. Yes
2. No

NUM_EDSAV
^NUMEDSAV_QSTNTXT
Enter 0 if nobody in the household owned or was the beneficiary of the educational or college savings
account as of the last day of ^LASTMONTH, ^CALENDAR_YEAR.
If the person or household was the owner or the beneficiary of three or more educational or college
savings accounts, the person should report the accounts with the largest balance.

CTRLNUM
**NON-DISPLAYED ITEM**

EDSAVNO
Page 358 of 537

**NON-DISPLAYED ITEM**

EDSAV_OWNER
Who was the owner of the (educational or college savings) account ^123_EDSAVFIL?
1. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
2. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
3. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
4. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
5. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
6. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
7. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
8. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
9. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
10. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
11. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
12. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
13. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
14. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
15. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
16. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
17. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
18. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
19. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
20. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
50. A non-household member

EDSAV_BENEFICIARY
Who was the beneficiary of the (educational or college savings) account?
1. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
2. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
3. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
4. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
5. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
6. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
7. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
8. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
Page 359 of 537

9. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
10. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
11. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
12. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
13. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
14. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
15. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
16. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
17. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
18. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
19. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
20. Display the LNO, ^FNAME, and ^LNAME where PEOPLE_TO_ROSTER = 1
21. Display the ^FNAME and ^LNAME of a Type 2 Person
22. Display the ^FNAME and ^LNAME of a Type 2 Person
23. Display the ^FNAME and ^LNAME of a Type 2 Person
24. Display the ^FNAME and ^LNAME of a Type 2 Person
25. Display the ^FNAME and ^LNAME of a Type 2 Person
50. A non-household member

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

LSPANSWERED
LSPANSWEREDOTH
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ANYJTRNT
Page 360 of 537

^ANYJTRNT_QSTNTXT
1. Yes
2. No

JTWHO4
With whom?
^JTWHOFRNOTE_FIL
Enter 50 if the respondent owns the rental property with a non-household member.

1. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

2. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

3. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

4. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

5. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

6. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

7. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

8. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

9. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

10. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

11. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

12. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

13. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

14. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

15. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

16. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

17. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

18. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

19. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

20. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

21. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

22. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

23. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

24. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

25. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh
50. Non-household member(s)

Page 361 of 537

OWNRNT
^INADDITIONFIL_OWNRNT ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did
^TEMPNAME ^ALSOFIL_OWNRNT own any rental property in ^HISHER name only?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

LSPANSWERED
LSPANSWEREDOTH
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ANYJTPROP
^ANYJTPROP_QSTNTXT
1. Yes
2. No

JTWHO5
With whom?
^JTWHOFRNOTE_FIL
Enter 50 if the respondent owns the non-retirement or non-rental property, such as a second home
with a non-household member.

1. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh
Page 362 of 537

2. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

3. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

4. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

5. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

6. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

7. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

8. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

9. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

10. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

11. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

12. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

13. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

14. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

15. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

16. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

17. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

18. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

19. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

20. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

21. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

22. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

23. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

24. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh

25. Display the LNO, ^FNAME, ^LNAME where AGE >= 15 (where PEOPLE_TO_ROSTER = 1 for people on the Hh
50. Non-household member(s)

OWNPROP
^INADDITIONFIL_OWNPROP ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL,
did ^TEMPNAME ^ALSOFIL_OWNPROP own any real estate (such as a vacation home, a deeded
timeshare, or an undeveloped lot) in ^HISHER name only?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

Page 363 of 537

CARNUM
**NON-DISPLAYED ITEM**

MODEL_YRX
VEHICLE ^X
What is the model year of ^WHICH_VEHICLE?
^FR_VEHICLE

MAKEX
VEHICLE ^X
What is the make of this vehicle?
Make of vehicle is its brand name (for example: Honda or Chevrolet).
Enter at least the first 3 letters of the car make or model to display the answer list.

MAKEX_SP
VEHICLE ^X
What is the make of this vehicle?

MODELX
VEHICLE ^X
Read if necessary:
What is the model of this vehicle?
1. CAR_MODEL1
2. CAR_MODEL2
3. CAR_MODEL3
4. CAR_MODEL4
5. CAR_MODEL5
6. CAR_MODEL6
7. CAR_MODEL7
8. CAR_MODEL8
9. CAR_MODEL9
Page 364 of 537

10. CAR_MODEL10
11. CAR_MODEL11
12. CAR_MODEL12
13. CAR_MODEL13
14. CAR_MODEL14
15. CAR_MODEL15
16. CAR_MODEL16
17. CAR_MODEL17
18. CAR_MODEL18
19. CAR_MODEL19
20. CAR_MODEL20
21. CAR_MODEL21
22. CAR_MODEL22
23. CAR_MODEL23
24. CAR_MODEL24
25. CAR_MODEL25
26. CAR_MODEL26
27. CAR_MODEL27
28. CAR_MODEL28
29. CAR_MODEL29
30. CAR_MODEL30
31. CAR_MODEL31
32. CAR_MODEL32
33. CAR_MODEL33
34. CAR_MODEL34
35. CAR_MODEL35
36. CAR_MODEL36
37. CAR_MODEL37
38. CAR_MODEL38
39. CAR_MODEL39
40. CAR_MODEL40
41. CAR_MODEL41
42. CAR_MODEL42
43. CAR_MODEL43
44. CAR_MODEL44
45. CAR_MODEL45
46. CAR_MODEL46

MODELX_SP
Page 365 of 537

VEHICLE ^X
What is the model of this vehicle?

WHO_VEHICLE
Who owns this vehicle as of the last day of ^LASTMONTH, ^CALENDAR_YEAR?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
2. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
3. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
4. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
5. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
6. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
7. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
8. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
9. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
10. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
11. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
12. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
13. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
14. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
15. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
16. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
17. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
18. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
19. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
20. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1

CTRLNUM
**NON-DISPLAYED ITEM**

AST5C
^VEHICLE_QSTNTXT
If respondent reports later that all vehicles in the household are leased, then change this value to "No".

Page 366 of 537

1. Yes
2. No

NUM_VEHICLE
^NUMVEHICLE_QSTNTXT
Enter 0 if the household no longer owned any vehicles as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Do not include leased vehicles.

CTRLNUM
**NON-DISPLAYED ITEM**

AST5D
? [F1]
^RV_QSTNTXT
Do not include leased vehicles.
Only include vehicles which have not been reported already.
1. Yes
2. No

TYPE_RECVEH
^TYPERV_QSTNTXT
Mark all that apply.
Do not include leased vehicles.
Only include vehicles which have not been reported already.
1. Motorcycle
2. Boat
3. Recreational vehicle (RV)
4. Another type of vehicle
Page 367 of 537

RECVEH_SP
What 'other' type of recreational vehicle?

ADINCSRCE2
The next part of the interview is about ^PTEMPNAME income and the value of ^PTEMPNAME
assets between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL. We want to be
both as accurate and efficient as we can, so it would be very helpful if you could refer to any
records you might have. (Also -- we know that people aren't used to talking about their income and the
value of their assets, but we ask these questions to get an overall picture of your community and the
nation -- NOT to find out about ^YOUANYONEFIL personally.)
At appropriate moments, encourage respondent to get records.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
Page 368 of 537

**NON-DISPLAYED ITEM**

astcode
**NON-DISPLAYED ITEM**

jintsp_pd
? [F1]
^JINTSPPD_QSTNTXT
^AST3CINT_FIL
^FRAST1A_FIL
^FRAST2A_FIL

jcatsp1y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $25, between $25 and $75, between $75 and $150, or more than $150?
1. Less than $25
2. $25 to $74.99
3. $75 to $149.99
4. $150 or more

jcatsp1value
? [F1]
JCATSP_QSTNTXT
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

jcatsp1range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $500, between
Page 369 of 537

$500 and $1,000, between $1,000 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $999
3. $1,000 to $4,999
4. $5,000 or more

jcatsp2y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1,500, or more than $1,500?
1. Less than $100
2. $100 to $499.99
3. $500 to $1,499.99
4. $1,500 or more

jcatsp2value
? [F1]
^JCATSP_QSTNTXT
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

jcatsp2range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) ^RANGEAMTFIL?
1. Less than $1,000
2. $1,000 to $4,999
3. $5,000 to $9,999
4. $10,000 or more
5. Less than $5,000
6. $5,000 to $9,999
7. $10,000 to $19,999
8. $20,000 or more
Page 370 of 537

jcatsp3y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $1,500, between $1,500 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $1,499.99
3. $1,500 to $4,999.99
4. $5,000 or more

jcatsp3value
? [F1]
^JCATSP_QSTNTXT
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
^AST3CMV_FIL
^FRAST1AMV_FIL

jcatsp3range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $100,000, or more than $100,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $99,999
4. $100,000 or more

spanswered

ctrlnum
**NON-DISPLAYED ITEM**

Page 371 of 537

lno
**NON-DISPLAYED ITEM**

astcode
**NON-DISPLAYED ITEM**

jintch_pd
? [F1]
Earlier I recorded that ^TEMPNAME owned ^ASNAME_BANKACCT jointly with Read name(s).
How much INTEREST INCOME was produced (by those joint ^ASNAME_BANKACCT) between
^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL?
^AST3CINT_FIL
^FRAST1A_FIL
^FRAST2A_FIL
Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO1

jcatch1y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $25, between $25 and $75, between $75 and $150, or more than $150?
1. Less than $25
2. $25 to $74.99
3. $75 to $149.99
4. $150 or more

jcatch1value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including interest earned) of the ^ASNAME_BANKACCT ^TEMPNAME owned
jointly with Read name(s)?

Page 372 of 537

Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO1

jcatch1range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $500, between
$500 and $1,000, between $1,000 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $999
3. $1,000 to $4,999
4. $5,000 or more

jcatch2y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1,500, or more than $1,500?
1. Less than $100
2. $100 to $499.99
3. $500 to $1,499.99
4. $1,500 or more

jcatch2value
? [F1]
As of the last day of ^LASTMONTH ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including interest earned) of the ^ASNAME_BANKACCT ^TEMPNAME owned
jointly with Read name(s)?
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO1
Page 373 of 537

jcatch2range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) ^RANGEAMTFIL?
1. Less than $1,000
2. $1,000 to $4,999
3. $5,000 to $9,999
4. $10,000 or more
5. Less than $5,000
6. $5,000 to $9,999
7. $10,000 to $19,999
8. $20,000 or more

jcatch3y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $1,500, between $1,500 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $1,499.99
3. $1,500 to $4,999.99
4. $5,000 or more

jcatch3value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including interest earned) of the ^ASNAME_BANKACCT ^TEMPNAME owned
jointly with Read name(s)?
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
^AST3CMV_FIL
^FRAST1AMV_FIL
Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO1.

Page 374 of 537

jcatch3range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $100,000, or more than $100,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $99,999
4. $100,000 or more

spchanswered
ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode
**NON-DISPLAYED ITEM**

jtothint_pd
? [F1]
^JTOTHINTPD_QSTNTXT
'Share' refers to share in dollars and not to percentage share.
^AST3CINT_FIL
^FRAST1A_FIL
^FRAST2A_FIL
Display the first and last name(s) of the person(s) selected in JTWHO1 (with
the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
Non-household member' when JTWHO1 = 50

Page 375 of 537

jcatot1y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $25, between $25 and $75, between $75 and $150, or more than $150?
1. Less than $25
2. $25 to $74.99
3. $75 to $149.99
4. $150 or more

jcatoth1value
? [F1]
^JCATOTH_QSTNTXT
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO1 (with
the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
Non-household member' when JTWHO1 = 50

jcatoth1range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $500, between
$500 and $1,000, between $1,000 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $999
3. $1,000 to $4,999
4. $5,000 or more

jcatot2y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
Page 376 of 537

less than $100, between $100 and $500, between $500 and $1,500, or more than $1,500?
1. Less than $100
2. $100 to $499.99
3. $500 to $1,499.99
4. $1,500 or more

jcatoth2value
? [F1]
^JCATOTH_QSTNTXT
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO1 (with
the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
Non-household member' when JTWHO1 = 50

jcatoth2range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) ^RANGEAMTFIL?
1. Less than $1,000
2. $1,000 to $4,999
3. $5,000 to $9,999
4. $10,000 or more
5. Less than $5,000
6. $5,000 to $9,999
7. $10,000 to $19,999
8. $20,000 or more

jcatot3y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
Page 377 of 537

less than $500, between $500 and $1,500, between $1,500 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $1,499.99
3. $1,500 to $4,999.99
4. $5,000 or more

jcatoth3value
? [F1]
^JCATOTH_QSTNTXT
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
^AST3CMV_FIL
^FRAST1AMV_FIL
Display the first and last name(s) of the person(s) selected in JTWHO1 (with
the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
Non-household member' when JTWHO1 = 50

jcatoth3range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $100,000, or more than $100,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $99,999
4. $100,000 or more

spanswered

ctrlnum
Page 378 of 537

**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode
**NON-DISPLAYED ITEM**

excl_cd
Earlier I recorded that ^TEMPNAME ^ALSOFIL_ASSETS owned CDs^OWNNAMEFIL_EXCL Were
those CDs included in ^PTEMPNAME ^IRA401FIL_EXCL, or did ^HESHE own them separately
from any retirement account(s) -- or both?
1. All CDs are included in IRA, Keogh, 401k, 403b, 503b, or thrift accounts
2. All CDs are owned separately from retirement accounts
3. Both -- some are included in retirement accounts and some are owned separately

oint_pd
? [F1]
^INCOMENOWFIL_OINT
^EARLIERFIL_OINT How much INTEREST INCOME did ^TEMPNAME earn ^OWNNAME_FIL (from
those ASNAME_BANKACCT) between ^MONTH1 1st. and the end of ^LASTMONTH
^CALENDAR_YRFIL?
^FRAST1A_FIL
^AST3CINT_FIL
^FRAST2A_FIL

ocat1y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $25, between $25 and $75, between $75 and $150, or more than $150?
1. Less than $25
Page 379 of 537

2. $25 to $74.99
3. $75 to $149.99
4. $150 or more

ocat1value
? [F1]
^REG_CHKFIL As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL
BALANCE or MARKET VALUE (including interest earned) of the ^ASNAME_BANKACCT
^OWNNAME_FIL?
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

ocat1range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $500, between
$500 and $1,000, between $1,000 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $999
3. $1,000 to $4,999
4. $5,000 or more

ocat2y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1,500, or more than $1,500?
1. Less than $100
2. $100 to $499.99
3. $500 to $1,499.99
4. $1,500 or more

ocat2value
? [F1]
Page 380 of 537

As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including interest earned) of the ^ASNAME_BANKACCT ^OWNNAME_FIL?
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

ocat2range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) ^RANGEAMTFIL?
1. Less than $1,000
2. $1,000 to $4,999
3. $5,000 to $9,999
4. $10,000 or more
5. Less than $5,000
6. $5,000 to $9,999
7. $10,000 to $19,999
8. $20,000 or more

ocat3y
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st. and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $1,500, between $1,500 and $5,000, or more than $5,000?
^FRAST1A_FIL
1. Less than $500
2. $500 to $1,499.99
3. $1,500 to $4,999.99
4. $5,000 or more

ocat3value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including interest earned) of the ^ASNAME_BANKACCT ^OWNNAME_FIL?
Page 381 of 537

Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
^AST3CMV_FIL
^FRAST1AMV_FIL

ocat3range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $100,000, or more than $100,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $99,999
4. $100,000 or more

dkint
^ASIDEFRMFIL_DKINT was the total amount of INTEREST INCOME ^TEMPNAME ^HAVHAS
earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL on all
^OTHERFIL_DKINT ^ASNAME_BANKACCT ^HESHE owned?
^FRAST1A_FIL
^AST3CINT_FIL
^FRAST2A_FIL

dkint1range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $25, between $25 and $75, between $75 and $150, or more than $150?
1. Less than $25
2. $25 to $74.99
3. $75 to $149.99
4. $150 or more

Page 382 of 537

dkint2range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1,500, or more than $1,500?
1. Less than $100
2. $100 to $499.99
3. $500 to $1,499.99
4. $1,500 or more

dkint3range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $1,500, between $1,500 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $1,499.99
3. $1,500 to $4,999.99
4. $5,000 or more

dkmrktval
^ASIDEFRMFIL_DKMRKTVAL was the TOTAL BALANCE or MARKET VALUE (including interest
earned) of the ^OTHERFIL_DKMRKTVAL ^ASNAME_BANKACCT ^HESHE owned as of the last
day of ^LASTMONTH, ^CALENDAR_YEAR?
Enter 0 if the person no longer owns the ^ASNAME_BANKACCT as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
^FRAST1AMV_FIL
^AST3CMV_FIL

dkmrktval1range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $500, between
$500 and $1,000, between $1,000 and $5,000, or more than $5,000?
1. Less than $500
Page 383 of 537

2. $500 to $999
3. $1,000 to $4,999
4. $5,000 or more

dkmrktval2range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) ^RANGEAMTFIL?
1. Less than $1,000
2. $1,000 to $4,999
3. $5,000 to $9,999
4. $10,000 or more
5. Less than $5,000
6. $5,000 to $9,999
7. $10,000 to $19,999
8. $20,000 or more

dkmrktval3range
ASSET TYPE: ^C_ASNAME_BANKACCT
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $5,000,
between $5,000 and $25,000, between $25,000 and $100,000, or more than $100,000?
1. Less than $5,000
2. $5,000 to $24,999
3. $25,000 to $99,999
4. $100,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode2
Page 384 of 537

**NON-DISPLAYED**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode2
**NON-DISPLAYED**

jtanywsp
^EARLIERFIL_JTANYWSP What kind of dividends did ^YOUTHEYFIL_JTANYW
^BOTHALLFIL_JTANYWSP get from those joint ^ASNAME_MFS? Were the dividends
automatically reinvested or did ^YOUTHEYFIL_JTANYW get dividend checks?
1. Dividend CHECKS
2. REINVESTED dividends
3. Both
4. Neither; no dividends received

jtdivsp_pd
? [F1]
^INCLUDEFIL_JTDIVSP ^CREDITEDFIL_JTDIVSP DIVIDEND INCOME was produced by those
joint ^ASNAME_MFS (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?
Include reinvested dividends in income.

jdivsp1y
ASSET TYPE: MUTUAL FUNDS
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $250, between $250 and $1,000, between $1,000 and $2,500, or more than $2,500?
1. Less than $250
2. $250 to $999.99
Page 385 of 537

3. $1,000 to $2,499.99
4. $2,500 or more

jdivsp1value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including dividends) of the mutual funds ^WHO_JDIVSPVALUE?
Enter 0 if the person no longer owns the mutual funds as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of mutual funds held outside of any retirement
account.
Display the first and last name(s) of the children under the age of 15 living
in the household who were selected in JTWHO2

jdivsp1range
ASSET TYPE: MUTUAL FUNDS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

jdivsp2y
ASSET TYPE: STOCKS
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1,000, or more than $1,000?
1. Less than $100
2. $100 to $499.99
3. $500 to $999.99
4. $1,000 or more

Page 386 of 537

jdivsp2value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including dividends) of the stocks ^WHO_JDIVSPVALUE?
Enter 0 if the person no longer owns the stocks as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of stocks held outside of any retirement account.
Display the first and last name(s) of the children under the age of 15 living
in the household who were selected in JTWHO2

jdivsp2range
ASSET TYPE: STOCKS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

spanswered

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode2
**NON-DISPLAYED**

jtanywch
^EARLIERFIL_JTANYWCH What kind of dividends did those joint ^MUTFNDSTOCKOTFIL
produce? Were the dividends automatically reinvested or did ^HESHE get dividend checks?
Page 387 of 537

Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO2
1. Dividend CHECKS
2. REINVESTED dividends
3. Both
4. Neither; no dividends received

jtdivch_pd
? [F1]
^INCLUDEFIL_JTDIVCH ^CREDITEDFIL_JTDIVCH DIVIDEND INCOME was produced by those
joint ^ASNAME_MFS (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?
Include reinvested dividends in income.

jdivch1y
ASSET TYPE: MUTUAL FUNDS
Wass the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $250, between $250 and $1,000, between $1,000 and $2,500, or more than $2,500?
1. Less than $250
2. $250 to $999.99
3. $1,000 to $2,499.99
4. $2,500 or more

jdivch1value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including dividends) of the mutual funds ^TEMPNAME owned jointly with Read
name(s)?
Enter 0 if the person no longer owns the mutual funds as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of mutual funds held outside of any retirement
account.
Page 388 of 537

Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO2

jdivch1range
ASSET TYPE: MUTUAL FUNDS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

jdivch2y
ASSET TYPE: STOCKS
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1,000, or more than $1,000?
1. Less than $100
2. $100 to $499.99
3. $500 to $999.99
4. $1,000 or more

jdivch2value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the TOTAL BALANCE or
MARKET VALUE (including dividends) of the stocks ^TEMPNAME owned jointly with Read
name(s)?
Enter 0 if the person no longer owns the stocks as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of stocks held outside of any retirement account.
Display the first and last name(s) of the child(ren) under the age of 15 who
were selected in JTWHO2
Page 389 of 537

jdivch2range
ASSET TYPE: STOCKS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

spchanswered
ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode2
**NON-DISPLAYED**

jtothany
^EARLIERFIL_JTOTHANY What kind of dividends did those joint ^MUTFNDSTOCKOTFIL
produce? Were the dividends automatically reinvested or did ^YOUTHEYFIL_JTANYW get
dividend checks?
Display the first and last name(s) of the person(s) selected in JTWHO2 (with
the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
non-household member(s)' when JTWHO1 = 50
1. Dividend CHECKS
2. REINVESTED dividends
3. Both
4. Neither; no dividends received

jtothdiv_pd
Page 390 of 537

? [F1]
^INCLUDEFIL_JTOTHDIV was ^PTEMPNAME^ANDWHO_JTOTHDIV share, in dollars, of the
^CREDITEDFIL_JTOTHDIV DIVIDEND INCOME that was produced by those joint
^MUTFNDSTOCKOTFIL (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?
'Share' refers to share in dollars and not to percentage share.
Include reinvested dividends in income.
Display the first and last name(s) of the person(s) selected in JTWHO2 (with
the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
non-household member(s)' when JTWHO1 = 50

jdivot1y
ASSET TYPE: MUTUAL FUNDS
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $250, between $250 and $1,000, between $1,000 and $2,500, or more than $2,500?
1. Less than $250
2. $250 to $999.99
3. $1,000 to $2,499.99
4. $2,500 or more

jdivot1value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was
^PTEMPNAME^ANDWHO_JTOTHDIV share, in dollars, of the TOTAL BALANCE or MARKET
VALUE (including dividends) of the mutual funds ^TEMPNAME owned jointly?
Enter 0 if the person no longer owns the mutual funds as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of mutual funds held outside of any retirement
account.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO2 (with
the exception of the person's spouse if one exists). Star the name(s) of the
Page 391 of 537

child(ren) under the age of 15 who are living in the household. Display 'a
non-household member(s)' when JTWHO1 = 50

jdivot1range
ASSET TYPE: MUTUAL FUNDS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

jdivot2y
ASSET TYPE: STOCKS
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $100, between $100 and $500, between $500 and $1000, or more than $1,000?
1. Less than $100
2. $100 to $499.99
3. $500 to $999.99
4. $1,000 or more

jdivot2value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was
^PTEMPNAME^ANDWHO_JTOTHDIV share, in dollars, of the TOTAL BALANCE or MARKET
VALUE (including dividends) of the stocks ^TEMPNAME owned jointly?
Enter 0 if the person no longer owns the stocks as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of stocks held outside of any retirement account.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO2 (with
Page 392 of 537

the exception of the person's spouse if one exists). Star the name(s) of the
child(ren) under the age of 15 who are living in the household. Display 'a
non-household member(s)' when JTWHO1 = 50

jdivot2range
ASSET TYPE: STOCKS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

spanswered
ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

astcode2
**NON-DISPLAYED**

exclude
Earlier I recorded that ^TEMPNAME ^ALSOFIL_EXCLUDE owned ^SOMEFIL ^MUTFNDSTOCKFIL
^OWNNAMEFIL_EXCLUDE Were those ^MUTFNDSTOCKFIL included in ^PTEMPNAME
^IRA401FIL_EXCL, or did ^HESHE own them separately from any retirement account(s) -- or
both?
1. All shares are included in IRA, Keogh, 401k, 403b, 503b, or thrift accounts
2. All shares are owned separately from retirement accounts
3. Both -- some are included in retirement accounts and some are owned separately

owntype
Page 393 of 537

^INCOMENOWFIL_OWNTYPE
^EARLIERFIL_OWNTYPE What kind of dividends did ^TEMPNAME get from those
^MUTFNDSTOCKFIL? Were the dividends automatically reinvested or did ^HESHE get dividend
checks?
1. Dividend CHECKS
2. REINVESTED dividends
3. Both
4. Neither; no dividends received

owndiv_pd
? [F1]
^INCOMENOWFIL_OWNDIV
^INCLUDEFIL_OWNDIV ^CREDITEDFIL_OWNDIV DIVIDEND INCOME did ^TEMPNAME receive
^OWNNAME_FIL from those ^ASNAME_MFS (between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL)?
Include reinvested dividends in income.

odiv1y
ASSET TYPE: MUTUAL FUNDS
Was the annual amount (earned between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL) less than $250, between $250 and $1,000, between $1,000 and $2,500, or
more than $2,500?
1. Less than $250
2. $250 to $999.99
3. $1,000 to $2,499.99
4. $2,500 or more

odiv1value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR , what was the TOTAL BALANCE or
MARKET VALUE (including dividends) of the mutual funds ^OWNNAME_FIL?

Page 394 of 537

Enter 0 if the person no longer owns the mutual funds as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of mutual funds held outside of any retirement
account.

odiv1range
ASSET TYPE: MUTUAL FUNDS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

odiv2y
ASSET TYPE: STOCKS
Was the annual amount (earned between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL) less than $100, between $100 and $500, between $500 and $1000, or more
than $1,000 dollars?
1. Less than $100
2. $100 to $499.99
3. $500 to $999.99
4. $1,000 or more

odiv2value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR , what was the TOTAL BALANCE or
MARKET VALUE (including dividends) of the stocks ^OWNNAME_FIL?
Enter 0 if the person no longer owns the stocks as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Please remind the person to only report the value of stocks held outside of any retirement account.

Page 395 of 537

odiv2range
ASSET TYPE: STOCKS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

dkanyw
Earlier I recorded that ^TEMPNAME owned some ^ASNAME_MFS. ^DKANYW_OWNNAMEFIL
kind of dividends did ^HESHE get from those ^ASNAME_MFS? Were the dividends automatically
reinvested or did ^HESHE get dividend checks?
1. Dividend CHECKS
2. REINVESTED dividends
3. Both
4. Neither; no dividends received

dkdiv
^ASIDEFRMFIL_DKDIV was the total amount of dividend income ^TEMPNAME ^HAVHAS earned
between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL on all
^OTHERFIL_DKDIV ^ASNAME_MFS ^HESHE owned?
Include reinvested dividends in income.

dkdiv1range
ASSET TYPE: MUTUAL FUNDS
Was the amount (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL) less
than $250, between $250 and $1,000, between $1,000 and $2,500, or more than $2,500?
1. Less than $250
2. $250 to $999.99
3. $1,000 to $2,499.99
4. $2,500 or more

Page 396 of 537

dkdiv2range
ASSET TYPE: STOCKS
Was the amount (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL) less
than $100, between $100 and $500, between $500 and $1,000, or more than $1,000?
1. Less than $100
2. $100 to $499.99
3. $500 to $999.99
4. $1,000 or more

dkdivvalue
^ASIDEFRMFIL_DKDIVVALUE was the TOTAL BALANCE or MARKET VALUE (including dividends)
of the ^OTHERFIL_DKDIVVALUE ^ASNAME_MFS ^HESHE owned as of the last day of
^LASTMONTH, ^CALENDAR_YEAR?
Enter 0 if the person no longer owns the ^ASNAME_MFS as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

dkdivvalue1range
ASSET TYPE: MUTUAL FUNDS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

dkdivvalue2range
ASSET TYPE: STOCKS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $1,000,
between $1,000 and $10,000, between $10,000 and $25,000, or more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

Page 397 of 537

ctrlnum
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

mobile_value
(Earlier I recorded that ^TEMPNAME ^OWNOWNSFIL_PR or AREIS in the process of buying
^PTEMPNAME primary residence.) As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what
was the value of ^PTEMPNAME mobile home; that is, how much ^DODOES ^TEMPNAME think it
would have sold for if it were for sale?
Enter 0 if the household did not own their mobile home as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

mobile_debt
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, was there a mortgage, installment loan,
contract to purchase, or other debt on this mobile home or site?
Reverse mortgages are included as debts against this home.
Enter "Yes" if the household has a reverse mortgage or a home equity loan.
1. Yes
2. No

mobile_loans
Altogether, how many mortgages, contracts, or other types of loans were there on this mobile
home as of the last day of ^LASTMONTH, ^CALENDAR_YEAR?

ctrlnum
**NON-DISPLAYED ITEM**

mhloan_code
Page 398 of 537

**NON-DISPLAYED ITEM**

mobile_amt
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much principal was owed on
^PTEMPNAME 123_FILL mortgage or loan on this mobile home?
If the household has a reverse mortgage or a home equity loan, the principal owed is the total amount
received to date.

mhsite_debt
Was this mortgage, contract, or other debt for just the site, just the mobile home, or did it apply
to both the mobile home and the site as of the last day of ^LASTMONTH, ^CALENDAR_YEAR?
1. Just the site
2. Just the mobile home
3. Both the mobile home and the site

ctrlnum
**NON-DISPLAYED ITEM**

property_value
(Earlier I recorded that ^TEMPNAME ^OWNOWNSFIL_PR, or AREIS in the process of buying,
^PTEMPNAME primary residence.) As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what
was the value of ^PTEMPNAME primary residence; that is, how much ^DODOES ^TEMPNAME
think it would have sold for if it were for sale?
Enter 0 if the household did not own their primary residence as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

property_debt
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, were there any mortgages, home equity
loans, or other debt on this home?
Reverse mortgages are included as debts against this home.
Page 399 of 537

Enter "Yes" if the household has a reverse mortgage or a home equity loan.
1. Yes
2. No

property_loans
Altogether, how many mortgages or other types of loans were there on this home as of the last
day of ^LASTMONTH, ^CALENDAR_YEAR?

ctrlnum
**NON-DISPLAYED ITEM**

proploan_code
**NON-DISPLAYED ITEM**

property_amt
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much principal was owed on
^PTEMPNAME 123_FILL mortgage or loan on this home?
If the household has a reverse mortgage or a home equity loan, the principal owed is the total amount
received to date.

yrs_debt
For the ^123_FILL mortgage or loan, what is the total number of years over which payments are
to be made?
The respondent should provide the full span of the mortgages, not the years remaining at the time of
interview.

property_rate
? [F1]
What was the annual interest rate on this ^123_FILL mortgage or loan as of the last day of
Page 400 of 537

^LASTMONTH, ^CALENDAR_YEAR?
Enter both a whole number and a decimal.
Respondents may report any whole number or a whole number and a fraction. For example, if the rate
is reported as '5 and 3/8ths %', then enter 5.375.
Here is a 'Fraction to Decimal Conversion Chart' to help convert the second part, the fraction, of the
respondent's answer:
1/8 = .125
1/4 = .25
3/8 = .375

1/2 = .5
5/8 = .625
3/4 = .75

7/8 = .875

Examples of mortgage interest rates converted to decimal form can be found in the help screen.

ratetype_debt
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, was the interest rate ^TEMPNAME
^PAY_FIL on this ^123_FILL mortgage or loan fixed, variable, or a combination of the two?
1. Fixed
2. Variable
3. Combination of fixed and variable

type_debt
? [F1]
Did ^TEMPNAME obtain this 123_FILL mortgage or loan through an FHA, VA, or other mortgage
program...
Read answer categories.
1. FHA?
2. VA?
3. Other mortgage program?
4. None of these?

rentmort_pay
How much was this household's ^RENTMORT payment in December ^CALENDAR_YEAR,
including any condominium or association fees?
Page 401 of 537

Include amounts paid for property taxes, property insurance, mortgage insurance, and any other fees
included in a typical monthly payment.
Enter 0 if no ^RENTMORT was paid.

rentmort_range
Was the amount (as of December, ^CALENDAR_YEAR) less than $400, between $400 and $750,
between $750 and $1,200, or more than $1,200?
1. Less than $400
2. $400 to $749
3. $750 to $1,199
4. $1,200 or more

ctrlnum
**NON-DISPLAYED ITEM**

utilities_expense
How much did this household pay for electricity, gas, basic telephone service, and other utilities
in December ^CALENDAR_YEAR?
Other common examples of utilities include water, heating oil and wood, trash or recycling, and mobile
telephone service (excluding data plans, applications, games, and ringtones.) Do not include cable TV
or internet.

utilities_range
Was the amount (as of December, ^CALENDAR_YEAR) less than $100, between $100 and $200,
between $200 and $300, or more than $300?
1. Less than $100
2. $100 to $199
3. $200 to $299
4. $300 or more

whopay
Starting with the person who paid the most, who paid for ^MOTRNTUTL_FILL in ^LASTMONTH
^CALENDAR_YEAR?
Page 402 of 537

Mark all that apply.

1. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

2. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

3. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

4. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

5. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

6. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

7. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

8. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

9. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

10. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

11. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

12. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

13. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

14. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

15. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

16. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

17. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

18. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

19. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

20. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

21. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

22. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

23. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

24. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO

25. LNO ROST_FNAME ROST_LNAME of all people AGE >= 15 either on the T2 roster or where PEOPLE_TO_RO
50. a non-household member

utilities_amt
How much did ^NAME_WHOPAY pay in December ^CALENDAR_YEAR?

ctrlnum
**NON-DISPLAYED ITEM**

lno
Page 403 of 537

**NON-DISPLAYED ITEM**

facelife
? [F1]
(Earlier ^TEMPNAME said ^HESHE owned life insurance policies.) As of the last day of
^LASTMONTH, ^CALENDAR_YEAR, what was the FACE VALUE of all life insurance policies that
^TEMPNAME ^HAVHAS? By face value, we mean the amount stated on an insurance policy, to
be paid upon death or maturity.
Enter 0 if the person no longer owns the life insurance policies as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

type_lifeinsur
? [F1]
Did ^TEMPNAME have any policies that build up a cash value or that ^TEMPNAME could borrow
on? These are sometimes called 'whole life', 'straight life', or 'universal life' policies.

1. Yes
2. No

cashlife
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the CASH VALUE of all life
insurance policies that ^TEMPNAME ^HAVHAS? The cash value is NOT the same as the face
value. By cash value, we mean the amount an insurance company will pay to the policyholder in
the event his or her policy is voluntarily terminated before its maturity; the cash value is the
savings component of most whole life and universal life insurance policies.
Enter 0 if the person no longer owns the life insurance policies as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

ctrlnum
**NON-DISPLAYED ITEM**

lno
Page 404 of 537

**NON-DISPLAYED ITEM**

EDUCSAV_CODE
**NON-DISPLAYED ITEM**

educ_value
? [F1]
^EDSAV_QSTNTXTFIL
If the person or household owned three or more educational or college savings accounts, the person
should report the accounts with the largest balance.

educ_range
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $10,000,
between $10,000 and $75,000, between $75,000 and $150,000, or more than $150,000?
1. Less than $10,000
2. $10,000 to $74,999
3. $75,000 to $149,999
4. $150,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

Page 405 of 537

jtrntsp_pd
^JTRNTSPPD_QSTNTXT
Gross rent is the total amount of money collected as rent before expenses.

jtnetsp_pd
? [F1]
^JTNETSPPD_QSTNTXT
Net income (or net loss) is the amount of money that the owner of rental property makes after paying
all expenses, regardless of whether the expenses are tax deductible. Examples of expenses can be
found in the Help Screen.
Enter a net loss as a negative amount.

spnet1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $2,500, between $2,500 and $5,000, or more than $5,000?
Enter a net loss in the first response category.
1. Less than $500
2. $500 to $2,499.99
3. $2,500 to $4,999.99
4. $5,000 or more

jtspmrkvalue
? [F1]
^JTSPMRKVALUE_QSTNTXT
Enter 0 if the person no longer owns the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Enter 0 if the rental property is attached to or located in this residence.

Page 406 of 537

spmrkvalue1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

jtspdebt
? [F1]
^JTSPDEBT_QSTNTXT
Enter 0 if the person owed no debt on the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Enter 0 if the rental property is attached to or located in this residence.

spdebt1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YRFIL) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

spanswered

ctrlnum
**NON-DISPLAYED ITEM**

lno
Page 407 of 537

**NON-DISPLAYED ITEM**

jtothrnt_pd
^JTOTHRNTPD_QSTNTXT
Gross rent is the total amount of money collected as rent before expenses.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO4 (with
the exception of the person's spouse if one exists). Display 'a
Non-household member' when JTWHO4 = 50

jtothnet_pd
? [F1]
^JTOTHNETPD_QSTNTXT
Net income (or net loss) is the amount of money that the owner of rental property makes after paying
all expenses, regardless of whether the expenses are tax deductible. Examples of expenses can be
found in the Help Screen.
Enter a net loss as a negative amount.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO4 (with
the exception of the person's spouse if one exists). Display 'a
Non-household member' when JTWHO4 = 50

othnet1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $2,500, between $2,500 and $5,000, or more than $5,000?
Enter a net loss in the first response category.
1. Less than $500
2. $500 to $2,499.99
3. $2,500 to $4,999.99
Page 408 of 537

4. $5,000 or more

jtothmrkvalue
? [F1]
^JTOTHMRKVALUE_QSTNTXT
Enter 0 if the person no longer owns the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
Enter 0 if the rental property is attached to or located in this residence.
Display the first and last name(s) of the person(s) selected in JTWHO4 (with
the exception of the person's spouse if one exists). Display 'a
Non-household member' when JTWHO4 = 50

othmrkvalue1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

jtothdebt
? [F1]
^JTOTHDEBT_QSTNTXT
Enter 0 if the person owed no debt on the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
Enter 0 if the rental property is attached to or located in this residence.

Page 409 of 537

Display the first and last name(s) of the person(s) selected in JTWHO4 (with
the exception of the person's spouse if one exists). Display 'a
Non-household member' when JTWHO4 = 50

othdebt1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YRFIL) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

spanswered

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

ownrent_pd
Earlier I recorded that ^TEMPNAME ^ALSOFIL_OWNRENT owned rental property
^OWNNAMEFIL_OWNRENT. How much GROSS rent did ^TEMPNAME receive from all rental
property owned ^OWNNAME_FIL between ^MONTH1 1st and the end of ^LASTMONTH
^CALENDAR_YRFIL?
Gross rent is the total amount of money collected as rent before expenses.

ownnet_pd
? [F1]
What was the NET income or NET loss after expenses (from all of those rental properties
^TEMPNAME owned ^OWNNAME_FIL between ^MONTH1 1st and the end of ^LASTMONTH
Page 410 of 537

^CALENDAR_YRFIL) ?
Net income (or net loss) is the amount of money that the owner of rental property makes after paying
all expenses, regardless of whether the expenses are tax deductible. Examples of expenses can be
found in the Help Screen.
Enter a net loss as a negative amount.

ownnet1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $2,500, between $2,500 and $5,000, or more than $5,000?
Enter a net loss in the first response category.
1. Less than $500
2. $500 to $2,499.99
3. $2,500 to $4,999.99
4. $5,000 or more

ownmrkvalue
? [F1]
Excluding properties attached to or located on ^PTEMPNAME own residence, and as of the last
day of ^LASTMONTH, ^CALENDAR_YEAR, what was the total market value of all of those rental
properties ^OWNNAME_FIL?
Enter 0 if the person no longer owns the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Enter 0 if the rental property is attached to or located in this residence.

ownmrkvalue1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
Page 411 of 537

2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

owndebt
? [F1]
Excluding properties attached to or located on ^PTEMPNAME own residence, and as of the last
day of ^LASTMONTH, ^CALENDAR_YEAR, what was the total value of any debt (such as
mortgages, deeds of trust, or other debt) owed on all of those rental properties (^TEMPNAME owned
^OWNNAME_FIL)?
Enter 0 if the person owed no debt on the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Enter 0 if the rental property is attached to or located in this residence.

owndebt1y
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YRFIL) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

dkrnt
^ASIDEFRMFIL_DKRNT was the total amount of GROSS rent ^TEMPNAME received between
^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL from all ^OTHERFIL_DKRNT
rental property ^HESHE owned?
Gross rent is the total amount of money collected as rent before expenses.

dkrntrange
ASSET TYPE: RENTAL PROPERTY
Page 412 of 537

Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

dknet
? [F1]
(^ASIDEFRMFIL_DKRNT) was the NET income or NET loss after expenses (from all of those rental
properties between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL) ?
Net income (or net loss) is the amount of money that the owner of rental property makes after paying
all expenses, regardless of whether the expenses are tax deductible. Examples of expenses can be
found in the Help Screen.
Enter a net loss as a negative amount.

dknetrange
ASSET TYPE: RENTAL PROPERTY
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $500, between $500 and $2,500, between $2,500 and $5,000, or more than $5,000?
1. Less than $500
2. $500 to $1,499.99
3. $1,500 to $4,999.99
4. $5,000 or more

dkvalue
^ASIDEFRMFIL_DKVALUE was the TOTAL MARKET VALUE from all ^OTHERFIL_DKVALUE
rental property ^HESHE owned as of the last day of ^LASTMONTH, ^CALENDAR_YEAR?
Enter 0 if the person no longer owns the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Enter 0 if the rental property is attached to or located in this residence.
Page 413 of 537

dkdebt
? [F1]
^ASIDEFRMFIL_DKDEBT properties attached to or located on ^PTEMPNAME own residence and
as of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the total value of any debt
(such as mortgages, deeds of trust, or other debt) owed on all ^OTHERFIL_DKDEBT rental
properties?
Enter 0 if the person owed no debt on the rental property as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
Enter 0 if the rental property is attached to or located in this residence.

dkdebtrange
ASSET TYPE: RENTAL PROPERTY
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YRFIL) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

jtspouse_mrkvalue
Page 414 of 537

? [F1]
^SPMRKVALUE_QSTNTXT
Enter 0 if the person no longer owned the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
If respondent is unsure of the value, then ask them "For example, about how much money would
^HESHE have received if ^HESHE tried to sell this property or timeshare"?

spmrkvalue2y
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

jtspredebt
^JTSPREDEBT_QSTNTXT
Enter 0 if the person owed no debt on the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

spdebt2y
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

Page 415 of 537

spanswered
ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

jtother_mrkvalue
? [F1]
^OTMRKVALUE_QSTNTXT
Enter 0 if the person no longer owned the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
If respondent is unsure of the value, then ask them "For example, about how much money would
^HESHE have received if ^HESHE tried to sell this property or timeshare"?
Display the first and last name(s) of the person(s) selected in JTWHO5 (with
the exception of the person's spouse if one exists). Display 'a
Non-household member' when JTWHO5 = 50

otmrkvalue2y
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

jtotredebt
^JTOTREDEBT_QSTNTXT
Enter 0 if the person owed no debt on the real estate as of the last day of ^LASTMONTH,
Page 416 of 537

^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
Display the first and last name(s) of the person(s) selected in JTWHO5 (with
the exception of the person's spouse if one exists). Display 'a
Non-household member' when JTWHO5 = 50

otdebt2y
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

spanswered
ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

self_mrkvalue
? [F1]
Earlier I recorded that ^TEMPNAME ^ALSOFIL_OWNREAL owned real estate (such as a vacation
home, a deeded timeshare, or an undeveloped lot) ^OWNNAME_FIL. As of the last day of
^LASTMONTH, ^CALENDAR_YEAR, what was the total market value of all of those properties?
Enter 0 if the person no longer owned the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
If respondent is unsure of the value, then ask them "For example, about how much money would
^HESHE have received if ^HESHE tried to sell this property or timeshare"?
Page 417 of 537

selfmrkvalue2y
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

selfdebt
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the total value of any debt
(such as mortgages, deeds of trust, or other debt) owed on all of those properties (^TEMPNAME
owned in ^HISHER own name)?
Enter 0 if the person owed no debt on the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

selfdebt2y
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

spanswered
dkrevalue
^ASIDEFRMFIL_DKREVALUE was the TOTAL MARKET VALUE from all ^OTHERFIL_DKREVALUE
real estate (such as a vacation home, a deeded timeshare, or an undeveloped lot) ^HESHE owned as
of the last day of ^LASTMONTH, ^CALENDAR_YEAR?
Enter 0 if the person no longer owned the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
If respondent is unsure of the value, then ask them "For example, about how much money would
Page 418 of 537

^HESHE have received if ^HESHE tried to sell this property or timeshare"?

dkrevaluerange
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

dkredebt
? [F1]
^ASIDEFRMFIL_DKREDEBT of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was the
total value of any debt (such as mortgages, deeds of trust, or other debt) owed on all of those
^OTHERFIL_DKREDEBT properties?
Enter 0 if the person owed no debt on the real estate as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

dkredebtrange
ASSET TYPE: REAL ESTATE
Was the amount (as of the last day of ^LASTMONTH ^CALENDAR_YEAR) less than $50,000,
between $50,000 and $150,000, between $150,000 and $250,000, or more than $250,000?
1. Less than $50,000
2. $50,000 to $149,999
3. $150,000 to $249,999
4. $250,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

Page 419 of 537

carno
**NON-DISPLAYED ITEM**

carfree
^QSTN_TYPECARFIL
1. Yes
2. No

carowed
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much was owed on that vehicle?

primary_use
Was this vehicle used primarily either for business purposes or for the transportation of a
disabled person?
Please do not consider a vehicle to be used primarily for business purposes if that vehicle was used
primarily for transportation to and from work.
1. Yes
2. No

ctrlnum
**NON-DISPLAYED ITEM**

type_recveh_num
**NON-DISPLAYED ITEM**

who_recveh
^RECVEH_INTRO Who owned the ^TYPE_RECVEH as of the last day of ^LASTMONTH,
^CALENDAR_YEAR?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
2. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
Page 420 of 537

3. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
4. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
5. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
6. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
7. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
8. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
9. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
10. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
11. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
12. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
13. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
14. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
15. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
16. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
17. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
18. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
19. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1
20. Display the LNO ROST_FNAME ROST_LNAME where AGE >= 15 and PEOPLE_TO_ROSTER = 1

rec_vehicle
If that ^TYPE_RECVEH were sold, as of the last day of ^LASTMONTH, ^CALENDAR_YEAR what
would it sell for?
Enter 0 if the household no longer owns the vehicle as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.

recvehicfree
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, did ^HESHE owe money on that
^TYPE_RECVEH?
1. Yes
2. No

recvehicowed
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much was owed on that
^TYPE_RECVEH?

Page 421 of 537

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

annuity_trust
? [F1]
(Earlier I recorded that ^TEMPNAME owned an annuity or a trust or managed investment account.) As
of the last day of ^LASTMONTH, CALENDARY_YEAR, did ^HESHE have just an annuity, just a
trust or managed investment account, both, or no longer own either?
1. Annuities
2. Trusts
3. Both
4. No longer owns either an annuity or trust/managed investment account

annuity_inc
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much annuity
income did ^TEMPNAME receive?
If annuity income is shared, count only ^HISHER share.

annuity_inc_range
ASSET TYPE: ANNUITIES
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $2,500, between $2,500 and $5,000, between $5,000 and $10,000 or more than $10,000?
1. Less than $2,500
2. $2,500 to $4,999
3. $5,000 to $9,999
4. More than $10,000

annuity_self
? [F1]
Did ^TEMPNAME have annuities in which some or all of the equity belonged to HIMHER?
Page 422 of 537

1. Yes
2. No

annuity_value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was ^PTEMPNAME share, in
dollars, of the total value of those annuities (in which ^TEMPNAME
^OWNOWNSFIL_ANNUITYTRUST some or all of the equity)?

annuity_range
ASSET TYPE: ANNUITIES
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $25,000,
between $25,000 and $50,000, between 50,000 and 100,000, or more than $100,000?
1. Less than $25,000
2. $25,000 to $49,999
3. $50,000 to $99,999
4. $100,000 or more

trust_inc
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how much trust or
managed investment account income did ^TEMPNAME receive?
If trust or managed investment account income in shared, count only ^HISHER share.

trust_inc_range
ASSET TYPE: TRUSTS OR MANAGED INVESTMENT ACCOUNTS
Was the amount (earned between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)
less than $2,500, between $2,500 and $5,000, between $5,000 and $10,000 or more than $10,000?
1. Less than $2,500
2. $2,500 to $4,999
3. $5,000 to $9,999
4. More than $10,000

Page 423 of 537

trust_self
? [F1]
Did ^TEMPNAME have trusts or managed investment accounts in which some or all of the equity
belong to HIMHER?
1. Yes
2. No

trust_value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was ^PTEMPNAME share, in
dollars, of the total value of those trusts or managed investment accounts (in which ^TEMPNAME
^OWNOWNSFIL_ANNUITYTRUST some or all of the equity)?

trust_range
ASSET TYPE: TRUSTS OR MANAGED INVESTMENT ACCOUNTS
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $25,000,
between $25,000 and $50,000, between $50,000 and $100,000, or more than $100,000?
1. Less than $25,000
2. $25,000 to $49,999
3. $50,000 to $99,999
4. $100,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

business_inv_num
(Earlier I recorded that ^TEMPNAME owned a business(es) as an investment only.) As of the last day
of ^LASTMONTH, ^CALENDAR_YEAR, how many businesses as an investment only did ^HESHE
own?
Page 424 of 537

Enter 0 for none.

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

invbusiness_code
**NON-DISPLAYED ITEM**

business_inv_name
What was the name ^NAME_BUSFIL
While respondents are allowed to report that they own up to 10 businesses as an investment only, we
are only asking the detailed questions for up to 3 businesses as an investment only.

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

invbusiness_code
**NON-DISPLAYED ITEM**

business_code
**NON-DISPLAYED ITEM**

percent_owned
^SELF_EMPFIL As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what percent of
^BUSINESS_NAMES did ^TEMPNAME own?

Page 425 of 537

^ENTER0_FIL
Please enter all ownership percentages as WHOLE numbers. For any NON-WHOLE number
ownership percentages, please round up or down accordingly. For example, for 50 percent, please enter
'50'; for 9.7 percent, please enter '10'; for 25.2 percent, please enter '25'.

business_value
? [F1]
(As of the last day of ^LASTMONTH, ^CALENDAR_YEAR) What was the total value of
^BUSINESS_NAMES before figuring in any debts that might be owed against it?
If respondent is unsure of the value, then ask them, "For example, about how much money would
^HESHE have received if ^HESHE sold all property and equipment associated with the business?"

business_range
ASSET TYPE: BUSINESS(ES) OWNED
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $10,000,
between $10,000 and $50,000, between $50,000 and $150,000, or more than $150,000?
1. Less than $10,000
2. $10,000 to $49,999
3. $50,000 to $149,999
4. $150,000 or more

business_debt
? [F1]
(As of the last day of ^LASTMONTH, ^CALENDAR_YEAR) What was the total debt owed against
^BUSINESS_NAMES?
Enter 0 for none.
Please include all outstanding debts even if they may be forgiven at a future date.
Please do not include fully forgiven loans as part of the businesses debt.

business_debt_range
ASSET TYPE: BUSINESS(ES) OWNED
Was the amount (as of the last day of ^LASTMONTH, ^CALENDAR_YEAR) less than $10,000,
between $10,000 and $50,000, between $50,000 and $150,000, or more than $150,000?
Page 426 of 537

1. Less than $10,000
2. $10,000 to $49,999
3. $50,000 to $149,999
4. $150,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

rndup2_income
? [F1]
(Earlier I recorded that ^TEMPNAME had Read investments.) Between ^MONTH1 1st and the end
of ^LASTMONTH ^CALENDAR_YRFIL, what was ^HISHER share of income from Read
investments ^INTOTAL_FIL? (If the income is shared, count only ^HISHER ^CHILDFIL)
Enter a net loss as a negative amount.
'Share' refers to share in dollars and not to percentage share.
Enter 0 if the asset generates no income.
Display the 'other' investments reported in AST4C_SP:
Financial Investments

Heading:

Other

rndup2_inc_range
ASSET TYPE: OTHER INVESTMENTS
Was the amount less than $25, between $25 and $100, between $100 and $500, or more than
$500?
1. Less than $25
2. $25 to $99.99
3. $100 to $499.99
4. $500 or more

Page 427 of 537

rndup2_value
? [F1]
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, what was ^HISHER share of the total
balance or market value of the Read investments ^TEMPNAME owned ^ALLTOG_FIL?
Enter 0 if the person no longer owns the 'other' investments as of the last day of ^LASTMONTH,
^CALENDAR_YEAR.
'Share' refers to share in dollars and not to percentage share.
If respondent is unsure of the value, then ask them "For example, about how much money would
^HESHE have received if ^HESHE tried to sell the assets"?
Display the list of 'other financial investment' reported in AST4C_SP
Heading: Other Financial Investments

rndup2_val_range
ASSET TYPE: OTHER INVESTMENTS
Was the amount less than $1,000, between $1,000 and $10,000, between $10,000 and $25,000, or
more than $25,000?
1. Less than $1,000
2. $1,000 to $9,999
3. $10,000 to $24,999
4. $25,000 or more

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

credit_cards
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME owe
any money for...
...store bills or credit card bills?
(...educational or education-related expenses?)
Page 428 of 537

(...medical bills ^YOUHESHE WASWERE unable to pay in full?)
(...any other debt we have not yet mentioned, including loans obtained through a bank or credit union,
money owed to private individuals, debt held against mutual funds or stocks (margin accounts), or any
other debt not covered?)
Please exclude store bills or credit card debt for business expenses that will be paid or reimbursed by
an employer or business.
1. Yes
2. No

educ_loans
? [F1]
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME owe any
money for)
(...store bills or credit card bills?)
...educational or education-related expenses?
(...medical bills ^YOUHESHE WASWERE unable to pay in full?)
(...any other debt we have not yet mentioned, including loans obtained through a bank or credit union,
money owed to private individuals, debt held against mutual funds or stocks (margin accounts), or any
other debt not covered?)
Examples include loans to students (such as Stafford Loans and Perkins loans), loans to parents (such
as PLUS loans), as well as other loans obtained for the purpose of financing education.
Please exclude any home equity loans taken out to pay for education.
1. Yes
2. No

med_debt
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME owe any
money for)
(...store bills or credit card bills?)
(...educational or education-related expenses?)
...medical bills ^YOUHESHE WASWERE unable to pay in full?
(...any other debt we have not yet mentioned, including loans obtained through a bank or credit union,
money owed to private individuals, debt held against mutual funds or stocks (margin accounts), or any
other debt not covered?)

Page 429 of 537

Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home
care.
Include any bills of the respondent's children that have not already been reported.

1. Yes
2. No

other_debt
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME owe any
money for)
(...store bills or credit card bills?)
(...educational or education-related expenses?)
(...medical bills ^YOUHESHE WASWERE unable to pay in full?)
...any other debt we have not yet mentioned, including loans obtained through a bank or credit
union, money owed to private individuals, debt held against mutual funds or stocks (margin
accounts), or any other debt not covered?
Please exclude any debt that the respondent has already reported.
1. Yes
2. No

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

Page 430 of 537

JTCC_DEBT
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL,) Did ^TEMPNAME owe
money for store bills or credit card bills jointly with ^HISHER ^SPOUSEPARTNER_FIL?
Please exclude store bills or credit card debt for business expenses that will be paid or reimbursed by
an employer or business.
1. Yes
2. No

JTCC_AMT
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME and
^HISHER ^SPOUSEPARTNER_FIL jointly owe for store bills or credit card bills?
Please exclude store bills or credit card debt for business expenses that will be paid or reimbursed by
an employer or business.
Enter 0 if the store bills or credit card debt have been paid in full.

spanswered
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SELFCC_DEBT
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL,) Did ^TEMPNAME owe
money for store bills or credit card bills in ^HISHER own name only?
Please exclude store bills or credit card debt for business expenses that will be paid or reimbursed by
an employer or business.
1. Yes
2. No

SELFCC_AMT
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME owe for
Page 431 of 537

store bills or credit card bills (in ^HISHER name only)?
Please exclude store bills or credit card debt for business expenses that will be paid or reimbursed by
an employer or business.
Enter 0 if the store bills or credit card debt have been paid in full.

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

JTEDUC_DEBT
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL,) Did ^TEMPNAME have
any loans for educational or education-related expenses jointly with ^HISHER
^SPOUSEPARTNER_FIL?
Please exclude any home equity loans taken out to pay for education.
1. Yes
2. No

JTEDUC_AMT
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME and
^HISHER ^SPOUSEPARTNER_FIL jointly owe in loans for educational or education-related
expenses?
Enter 0 if the loans have been paid in full.

Page 432 of 537

spanswered
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SELFEDUC_DEBT
(Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL,) Did ^TEMPNAME have
any loans for educational or education-related expenses in ^HISHER own name only?
Please exclude any home equity loans taken out to pay for education.
1. Yes
2. No

SELFEDUC_AMT
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME owe in
loans for educational or education-related expenses (in ^HISHER name only)?
Enter 0 if the loans have been paid in full.

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

med_amt
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME owe for
medical bills ^YOUHESHE WASWERE unable to pay in full?
Exclude bills that will likely be paid by the insurance company.
Enter 0 if the medical bills have been paid in full.

Page 433 of 537

med_range
Was the amount less than $1,000, between $1,000 and $2,500, between $2,500 and $5,000, or
more than $5,000?
1. less than $1,000
2. $1,000 to $2,500
3. $2,501 to $5,000
4. greater than $5,000

ctrlnum
lno
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

JTOTH_DEBT
Did ^TEMPNAME have other debt (including money owed to private individuals, debts held agains
mutual funds or stocks (margin accounts), or any other debt not covered) jointly with ^HISHER
SPOUSEPARTNER_FIL (between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?
Please exclude any debt that the respondent has already reported.
1. Yes
2. No

JTOTH_AMT
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME and
^HISHER ^SPOUSEPARTNER_FIL jointly owe in other debt (including money owed to private
individuals, debts held against mutual funds or stocks (margin accounts), or any other debt not covered)
?
Please exclude any debt that the respondent has already reported.
Enter 0 if the 'other' debt has been paid in full.

Page 434 of 537

spanswered
CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

SELFOTH_DEBT
Did ^TEMPNAME have other debt (including money owed to private individuals, debts held against
mutual funds or stocks (margin accounts), or any other debt not covered) in ^HISHER own name only
(between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL)?
Please exclude any debt that the respondent has already reported.
1. Yes
2. No

SELFOTH_AMT
As of the last day of ^LASTMONTH, ^CALENDAR_YEAR, how much did ^TEMPNAME owe in
other debt (including money owed to private individuals, debts held against mutual funds or stocks
(margin accounts), or any other debt not covered)?
Please exclude any debt that the respondent has already reported.
Enter 0 if the 'other' debt has been paid in full.

ASTRECUSE
Did the respondent use any records to answer any asset questions?
If this is a telephone interview, please record whether you can tell if the respondent used any records.
Has the respondent mentioned anything in passing (for example, "Hold on, let me check that.")? Has the
respondent reported exact amounts (for example, $1,234.56)? Could you hear papers shuffling? If yes,
or if you could tell in some other way that the respondent used records, enter 1. If you cannot tell
whether the respondent used records, enter CTRL+D.

1. Yes
2. No

Page 435 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

UTILZ_INTRO
? [F1]
Next I'll ask some questions about doctor visits, (such as how often ^TEMPNAME visited a doctor or
dentist,) ^UTILZ_INTRO_FIL
1. Enter 1 to continue

HLTHSTS
Would you say ^HISHER health in general is...
(These questions apply to both physical and mental health.)
Read answer categories.
1. Excellent?
2. Very good?
3. Good?
4. Fair?
5. Poor?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HOSPNGHT
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, ^WEREWAS
^TEMPNAME a patient in a hospital overnight or longer?

Page 436 of 537

1. Yes
2. No

HOSPNMNGT
? [F1]
How many nights in total did ^HESHE spend in a hospital of any type (between ^MONTH1 1st and
the end of ^LASTMONTH ^CALENDAR_YRFIL)?

HOSPRSNNGT
Which of the following describes why ^HESHE entered the hospital ^RECENT_STAYFIL
Read answer categories.
Mark all that apply.
1. For a diagnostic test to determine what was wrong?
2. For a birth (either to be born, or to give birth, including C-section)?
3. To have an operation or surgery?
4. For some other treatment or therapy not including surgery?
5. To be treated for Covid-19 (suspected or diagnosed), or complications from Covid-19?
6. For any other reason?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PRESCRIPYR
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, did ^TEMPNAME take
any prescription medications?
^BIRTHCONTROL_FIL
1. Yes
2. No
Page 437 of 537

PRESCRIP
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL did ^HESHE take
prescription medicines on a daily basis for a month or more?
^BIRTHCONTROL_FIL
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

DENTALVIS
Q
Between ^MONTH1 1st and the end of ^LASTMONTH ^CALENDAR_YRFIL, how many visits did
^TEMPNAME make to a dentist or other dental professional?
Enter 0 for none.

DENTTHLS
^C_HAVHAS ^TEMPNAME lost any of ^HISHER permanent adult teeth?
Exclude the removal of wisdom teeth.
1. Yes
2. No

DENTALTH
^C_HAVHAS ^HESHE lost ALL of ^HISHER permanent adult teeth?
1. Yes
2. No

Page 438 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HLTHPRVD
R
^HLTHPROV_QSTNTXTFIL
Enter 0 for none.
Exclude email contacts.

HLTHDR
Did that visit or call include contact with a physician?
1. Yes
2. No

HLTHDR_NO
How many of the ^NUM_VISITFIL visits or calls included contact with a physician?

DAYSICK
^DAYSICK_QSTNTXTFIL
Enter 0 for none.
If the person can't provide the exact number of days, ask for an estimate.

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
Page 439 of 537

**NON-DISPLAYED ITEM**

MEDCRPAYC
CC
Next I will ask about out-of-pocket medical expenses between ^MONTH1 1st and the end of
^LASTMONTH ^CALENDAR_YRFIL.
^MOOP_INTRO
^MOOP_QSTNTXT
^MOOP_NOTE
^MOOP_FRNOTE

MEDCRPAYC_RANGE
CC
Was it ...
Read answer categories.
Enter 0 for none.
0. $0?
1. $1 to $300?
2. $301 to $500?
3. $501 to $1,000?
4. $1,001 to $2,000?
5. $2,001 to $3,000?
6. $3,001 to $4,000?
7. $4,001 to $7,000?
8. $7,001 to $11,000?
9. $11,001 or more?

WMEDCRPAYC
Who in the household did ^TEMPNAME pay for?

Page 440 of 537

Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

MEDCRPAYS
^MOOPS_QSTNTXT

MEDCRPAYS_RANGE
CC
Was it ...
Read answer categories.
Enter 0 for none.
0. $0?
1. $1 to $50?
2. $51 to $100?
3. $101 to $300?
Page 441 of 537

4. $301 to $500?
5. $501 to $800?
6. $801 to $1,000?
7. $1,001 to $3,000?
8. $3,001 to $6,000?
9. $6,001 or more?

WMEDCRPAYS
Who in the household did ^TEMPNAME pay for?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

MDPAY
CC, ? [F1]
^MDPAY_QSTNTXT

Page 442 of 537

MDPAY_RANGE
CC
Was it ...
Read answer categories.
Enter 0 for none.
0. $0?
1. $1 to $50?
2. $51 to 100?
3. $101 to $300?
4. $301 to $500?
5. $501 to $800?
6. $801 to $1,000?
7. $1,001 to $3,000?
8. $3,001 to $6,000?
9. $6,001 or more?

WMDPAY
Who in the household did ^TEMPNAME pay for?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
Page 443 of 537

17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

OTCMDPAY
^OTCMDPAY_QSTNTXT

OTCMDPAY_RANGE
Was it ...
Read answer categories.
Enter 0 for none.
0. $0?
1. $1 to $10?
2. $11 to $50?
3. $51 to $100?
4. $101 to $200?
5. $201 to $300?
6. $301 to $500?
7. $501 to $1,000?
8. $1,001 to $5,000?
9. $5,001 or more?

WOTCMDPAY
Who in the household did ^TEMPNAME pay for?
Mark all that apply.
1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
Page 444 of 537

8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

FLEXSPND
? [F1]
^INTRO_HSA, did ^TEMPNAME have a Flexible Spending Account for health expenses?

1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ANYHICOV
**NON-DISPLAYED ITEM**

NOINDNT
Earlier ^TEMPNAME said that ^HESHE ^WEREWAS not covered by any health insurance in
Read month(s). During ^THATTHOSE_MOFIL did ^TEMPNAME go to a dentist or other dental
professional?
Page 445 of 537

Display the name of the months of no health insurance coverage as reported in
the EHC (include ONLY reference months).
1. Yes
2. No

NOINDOC
(Earlier ^TEMPNAME said that ^HESHE ^WEREWAS not covered by any health insurance in Read
month(s).) During ^THATTHOSE_MOFIL did ^TEMPNAME go to a doctor, nurse, or other medical
provider?
Display the name of the months of no health insurance coverage as reported in
the EHC (include ONLY reference months).
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

NOINCLN
Where did ^TEMPNAME go to get those health care services...
Read answer categories.
Mark all that apply.
1. Clinic or Public Health Department?
2. Emergency room?
3. Hospital, excluding emergency room?
4. VA Hospital?
5. Doctor's office?
6. Dentist's office?
7. Someplace else?
Page 446 of 537

NOININC
Did anyone ask what ^PTEMPNAME income was before they set a price for the services?
1. Yes
2. No

NOINTRT
Did ^TEMPNAME receive treatment for an illness or injury?
1. Yes
2. No

NOINCHK
Did ^TEMPNAME receive any routine or preventative care, ^TYPECAREFIL?
1. Yes
2. No

ANYHICOV
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

ADULT_DISABLE
**NON-DISPLAYED ITEM**

HEARING
Now we want to learn about people who have difficulties doing certain activities because of
physical, mental, or emotional health problems.
^C_AREIS ^TEMPNAME deaf or ^DODOES ^HESHE have serious difficulty hearing?
Page 447 of 537

1. Yes
2. No

SEEING
^C_AREIS ^TEMPNAME blind or ^DODOES ^HESHE have serious difficulty seeing even when
wearing glasses or contacts?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

COGNIT_AD
Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME experience any of
the following...
...serious difficulty concentrating, remembering, or making decisions?
(...serious difficulty walking or climbing stairs?)
(...difficulty dressing or bathing?)
(...difficulty doing errands alone such as visiting a doctor's office or shopping?)
1. Yes
2. No

AMBULAT_AD
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME experience any of the
following...)
(...serious difficulty concentrating, remembering, or making decisions?)
...serious difficulty walking or climbing stairs?
(...difficulty dressing or bathing?)
(...difficulty doing errands alone such as visiting a doctor's office or shopping?)
1. Yes
Page 448 of 537

2. No

SELFCARE_AD
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME experience any of the
following...)
(...serious difficulty concentrating, remembering, or making decisions?)
(...serious difficulty walking or climbing stairs?)
...difficulty dressing or bathing?
(...difficulty doing errands alone such as visiting a doctor's office or shopping?)
1. Yes
2. No

ERRANDS
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME experience any of the
following...)
(...serious difficulty concentrating, remembering, or making decisions?)
(...serious difficulty walking or climbing stairs?)
(...difficulty dressing or bathing?)
...difficulty doing errands alone such as visiting a doctor's office or shopping?
1. Yes
2. No

SIT_DIF
C_DODOES ^TEMPNAME have any difficulty:
... sitting for one hour?
(... lifting or carrying something as heavy as 10 pounds (such as a bag of groceries)?)
(... using ^YOURHISHER hands and fingers to do things such as picking up a glass or grasping a
pencil?)

1. Yes
2. No

LIFT10_DIF
Page 449 of 537

(C_DODOES ^TEMPNAME have any difficulty:)
... sitting for one hour?
... lifting or carrying something as heavy as 10 pounds (such as a bag of groceries)?
(... using ^YOURHISHER hands and fingers to do things such as picking up a glass or grasping a
pencil?)
1. Yes
2. No

GRASP_DIF
(C_DODOES ^TEMPNAME have any difficulty:)
(... sitting for one hour?)
(... lifting or carrying something as heavy as 10 pounds (such as a bag of groceries)?)
... using ^YOURHISHER hands and fingers to do things such as picking up a glass or grasping a
pencil?
1. Yes
2. No

LRN_DIS_AD
C_DODOES ^TEMPNAME have a learning or developmental disability? (This could include
conditions such as dyslexia, ADHD, autism, Down Syndrome, or some other learning or developmental
disability.)
1. Yes
2. No

MENT_DIS_AD
C_DODOES ^TEMPNAME have a mental or emotional condition? (This could include conditions
such as depression, anxiety, or some other psychological condition.)

1. Yes
2. No

FINDJOB
Page 450 of 537

Because of a physical, mental, or emotional problem...
...^DODOES ^TEMPNAME have difficulty finding a job or remaining employed?
(...AREIS ^TEMPNAME prevented from working?)
1. Yes
2. No

JOBCANT
(Because of a physical, mental, or emotional problem...)
(...^DODOES ^TEMPNAME have difficulty finding a job or remaining employed?)
...AREIS ^TEMPNAME prevented from working?
1. Yes
2. No

HLTHCOND_AD
C_DODOES ^TEMPNAME have any physical, mental, or emotional health conditions lasting 12
months or longer that limit ^YOURHISHER daily activities?
1. Yes
2. No

COND1_AD
^WORKDIS_FIL What condition or conditions ^ACTIVITY_FIL?
Enter at least the first 3 letters of the condition to display the answer list.
Enter "None" for no conditions.
Enter "Other" for a condition not on the answer list.

COND1CODE_AD
OTHADCOND_SP
Enter the respondent's "Other" condition that could not be found on the answer list.
If you do not recall the person's "Other" condition, read the optional question text below.
(Could you please repeat the name of the condition you just reported?)
Page 451 of 537

COND2_AD
Any other conditions?
Enter at least the first 3 letters of the condition to display the answer list.
Enter "None" for no conditions.
Enter "Other" for a condition not on the answer list.

COND2CODE_AD
COND3_AD
Any other condition?
Enter at least the first 3 letters of the condition to display the answer list.
Enter "None" for no conditions.
Enter "Other" for a condition not on the answer list.

COND3CODE_AD
AGE_5TO14
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

COGNIT
Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME...
...experience serious difficulty concentrating, remembering, or making decisions?
(...experience serious difficulty walking or climbing stairs?)
(...experience difficulty dressing or bathing?)
(...have limited ability to play with other children of the same age?)
(...have limitations in ^HISHER ability to do regular school work?)
1. Yes
Page 452 of 537

2. No

AMBULAT
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME...)
(...experience serious difficulty concentrating, remembering, or making decisions?)
...experience serious difficulty walking or climbing stairs?
(...experience difficulty dressing or bathing?)
(...have limited ability to play with other children of the same age?)
(...have limitations in ^HISHER ability to do regular school work?)
1. Yes
2. No

SELFCARE
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME...)
(...experience serious difficulty concentrating, remembering, or making decisions?)
(...experience serious difficulty walking or climbign stairs?)
...experience difficulty dressing or bathing?
(...have limited ability to play with other children of the same age?)
(...have limitations in ^HISHER ability to do regular school work?)
1. Yes
2. No

PLAYDIF
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME...)
(...experience serious difficulty concentrating, remembering, or making decisions?)
(...experience serious difficulty walking or climbign stairs?)
(...experience difficulty dressing or bathing?)
...have limited ability to play with other children of the same age?
(...have limitations in ^HISHER ability to do regular school work?)
1. Yes
2. No

SKOOLWK
(Because of a physical, mental, or emotional problem, ^DODOES ^TEMPNAME...)
Page 453 of 537

(...experience serious difficulty concentrating, remembering, or making decisions?)
(...experience serious difficulty walking or climbign stairs?)
(...experience difficulty dressing or bathing?)
(...have limited ability to play with other children of the same age?)
...have limitations in ^HISHER ability to do regular school work?
1. Yes
2. No

LRN_DIS
C_DODOES ^TEMPNAME have a learning or developmental disability? (This could include
conditions such as dyslexia, ADHD, autism, Down Syndrome, or some other learning or developmental
disability.)
1. Yes
2. No

MENT_DIS
C_DODOES ^TEMPNAME have a mental or emotional condition? (This could include conditions
such as depression, anxiety, or some other psychological condition.)
1. Yes
2. No

HLTHCOND
C_DODOES ^TEMPNAME have any physical, mental, or emotional health conditions lasting 12
months or longer that limit ^YOURHISHER ordinary activities?
1. Yes
2. No

COND1
^WORKDIS_FIL What condition or conditions ^ACTIVITY_FIL?
Enter at least the first 3 letters of the condition to display the answer list.
Enter "None" for no conditions.

Page 454 of 537

Enter "Other" for a condition not on the answer list.

COND1CODE
OTHCHCOND_SP
Enter the child's "Other" condition that could not be found on the answer list.
If you do not recall the child's "Other" condition, read the optional question text below.
(Could you please repeat the name of the condition you just reported?)

COND2
Any other conditions?
Enter at least the first 3 letters of the condition to display the answer list.
Enter "None" for no conditions.
Enter "Other" for a condition not on the answer list.

COND2CODE
COND3
Any other condition?
Enter at least the first 3 letters of the condition to display the answer list.
Enter "None" for no conditions.
Enter "Other" for a condition not on the answer list.

COND3CODE
AGE_LESSTHAN5
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
Page 455 of 537

**NON-DISPLAYED ITEM**

DDELAY
C_DODOES ^TEMPNAME have a developmental condition or delay that limits ordinary activities?
1. Yes
2. No

FERT_INTRO
? [F1]
Next I'll ask some questions about Text to appear on introductory screen of Fertility/Parent
Mortality/Nationality depending on subsequent content.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

I_PWCEB
**NON-DISPLAYED ITEM**

NEWCHILD_FLAG
**NON-DISPLAYED ITEM**

COPYSOURCEFLAG
GRNDPR_FLG
**NON-DISPLAYED ITEM**

I_GRNDPR
Page 456 of 537

GRNDPR
Ask or verify.
^C_AREIS ^TEMPNAME a grandparent - that is, ^ANYCHILDFIL have any biological or adopted
children of their own who are currently living?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CEB_FLAG
**NON-DISPLAYED ITEM**

par_unknown
PARCHL_COUNT
**NON-DISPLAYED ITEM**

PARCHL
^ALTOGETHERFIL many children ^HAVHAS ^HESHE ever ^BIRTHFATHERFIL?
Count all biological children of this person, regardless of whether they were born within or outside of
any marriage. Include those who don't live with this person now, or if they died or were adopted by
someone else.
Do not count children adopted by this person, foster children, or stepchildren. Do not count stillbirths
and do not count children not yet born.
Enter 0 for none.

KIDLISTCHK
I am showing that
that correct?

Read name(s) ^FERT_AREIS ^PTEMPNAME biological ^CHILDFERTFIL. Is

Page 457 of 537

Display the first names and ages of the children in ^BIOCHILDLIST.
1. Yes
2. No

KIDLIST_REV
^PCHK_Q
Read answer categories.
Mark all that apply.
Enter 95 if all of the children are biological children.
Enter 96 if none of these children are biological children.
1. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
2. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
3. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
4. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
5. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
6. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
7. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
8. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
9. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
10. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
11. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
12. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
13. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
14. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
15. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
16. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
17. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
18. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
19. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
20. Fill with LNO, ^FNAME, ^LNAME from BIOCHILDLIST?
95. All of the children are ^HISHER biological children?
96. None of the children are ^HISHER biological children?

Page 458 of 537

SAMEPAR
? [F1]
Ask or verify:
Do ^ALLBOTH of ^PTEMPNAME biological children have the same biological Mother/Father fill
for fertility section?
1. Yes
2. No

FERT_CONF
You have keyed:
NUMBER OF CHILDREN:
LIST OF KNOWN CHILDREN: ^FERT_BIOCHILDLIST
WARNING: Once you enter 1 to continue, you cannot make changes to the information above.
Enter 1 to continue.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HVARKID_F
**NON-DISPLAY ITEM**

KIDLNO
CHLNAME
Child roster name intro
^CHLNAMEFIL
Page 459 of 537

NEWKID
KIDAGE
COPIED
CHL_BMON
What is this child's month and year of birth?
Enter month.
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

CHL_BYR
(What is this child's month and year of birth?)
Enter year.

CHL_AGEGS
? [F1]
How old would you say this child is?
Enter best estimate of age.

Page 460 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

HVAR_CLST
**NON-DISPLAY ITEM**

CLUSTER
? [F1]
^CLUSTERFIL
Mark all that apply.
1. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
2. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
3. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
4. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
5. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
6. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
7. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
8. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
9. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
10. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
11. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
12. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
13. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
14. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
15. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
16. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
17. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
18. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
19. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
20. Display the LNO CHLNAME, KIDAGE of each child from BLKBKIDS
95. All of these children have the same biological Mother/Father fill for fertility section

Page 461 of 537

OP_LIVHH
Does

Read name(s)'s biological Mother/Father fill for fertility section live here?

Display the names and ages of children from ^CHL_CLUSTERFIL.
1. Yes
2. No

WHOBIOP
Ask or verify:
Who is

Read name(s)'s biological Mother/Father fill for fertility section?

Display the names and ages from ^CHL_CLUSTERFIL.
1. LNO, ^FNAME ^LNAME from TLNPAR
2. LNO, ^FNAME ^LNAME from TLNPAR
3. LNO, ^FNAME ^LNAME from TLNPAR
4. LNO, ^FNAME ^LNAME from TLNPAR
5. LNO, ^FNAME ^LNAME from TLNPAR
6. LNO, ^FNAME ^LNAME from TLNPAR
7. LNO, ^FNAME ^LNAME from TLNPAR
8. LNO, ^FNAME ^LNAME from TLNPAR
9. LNO, ^FNAME ^LNAME from TLNPAR
10. LNO, ^FNAME ^LNAME from TLNPAR
11. Someone not listed.

CLUSTER_DONE
Enter 1 to continue.

1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
Page 462 of 537

**NON-DISPLAYED ITEM**

PREGWORK
Now I'm going to ask about leave from work ^TEMPNAME may have taken leading up to or right
after the birth of ^HISHER first child. Did ^HESHE work for pay at a job or business at any time
during that pregnancy?
1. Yes
2. No

PREBIRTHINT
How many weeks before the birth of ^PTEMPNAME first child did ^YOUHESHE stop working?
Enter "0" if the person continued working right up until the delivery or stopped working less than one
week prior to the birth.
The maximum number of weeks allowed is 42. If the number is greater than 42, then enter 42.

PREGRSN
DD
In order for ^TEMPNAME to stop working before ^YOURHISHER first child was born, what type of
leave, if any, did ^HESHE use...
Read answer categories.
Mark all that apply.
1. Quit?
2. Let go from the job?
3. Paid maternity or paternity leave?
4. Unpaid maternity or paternity leave?
5. Paid sick leave?
6. Unpaid sick leave?
7. Disability leave?
8. Paid vacation leave?
9. Some other kind of leave?
10. Did not take leave DO NOT READ

Page 463 of 537

BIRTHRSN
DD
After ^PTEMPNAME first child was born, and up to the time the baby was 12 weeks old, what type
of leave, if any, did ^TEMPNAME use...
Read answer categories.
Mark all that apply.
1. Quit?
2. Let go from the job?
3. Paid maternity or paternity leave?
4. Unpaid maternity or paternity leave?
5. Paid sick leave?
6. Unpaid sick leave?
7. Disability leave?
8. Paid vacation leave?
9. Some other kind of leave?
10. Did not take leave DO NOT READ

BIRTHWORK
Did ^TEMPNAME work for pay at any time after the birth of ^YOURHISHER first child?
1. Yes
2. No

PSTBIRTHINT
How old was ^PTEMPNAME first child when ^YOUHESHE started working?
Respondent can answer in weeks, months, or years.

PSTBIRTH_TP
Ask only if the respondent did not include in the previous answer. Otherwise, enter the answer.
Is the child's age in weeks, months, or years?

1. Weeks
2. Months
Page 464 of 537

3. Years

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

BIOMOM
The intent of these questions is to collect information about the respondent's biological parents, even if
the respondent is adopted or has a step-parent.
Is ^PTEMPNAME biological mother (still) alive?
1. Yes
2. No

BIOMOMDEATH_RESPAGE
How old ^WEREWAS ^TEMPNAME when ^HISHER (biological) mother passed away?

BIOMOMDEATH_RESPUNDR19
^C_WASWERE ^TEMPNAME younger than 19 years old when ^HISHER (biological) mother passed
away?
1. Yes
2. No

BIOMOMUS
? [F1]
Was ^PTEMPNAME (biological) mother born in the United States?
1. Yes
2. No

Page 465 of 537

BIOMOMCOUNTRY
? [F1]
In what country was ^PTEMPNAME (biological) mother born?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
Page 466 of 537

37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
Page 467 of 537

76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other
Page 468 of 537

BIOMOMNAT
? [F1]
In what country was ^PTEMPNAME (biological) mother born?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
Page 469 of 537

37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
Page 470 of 537

76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other
Page 471 of 537

BIODAD
The intent of these questions is to collect information about the respondent's biological parents, even if
the respondent is adopted or has a step-parent.
Is ^PTEMPNAME biological father (still) alive?
1. Yes
2. No

BIODADDEATH_RESPAGE
How old ^WEREWAS ^TEMPNAME when ^HISHER (biological) father passed away?

BIODADDEATH_RESPUNDR19
^C_WASWERE ^TEMPNAME younger than 19 years old when ^HISHER (biological) father passed
away?
1. Yes
2. No

BIODADUS
? [F1]
Was ^PTEMPNAME (biological) father born in the United States?
1. Yes
2. No

BIODADCOUNTRY
? [F1]
In what country was ^PTEMPNAME (biological) father born?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
4. Argentina
5. Armenia
6. Australia
Page 472 of 537

7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
43. Greece
44. Grenada
45. Guam
Page 473 of 537

46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
82. Poland
83. Portugal
84. Puerto Rico
Page 474 of 537

85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other

BIODADNAT
? [F1]
In what country was ^PTEMPNAME (biological) father born?
1. United States (US, USA)
2. Afghanistan
3. American Samoa
Page 475 of 537

4. Argentina
5. Armenia
6. Australia
7. Austria
8. Azores
9. Bahamas
10. Bangladesh
11. Barbados
12. Belgium
13. Belize
14. Bermuda
15. Bolivia
16. Bosnia and Herzegovina
17. Brazil
18. Burma/Myanmar
19. Cambodia
20. Canada
21. Caribbean
22. Chile
23. China
24. Colombia
25. Costa Rica
26. Cuba
27. Czech Republic
28. Czechoslovakia
29. Denmark
30. Dominica
31. Dominican Republic
32. Ecuador
33. Egypt
34. El Salvador
35. England
36. Ethiopia
37. Fiji
38. Finland
39. France
40. Germany
41. Ghana
42. Great Britain
Page 476 of 537

43. Greece
44. Grenada
45. Guam
46. Guatemala
47. Guyana
48. Haiti
49. Honduras
50. Hong Kong
51. Hungary
52. India
53. Indonesia
54. Iran
55. Iraq
56. Ireland
57. Israel
58. Italy
59. Jamaica
60. Japan
61. Jordan
62. Kenya
63. Korea
64. Laos
65. Latvia
66. Lebanon
67. Lithuania
68. Malaysia
69. Mexico
70. Morocco
71. Netherlands
72. New Zealand
73. Nicaragua
74. Nigeria
75. Northern Marianas
76. Norway
77. Pakistan
78. Palestine
79. Panama
80. Peru
81. Philippines
Page 477 of 537

82. Poland
83. Portugal
84. Puerto Rico
85. Romania
86. Russia
87. Scotland
88. Slovakia
89. South Africa
90. South Korea
91. Spain
92. Sweden
93. Switzerland
94. Syria
95. Taiwan
96. Thailand
97. Trinidad and Tobago
98. Turkey
99. U.S. Virgin Islands
100. Ukraine
101. United Kingdom
102. United States (US, USA)
103. Uruguay
104. USSR
105. Venezuela
106. Vietnam
107. Yugoslavia
108. Other Africa
109. Other Asia
110. Other Central America
111. Other Europe
112. Other Pacific Islands
113. Other South America
114. Other

I_BIOMOM
I_BIOMOMD_RESPAGE
**NON-DISPLAYED ITEM**

Page 478 of 537

I_BIOMOMD_RUNDR19
I_BIOMOMUS
I_BIOMOMCOUNTRY
I_BIODAD
**NON_DISPLAY ITEM**

I_BIODADD_RESPAGE
**NON-DISPLAYED ITEM**

I_BIODADD_RUNDR19
**NON-DISPLAYED ITEM**

I_BIODADUS
I_BIODADCOUNTRY
CHILD_INTRO
? [F1]
Next I'll ask some questions about children in the household. I will ask aboutChild care fill
children's attitude towards school and homework, children's interaction with both parents or
caregivers, and about activities children participate in both inside and outside of school.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

PAR
During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of
the following arrangements to look afterChild/children for Child Care Read name(s) while
^TEMPNAME ^WEREWAS working (or in school).
Child's other parent or stepparent?
Page 479 of 537

If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

PARWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
Child's other parent or stepparent?)
Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
Page 480 of 537

22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

CSELF
(During a typical week in fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) while ^TEMPNAME
^WEREWAS working (or in school).
Did ^TEMPNAME care forChild/children for Child Care
working/in school suffix fill?

Read name(s) Designated parent

If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

SELFWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if you used any of the following
arrangements to look afterChild/children for Child Care Read name(s) while you were working (or in
school).
Did ^TEMPNAME care forChild/children for Child Care
^WEREWAS working (or in school))

Read name(s) while ^TEMPNAME

Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
Page 481 of 537

8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

SIB15
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
Brother or sister age 15 or older?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

SIB15WHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.

Page 482 of 537

Brother or sister age 15 or older?)
Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

GRAN
^CC_NONWORKINTROFIL
Grandparent?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
Page 483 of 537

If the respondent is the grandparent of the children in question, then ask about "other grandparents."
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

GRANWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look after Child/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
Grandparent?)
Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
Page 484 of 537

24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

OTHR
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
Any other relative?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

OTHRWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
Any other relative?)
Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
Page 485 of 537

12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

FAM
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
Family day care provider caring for two or more children outside of ^PTEMPNAME home?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

FAMWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
Family day care provider caring for two or more children outside of ^PTEMPNAME home?)
Which child or children?
Mark all that apply.
Page 486 of 537

1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

NREL
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
A non-relative such as a friend, neighbor, sitter, nanny, or au pair?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
Page 487 of 537

2. No

NRELWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
A non-relative such as a friend, neighbor, sitter, nanny, or au pair?)
Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

Page 488 of 537

DAYCARE
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if you used any of the following
arrangements to look afterChild/children for Child Care Read name(s) Designated parent working/not
working suffix fill.)
A child care or day care center?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:

List names of all children under 15 for whom respondent is LNGD.

1. Yes
2. No

DAYWHCH
(During a typical week in the fall ^CALENDAR_YRFIL, please tell me if you used any of the following
arrangements to look afterChild/children for Child Care Read name(s) Designated parent working/not
working suffix fill.
A child care or day care center?)
Which child or children?
Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
Page 489 of 537

17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

DAYHS
ISTHISCC child care or day care CENTER a Head Start program?
Head Start is a federally sponsored preschool program primarily for children from low-income families.
1. Yes
2. No

DAYHSWHCH
(ISTHISCC child care or day care CENTER a Head Start program?)
Which child or children are in a Head Start program?
Mark all that apply.

1. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

2. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

3. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

4. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

5. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

6. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

7. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

8. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

9. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

10. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

11. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

12. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

13. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=
Page 490 of 537

14. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

15. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

16. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

17. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

18. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

19. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

20. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

21. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

22. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

23. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

24. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

25. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=
26. Someone not listed.

NUR
(During a typical WEEK in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
A nursery or preschool?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:
LNGD.

List the names of all children ages 2-7 for whom the respondent is

1. Yes
2. No

NURWHCH
(During a typical WEEK in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
A nursery or preschool?)
Which child or children?
Mark all that apply.

Page 491 of 537

CHILDREN:
LNGD.

List the names of all children 2-7 for whom the respondent is

1. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

2. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

3. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

4. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

5. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

6. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

7. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

8. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

9. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

10. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

11. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

12. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

13. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

14. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

15. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

16. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

17. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

18. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

19. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

20. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

21. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

22. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

23. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

24. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

25. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=
26. Someone not listed.

NURHS
ISTHISCC nursery School/Schools for Child Care or preSchool/Schools for Child Care a Head
Start program?
Head Start is a federally sponsored preschool program primarily for children from low-income families.
1. Yes
2. No

Page 492 of 537

NURHSWHCH
(ISTHISCC nursery or preSchool/Schools for Child Care a Head Start program?)
Which child or children are in a Head Start program?
Mark all that apply.

1. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

2. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

3. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

4. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

5. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

6. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

7. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

8. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

9. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

10. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

11. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

12. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

13. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

14. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

15. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

16. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

17. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

18. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

19. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

20. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

21. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

22. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

23. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

24. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

25. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=
26. Someone not listed.

HEADSTART
(During a typical WEEK in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
A Head Start program?

Page 493 of 537

If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
Head Start is a federally sponsored preschool program primarily for children from low-income families.
CHILDREN:
LNGD.

List the names of all children ages 2-7 for whom the respondent is

1. Yes
2. No

HEADSTWHCH
(During a typical WEEK in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look after Child/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
A Head Start program?)
Which child or children?
Mark all that apply.

1. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

2. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

3. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

4. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

5. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

6. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

7. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

8. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

9. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

10. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

11. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

12. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

13. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

14. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

15. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

16. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

17. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

18. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

19. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=
Page 494 of 537

20. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

21. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

22. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

23. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

24. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=

25. LNO, ^FNAME where AGE >1 and AGE < 8, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER=
26. Someone not listed.

PROG
(During a typical WEEK in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.)
Before or after school care programs?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
CHILDREN:
LNGD.

List names of all children ages 3-14 for whom the respondent is

1. Yes
2. No

PROGWHCH
(During a typical WEEK in the fall ^CALENDAR_YRFIL, please tell me if ^TEMPNAME used any of the
following arrangements to look afterChild/children for Child Care Read name(s) Designated parent
working/not working suffix fill.
Before or after school care programs?)
Which child or children?
Mark all that apply.

1. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

2. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

3. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

4. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

5. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

6. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER
Page 495 of 537

7. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

8. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

9. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

10. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

11. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

12. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

13. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

14. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

15. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

16. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

17. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

18. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

19. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

20. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

21. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

22. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

23. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

24. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER

25. LNO, ^FNAME where AGE >2 and AGE < 15, (LNMOM or LNDAD or LNGRD = LNO) & PEOPLE_TO_ROSTER
26. Someone not listed.

KIDSELF
Sometimes it is difficult to make arrangements to look after children all of the time. During a
typical week in the fall ^CALENDAR_YRFIL, did Child/children for Child Care Read name(s) care
for ^HIMHERSELFFIL_CC for even a small amount of time when ^TEMPNAME ^WEREWAS not
there?
If the respondent has trouble identifying a "typical week", then ask: (What did ^TEMPNAME use in a
typical week in October ^CALENDAR_YRFIL?)
1. Yes
2. No

KSELFWHCH
(Sometimes it is difficult to make arrangements to look after children all of the time. During a typical
week in the fall ^CALENDAR_YRFIL, did Child/children for Child Care Read name(s) care for
^HIMHERSELFFIL_CC for even a small amount of time?)
Which child or children?
Page 496 of 537

Mark all that apply.
1. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
2. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
3. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
4. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
5. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
6. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
7. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
8. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
9. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
10. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
11. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
12. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
13. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
14. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
15. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
16. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
17. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
18. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
19. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
20. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
21. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
22. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
23. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
24. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
25. LNO, ^FNAME where AGE >= 0 and AGE < 15, (LNGD = LNO) & PEOPLE_TO_ROSTER=1
26. Someone not listed.

WORKREFYEAR
PAYREFYR
Did ^TEMPNAME or ^HISHER family pay for child care at any time while ^TEMPNAME
^WEREWAS working during ^REFYEAR?
Include cost of preschool and nursery school, but do not include tuition costs for kindergarten or grade
school.
1. Yes
2. No

Page 497 of 537

PAYWKREFYR
In a typical week in ^REFYEAR when ^TEMPNAME ^WEREWAS working, how much did
^TEMPNAME or ^HISHER family pay for child care?
Include cost of preschool and nursery school, but do not include tuition costs for kindergarten or grade
school.
If the respondent has trouble reporting the amount for a typical week, then ask: (How much did
^TEMPNAME or ^PTEMPNAME family pay for child care in the last week where child care was used?)

PAY
I'd like you to think about all the child care arrangements used for
^CALENDAR_YRFIL.

Read name(s) in the fall

Did ^TEMPNAME or ^HISHER family usually pay for any of these arrangements for this
child/these children under 15?
Include cost of preschool and nursery school, but do not include tuition costs for kindergarten or grade
school.
Child/children for Child Care: List the names of all children on TCHILD_CC014
answer list, excluding 'someone not listed'.
1. Yes
2. No
3. Did not use any arrrangements

PAYWK
Intro CAREPAY text if speaking to the reference person a typical WEEK in the fall
^CALENDAR_YRFIL, how much did ^TEMPNAME or ^HISHER family pay for all of these
arrangements for Read name(s)?
Include cost of preschool and nursery school, but do not include tuition costs for kindergarten or grade
school.
Do not include money paid to household members for care arrangements such as babysitting.
If the respondent has trouble reporting the amount for a typical week, then ask: (How much did
^TEMPNAME or ^PTEMPNAME family pay any of these arrangements in a typical week in October
^CALENDAR_YRFIL?)
Child/children for Child Care: List the names of all children on TCHILD_CC014
answer list, excluding 'someone not listed'.

Page 498 of 537

PAYHELP
Sometimes a parent may pay less than the total cost of a child care arrangement because some
other person or agency pays part of the cost. By this I mean a government agency,
^PTEMPNAME employer, or someone else outside of ^HISHER household.
Did any person or agency help pay for ^PAYFILL care in the fall ^CALENDAR_YRFIL?
Remind the respondent to include all children under 15: (Please include all of ^PTEMPNAME children
under 15 who were living with ^TEMPNAME in the fall ^CALENDAR_YRFIL.)
1. Yes
2. No

WHOPAID
What persons or agencies helped to pay for part or all of ^PTEMPNAME ^PCHILD care in the fall
^CALENDAR_YRFIL?
Mark all that apply.
Remind the respondent to include all children under 15: (Please include all of ^PTEMPNAME children
under 15 who were living with ^TEMPNAME in the fall ^CALENDAR_YRFIL.)
1. Welfare or Social Services
2. Employer
3. Non-resident parent
4. Relative or friend
5. Other

LIST
^C_WASWERE ^TEMPNAME on a waiting list for a child care arrangement in the fall
^CALENDAR_YRFIL?
Remind the respondent to include all children under 15: (Please include all of ^PTEMPNAME children
under 15 who were living with ^TEMPNAME in the fall ^CALENDAR_YRFIL.)
1. Yes
2. No

WORKMORE
Did ^TEMPNAME have any problems in obtaining child care that prevented ^TEMPNAME from
^WRK_WRKM in the fall ^CALENDAR_YRFIL?
Page 499 of 537

Remind the respondent to include all children under 15: (Please include all of ^PTEMPNAME children
under 15 who were living with ^TEMPNAME in the fall ^CALENDAR_YRFIL.)
1. Yes
2. No

TIMELOST
^TIMELOSTINTRO much time, if any, did ^TEMPNAME lose in the fall ^CALENDAR_YRFIL from
work or school either because of failures in child care arrangements or because ^TEMPNAME
could not find a child care provider?
Enter number. The next screen captures whether this is reported as hours, days, or weeks.

TIMELOST_TYPE
(^TIMELOSTINTRO much time, if any, was lost in the fall ^CALENDAR_YRFIL from work or school
either because of failures in child care arrangements or because ^TEMPNAME could not find a child
care provider?)
Read if necessary:
Is that hours, days, or weeks?
1. Hours
2. Days
3. Weeks

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CHLD_ANY
(People in need don't always receive unrestricted cash payments from the government - they may
receive money for specific activities or other kinds of help.)
Thinking now about all months since ^MONTH1 1st ^CALENDAR_YRFIL, did ^TEMPNAME ever
Page 500 of 537

receive any child care services or assistance so ^HESHE could go to work or school or training?
1. Yes
2. No

CHLD_OTH_REC
question text fill
Mark all that apply.
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

CTRLNUM
Page 501 of 537

**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

DINLNGD
Now I would like to ask you some (additional) questions about

Read name(s).

In a typical week, how many days ^DODOES ^TEMPNAME eat dinner with them?
CHILDREN: List the names of all children for whom respondent is the LNGD.
0. None
1. One day
2. Two days
3. Three days
4. Four days
5. Five days
6. Six days
7. Seven days

DINOP
In a typical week, how many days does question text for DINOP eat dinner with
FR Help screen for single parents
0. None
1. One day
2. Two days
3. Three days
4. Four days
5. Five days
6. Six days
7. Seven days

READCWB
Intro to READCWB

Page 502 of 537

Read name(s)?

In a typical week , about how many days ^DODOES ^TEMPNAME or any family member read
stories to: Read name(s)?
Children: Please list all children under 6 for whom the respondent is the
LNGD.
0. None
1. One day
2. Two days
3. Three days
4. Four days
5. Five days
6. Six days
7. Seven days

OUTINGLNGD
In a typical week, about how many days ^DODOES ^TEMPNAME take Read name(s) on any kind
of outing, such as to the park, library, zoo, a store, church, a restaurant, or a family gathering?
Children: Please list all children under 6 for whom the respondent is the
LNGD.
0. None
1. One day
2. Two days
3. Three days
4. Four days
5. Five days
6. Six days
7. Seven days

OUTINGSOP
In a typical week, about how many days does question text for DINOP take Read name(s) on any
kind of outing, such as to the park, library, zoo, a store, church, a restaurant, or a family
gathering?
FR Help screen for single parents
0. None
1. One day
Page 503 of 537

2. Two days
3. Three days
4. Four days
5. Five days
6. Six days
7. Seven days

REPGRD
C_HAVEHASCWB this/these for 6-17
any reason?

Read name(s) ever repeated a grade, or been held back for

Children: Please list all children ages 6-17 for whom the respondent is the
LNGD.
1. Yes
2. No

REPGRDWHCH
(C_HAVEHASCWB this/these for 6-17
reason?)

Read name(s) ever repeated a grade, or been held back for any

Which child or children?
Mark all that apply.
1. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
2. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
3. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
4. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
5. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
6. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
7. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
8. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
9. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
10. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
11. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
12. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
13. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
14. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
15. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
Page 504 of 537

16. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
17. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
18. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
19. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
20. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
26. Someone not listed

EXPSCH
C_HAVEHASCWB this/these for 6-17
from school?

Read name(s) ever been suspended, excluded, or expelled

Children: Please list all children ages 6-17 for whom the respondent is the
LNGD.
1. Yes
2. No

EXPSCHWHCH
(C_HAVEHASCWB this/these for 6-17
from school?)

Read name(s) ever been suspended, excluded, or expelled

Which child or children?
Mark all that apply.
1. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
2. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
3. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
4. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
5. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
6. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
7. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
8. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
9. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
10. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
11. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
12. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
13. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
14. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
15. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
Page 505 of 537

16. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
17. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
18. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
19. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
20. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
26. Someone not listed

GIFTED
C_HAVEHASCWB this/these for 6-17 Read name(s) ever gone to any special classes for gifted
students, or done advanced work in any subject?
Children: Please list all children ages 6-17 for whom the respondent is the
LNGD.
1. Yes
2. No

GIFTDWHCH
(C_HAVEHASCWB this/these for 6-17 Read name(s) ever gone to any special classes for gifted
students, or done advanced work in any subject?)
Which child or children?
Mark all that apply.
1. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
2. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
3. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
4. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
5. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
6. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
7. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
8. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
9. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
10. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
11. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
12. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
13. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
14. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
15. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
Page 506 of 537

16. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
17. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
18. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
19. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
20. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
26. Someone not listed

SPORT
In ^REFYEAR, did this/these for 6-17

Read name(s) play on a sports team?

Either in or out of school.
Children: List all children ages 6-17 for whom the respondent is LNGD.
1. Yes
2. No

SPORTWHCH
(In ^REFYEAR, did this/these for 6-17

Read name(s) play on a sports team, either in or out of school?)

Which child or children?
Mark all that apply.
1. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
2. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
3. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
4. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
5. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
6. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
7. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
8. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
9. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
10. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
11. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
12. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
13. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
14. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
15. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
Page 507 of 537

16. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
17. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
18. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
19. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
20. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
26. Someone not listed

LESSON
In ^REFYEAR, did this/these for 6-17 Read name(s) take lessons after school or on weekends in
subjects like music, dance, language, computers, or religion?
Children: Please list all children ages 6-17 for whom the respondent is the
LNGD.
1. Yes
2. No

LESSONWHCH
(In ^CALENDAR_YEAR, did this/these for 6-17 Read name(s) take lessons after school or on
weekends in subjects like music, dance, language, computers, or religion?)
Which child or children?
Mark all that apply.
1. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
2. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
3. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
4. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
5. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
6. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
7. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
8. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
9. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
10. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
11. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
12. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
13. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
14. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
15. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
Page 508 of 537

16. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
17. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
18. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
19. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
20. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
26. Someone not listed

CLUB
In ^REFYEAR, did this/these for 6-17 Read name(s) participate in any clubs or organizations
after school or on weekends, such as Scouts, a religious group, or a Girls' or Boys' club?
Children: List all children age 6-17 for whom the respondent is the LNGD.
1. Yes
2. No

CLUBWHCH
(In ^REFYEAR, did this/these for 6-17 Read name(s) participate in any clubs or organizations after
school or on weekends, such as Scouts, a religious group, or a Girls' or Boys' club?)
Which child or children?
Mark all that apply.
1. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
2. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
3. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
4. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
5. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
6. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
7. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
8. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
9. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
10. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
11. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
12. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
13. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
14. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
15. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
Page 509 of 537

16. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
17. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
18. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
19. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
20. LNO, FNAME LNAME where AGE > 5 and AGE < 18 and the respondent is the child's guardian
26. Someone not listed

RELIG
In ^CALENDAR_YEAR, how often did Read name(s) go to a religious service, a religious social
event, or to religious education such as Sunday school?
If designated parent has more than one child and has trouble determining how often, then ask, (In the
past year, how often did ^HISHER OLDEST child go to a religious service, a religious social event, or to
a religious education such as Sunday school?)
CHILDREN: List all children ages 6-17 for whom the respondent is LNGD.
1. Never
2. Several times a year
3. About once a month
4. About once a week
5. Every day or almost every day

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

KIDLNO
**NON-DISPLAY ITEM**

HVARKID
**NON-DISPLAY ITEM**

CARES
Page 510 of 537

^SCHCARE
1. All of the time?
2. Most of the time?
3. Some of the time?
4. None of the time?
6. Not enrolled? (DO NOT READ)

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

KIDLNO
**NON-DISPLAYED ITEM**

HVARKID
**NON-DISPLAY ITEM**

WORKS
^SCHWORK
1. All of the time?
2. Most of the time?
3. Some of the time?
4. None of the time?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**
Page 511 of 537

KIDLNO
**NON-DISPLAYED ITETM**

HVARKID
**NON-DISPLAY ITEM**

GETBY
^SCHGETBY
1. All of the time?
2. Most of the time?
3. Some of the time?
4. None of the time?

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

KIDLNO
**NON-DISPLAYED ITEM**

HVARKID
**NON-DISPLAY ITEM**

HMWRK
^SCHHMWK
1. All of the time?
2. Most of the time?
3. Some of the time?
4. None of the time?

Page 512 of 537

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

AWB_INTRO
? [F1]
Next I'll ask some questions about conditions in your home, the safety of your neighborhood,
and questions about whether or not ^TEMPNAME had problems obtaining the kinds or amount of
food ^TEMPNAME needed.
1. Enter 1 to continue

AWBCRACK
I have some questions about the place where ^TEMPNAME ^WEREWAS living in ^REFYEAR.
Were the following conditions present...
If the respondent lived in more than one place, ask about where the respondent lived the longest or
spent the most time during the year. Record persistent conditions, or conditions that were present for
the majority of the time.
...holes in the walls or ceiling, or cracks wider than the edge of a dime?
(...holes in the floor big enough to catch your foot on?)
(...problems with pests such as rats, mice, roaches, or other insects?)
(...a toilet, hot water heater, or other plumbing that didn't work?)
1. Yes
2. No

AWBHOLES
(I have some questions about the place where ^TEMPNAME ^WEREWAS living in ^REFYEAR. Were
the following conditions present...)
If the respondent lived in more than one place, ask about where the respondent lived the longest or
spent the most time during the year. Record persistent conditions, or conditions that were present for
the majority of the time.
(...holes in the walls or ceiling, or cracks wider than the edge of a dime?)
...holes in the floor big enough to catch your foot on?
Page 513 of 537

(...problems with pests such as rats, mice, roaches, or other insects?)
(...a toilet, hot water heater, or other plumbing that didn't work?)
1. Yes
2. No

AWBPESTS
(I have some questions about the place where ^TEMPNAME ^WEREWAS living in ^REFYEAR. Were
the following conditions present...)
If the respondent lived in more than one place, ask about where the respondent lived the longest or
spent the most time during the year. Record persistent conditions, or conditions that were present for
the majority of the time.
(...holes in the walls or ceiling, or cracks wider than the edge of a dime?)
(...holes in the floor big enough to catch your foot on?)
...problems with pests such as rats, mice, roaches, or other insects?
(...a toilet, hot water heater, or other plumbing that didn't work?)
1. Yes
2. No

AWBPLUMB
(I have some questions about the place where ^TEMPNAME ^WEREWAS living in ^REFYEAR. Were
the following conditions present...)
If the respondent lived in more than one place, ask about where the respondent lived the longest or
spent the most time during the year. Record persistent conditions, or conditions that were present for
the majority of the time.
(...holes in the walls or ceiling, or cracks wider than the edge of a dime?)
(...holes in the floor big enough to catch your foot on?)
(...problems with pests such as rats, mice, roaches, or other insects?)
...a toilet, hot water heater, or other plumbing that didn't work?
1. Yes
2. No

AWBTRAFF
Do you think any of the following conditions were problems in the neighborhood where
^TEMPNAME lived in ^REFYEAR...
Page 514 of 537

If the respondent lived in more than one place, ask about where the respondent lived the longest or
spent the most time during the year. Record persistent conditions, or conditions that were present for
the majority of the time.
...street noise or heavy street traffic?
(...trash, litter, or garbage in the streets or lots?)
1. Yes
2. No

AWBTRASH
(Do you think any of the following conditions were problems in the neighborhood where ^TEMPNAME
lived in ^REFYEAR...)
If the respondent lived in more than one place, ask about where the respondent lived the longest or
spent the most time during the year. Record persistent conditions, or conditions that were present for
the majority of the time.
(...street noise or heavy street traffic?)
...trash, litter, or garbage in the streets or lots?
1. Yes
2. No

AWBSTAY
Did ^TEMPNAME stay in ^PTEMPNAME home at certain times during ^REFYEAR because
^HESHE thought ^HESHE might be unsafe?
If the respondent lived in more than one place, ask for the place where he or she lived the longest or
spent the most time. Record persistent conditions, or conditions that were present for the majority of the
time.
1. Yes
2. No

AWBSAFE
Was ^PTEMPNAME neighborhood in ^REFYEAR...
Read answer categories.

Page 515 of 537

1. Very safe?
2. Somewhat safe?
3. Somewhat unsafe?
4. Very unsafe?

AWBMORT
Next are questions about difficulties people sometimes have in meeting their essential household
expenses.
During ^REFYEAR, was there ANY time when ^YOUYOURHOUSEHOLD_ADULT_WB...
...did not pay the full amount of the rent or mortgage?
(...did not pay the full amount of the gas, oil, or electricity bill?)
If respondent owns the residence free and clear, enter '2' and continue.
1. Yes
2. No

AWBGAS
(Next are questions about difficulties people sometimes have in meeting their essential household
expenses.
During ^REFYEAR, was there ANY time when ^YOUYOURHOUSEHOLD_ADULT_WB...)
(...did not pay the full amount of the rent or mortgage?
...did not pay the full amount of the gas, oil, or electricity bill?
1. Yes
2. No

ECVD_RENT
Would you say that not paying the full rent or mortgage was due to events related to the
coronavirus pandemic last year?
1. Yes
2. No

CTRLNUM
Page 516 of 537

**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

FOODF1
These next questions are about whether ^TEMPNAME could afford the food ^HESHE needed
during ^CALENDAR_YEAR. I'm going to read you some statements that people have made about
their food situations.
The first statement is, "The food that ^IWE_FOOD bought just didn't last, and ^IWE_FOOD didn't
have money to get more." Was that often, sometimes, or never true for
^YOUYOURHOUSEHOLD_ADULT_WB in ^CALENDAR_YRFIL?
1. Often true
2. Sometimes true
3. Never true

FOODF2
^C_IWE_FOOD couldn't afford to eat balanced meals." Was that often, sometimes, or never true
for ^YOUYOURHOUSEHOLD_ADULT_WB in ^REFYEAR?
1. Often true
2. Sometimes true
3. Never true

FOODF3
In ^REFYEAR, did ^YOUOTHERADULTS_FOOD ever cut the size of meals or skip meals because
there wasn't enough money for food?
1. Yes
2. No

FOODF4
How often did this happen...
Read answer categories.

Page 517 of 537

1. Almost every month?
2. Some months but not every month?
3. Only 1 or 2 months?

FOODF5
In ^REFYEAR, did ^TEMPNAME ever eat less than ^HESHE felt you should because there wasn't
enough money for food?
1. Yes
2. No

FOODF6
In ^REFYEAR, ^WEREWAS ^TEMPNAME ever hungry but didn't eat because there wasn't enough
money for food?
1. Yes
2. No

CTRLNUM
**NON-DISPLAYED ITEM**

FIN
^FINQ_FIL
1. Enter 1 to continue

CTRLNUM
ULTADDR
UPHONE_INT
UWHOSPEAK
WHO_SPEAK_WITH
Do not read to the respondent.
Select the person (based on his or her line number) with whom you are speaking right now.
Page 518 of 537

1. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
2. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
3. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
4. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
5. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
6. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
7. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
8. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
9. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
10. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
11. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
12. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
13. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
14. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
15. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
16. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
17. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
18. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
19. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15
20. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15

CTRLNUM
**NON-DISPLAYED ITEM**

CTRLNUM
**NON-DISPLAYED ITEM**

LNO
**NON-DISPLAYED ITEM**

TELEPHONE_NO
Ask or verify.
What is the telephone number where ^TEMPNAME would like to be called?

Page 519 of 537

TELEPHONE_TYPE
What type of telephone is it?
1. Home
2. Work
3. Cellular or digital
4. Beeper/Pager/Answering service
5. Public (pay phone)
6. Toll free
7. Other

SEC_TELEPHONE_NO
Ask or verify.
What is the second telephone number where ^TEMPNAME would like to be called?

SEC_TELEPHONE_TYPE
What type of telephone is it?
1. Home
2. Work
3. Cellular or digital
4. Beeper/Pager/Answering service
5. Public (pay phone)
6. Toll free
7. Other

BEST_TIME_CONTACT
Ask or verify.
When is the best time to contact ^TEMPNAME?
Do not read answer categories.
1. Morning (9am - 12 noon)
2. Noon/lunchtime (11:00am - 1pm)
3. Afternoon (12 noon - 4pm)
4. Suppertime/early evening/dinner time (4pm - 7pm)
5. Evening (6pm - 9pm)
Page 520 of 537

6. Anytime (9am - 9pm)
7. Late evening/night (7pm - 9pm)
8. Daytime (9am - 4pm)
9. After 5pm
10. Other

CONT_PSN1_FNAME
Ask or verify.
What is the first name of a close relative or friend, not currently living at this address, who would
know how to reach ^TEMPNAME if we are unable to do so?

CONT_PSN1_LNAME
Ask or verify.
What is this person's last name?

CONT_PSN1_REL
Ask or verify.
What is Fill for contact person's name's relationship to ^TEMPNAME?

CONT_PSN1_TELENO
What is Fill for contact person's name's telephone number?
Include the area code, prefix, suffix, and the extension (if one exists).

CONT_PSN1_PO
Ask or verify.
In what city does Fill for contact person's name live?

CONT_PSN1_STATE_CODE
CONT_PSN1_ST
Ask or verify.
In what state does Fill for contact person's name live?
Page 521 of 537

1. Alabama
2. Alaska
3. American Samoa
4. Arizona
5. Arkansas
6. California
7. Colorado
8. Connecticut
9. Delaware
10. District of Columbia
11. Florida
12. Georgia
13. Guam
14. Hawaii
15. Idaho
16. Illinois
17. Indiana
18. Iowa
19. Kansas
20. Kentucky
21. Louisiana
22. Maine
23. Maryland
24. Massachusetts
25. Michigan
26. Minnesota
27. Mississippi
28. Missouri
29. Montana
30. Nebraska
31. Nevada
32. New Hampshire
33. New Jersey
34. New Mexico
35. New York
36. North Carolina
37. North Dakota
38. Northern Marianas
39. Ohio
Page 522 of 537

40. Oklahoma
41. Oregon
42. Other place
43. Pennsylvania
44. Puerto Rico
45. Rhode Island
46. South Carolina
47. South Dakota
48. Tennessee
49. Texas
50. U.S. Virgin Islands
51. Utah
52. Vermont
53. Virginia
54. Washington
55. West Virginia
56. Wisconsin
57. Wyoming

LNO
**NON-DISPLAYED ITEM**

LTRADDR
To whom should future correspondence be addressed?
Read name(s) if necessary.
1. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
2. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
3. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
4. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
5. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
6. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
7. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
8. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
9. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
10. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
11. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
Page 523 of 537

12. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
13. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
14. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
15. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
16. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
17. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
18. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
19. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
20. Display the LNO, ^FNAME, ^LNAME, where AGE >= 15 and (WAVE =1 or (WAVE GE 2 and OSP_FLAG = 1))
99. No one

CTRLNUM
**NON-DISPLAYED ITEM**

BCINFO
Was the noninterview status determined by observation only or did someone provide you with
information about the housing unit?
1. By observation only
2. Information provided by someone else

BCINFO2_MONTH
Enter the month in which the household left the sample.
1. ^MONTH1, ^CALENDAR_YEAR
2. ^MONTH2, ^CALENDAR_YEAR
3. ^MONTH3, ^CALENDAR_YEAR
4. ^MONTH4, ^CALENDAR_YEAR
5. ^MONTH5, ^CALENDAR_YEAR
6. ^MONTH6, ^CALENDAR_YEAR
7. ^MONTH7, ^CALENDAR_YEAR
8. ^MONTH8, ^CALENDAR_YEAR
9. ^MONTH9, ^CALENDAR_YEAR
10. ^MONTH10, ^CALENDAR_YEAR
11. ^MONTH11, ^CALENDAR_YEAR
12. ^MONTH12, ^CALENDAR_YEAR
13. ^INTV_MONTH1, ^INTV_YEAR
Page 524 of 537

14. ^INTV_MONTH2, ^INTV_YEAR
15. ^INTV_MONTH3, ^INTV_YEAR
16. ^INTV_MONTH4, ^INTV_YEAR
17. ^INTV_MONTH5, ^INTV_YEAR
18. ^INTV_MONTH6, ^INTV_YEAR

BCINFO2_DAY
Enter the day in which the household left the sample.

BCINFO2_FN
Enter the first name of the person providing the noninterview status.

BCINFO2_LN
Enter the last name of the person providing the noninterview status.

BCINFO2_CPREL
Enter the title of the contact person (relative, neighbor, etc.).

BCINFO2_STRNUM
Enter the street number (including any unit designation) of the contact person's address.

BCINFO2_STRNME
Enter the street name of the contact person's address.

BCINFO2_PO
Enter the city of the contact person's address.

bcinfo2_st
Enter the state of the contact person's address.
AL. Alabama
AK. Alaska
AZ. Arizona
AR. Arkansas
Page 525 of 537

CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
NE. Nebraska
NV. Nevada
NH. New Hampshire
NJ. New Jersey
NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
SD. South Dakota
TN. Tennessee
Page 526 of 537

TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming

bcinfo2_zip
Enter the zip code of the contact person's address.

BCINFO2_ZIP4
Enter the 4-digit zip code of the contact person's address.

bcinfo2_phone
BCINFO2_AR
Enter the area code of the contact person's telephone number.

BCINFO2_NO
Enter the contact person's telephone number.

BCINFO2_EXT
Enter any extension to the contact person's telephone number (if applicable).

ctrlnum
**NON-DISPLAYED ITEM**

TRANSMIT
Do not read to the respondent.
Are you ready to transmit the case?

Page 527 of 537

1. Yes
2. No

ctrlnum
**NON-DISPLAYED ITEM**

lno
why_typez_hhld
^TYPEZHHLDQSTNTXTFIL

1. Person was ill or in the hospital
2. Person was temporarily away from home
3. Other

typez_specify
What is the other reason?

ctrlnum
**NON-DISPLAYED ITEM**

visit_count
How many times have you attempted personal contact (actually visited the address)?

int_mode
Was ^MAJORITY_FIL this interview done by telephone interview or by personal interview?
1. Telephone interview
2. Personal interview

THANKYOU
Interview Number: Wave
Page 528 of 537

THANKYOU
Enter 1 to continue.
1. Enter 1 to continue

other_name
Do not read to the respondent.
Identify the person who responded to the majority of this interview.

1. Display the LNO ROST_FNAME ROST_LNAME
2. Display the LNO ROST_FNAME ROST_LNAME
3. Display the LNO ROST_FNAME ROST_LNAME
4. Display the LNO ROST_FNAME ROST_LNAME
5. Display the LNO ROST_FNAME ROST_LNAME
6. Display the LNO ROST_FNAME ROST_LNAME
7. Display the LNO ROST_FNAME ROST_LNAME
8. Display the LNO ROST_FNAME ROST_LNAME
9. Display the LNO ROST_FNAME ROST_LNAME
10. Display the LNO ROST_FNAME ROST_LNAME
11. Display the LNO ROST_FNAME ROST_LNAME
12. Display the LNO ROST_FNAME ROST_LNAME
13. Display the LNO ROST_FNAME ROST_LNAME
14. Display the LNO ROST_FNAME ROST_LNAME
15. Display the LNO ROST_FNAME ROST_LNAME
16. Display the LNO ROST_FNAME ROST_LNAME
17. Display the LNO ROST_FNAME ROST_LNAME
18. Display the LNO ROST_FNAME ROST_LNAME
19. Display the LNO ROST_FNAME ROST_LNAME
20. Display the LNO ROST_FNAME ROST_LNAME

spanish_int
Did you conduct any of this household's interview in Spanish?

1. Yes
2. No
Page 529 of 537

CHECKOUT
**NON-DISPLAYED ITEM**

language_int
What language is spoken in this household that prevented you from conducting the interview?
1. Spanish or Spanish Creole
2. Chinese
3. French (including Patois, Cajun)
4. French Creole
5. Tagalog, Filipino
6. Vietnamese
7. German
8. Korean
9. Russian
10. Italian
11. Hindi, Urdu
12. Arabic
13. Portuguese or Portuguese Creole
14. Polish
15. Persian
16. Gujarati
17. Other

SHOWFINAL
MODE: ^INT_MODEFIL
OUTCOME: ^OUTCOMEFIL
MARK: ^MARKFIL
MARKTWO: ^MARKTWOFIL
Enter 1 to continue.
1. Enter 1 to continue

CTRLNUM
**NON-DISPLAYED ITEM**
Page 530 of 537

CALLBACK_DATE
I'd like to schedule a return visit to finish the interview.
What DATE would be best to visit again to conduct the interview?
Enter the date (MM/DD/YYYY).

CALLBACK_TIME
(What TIME would be best to visit again to conduct the inteview?)
Enter the time (hour, minutes, and am or pm).

THANKYOU_CALLBACK
Thank you for your help. I will come back at the time suggested.
^CALLBACKAPPTFIL
Enter 1 to continue.
1. Enter 1 to continue

ctrlnum
**NON-DISPLAYED ITEM**

alreadyspawned
movercounter
lno
**NON-DISPLAY ITEM**

LNO
whoelse
Ask if necessary:
Did any of the following people
address?

Read name(s) move with ^MOVERNAME_FIL to the same

Mark all that apply.

Page 531 of 537

If none of the people listed below moved together, then mark 0.
If the person doesn't know (or refuses to answer) who moved with ^MOVERNAME_FIL to the same
address, then select all the names listed below.
0. No one else moved to same new address
1. See Special Instructions
2. See Special Instructions
3. See Special Instructions
4. See Special Instructions
5. See Special Instructions
6. See Special Instructions
7. See Special Instructions
8. See Special Instructions
9. See Special Instructions
10. See Special Instructions
11. See Special Instructions
12. See Special Instructions
13. See Special Instructions
14. See Special Instructions
15. See Special Instructions
16. See Special Instructions
17. See Special Instructions
18. See Special Instructions
19. See Special Instructions
20. See Special Instructions
21. See Special Instructions
22. See Special Instructions
23. See Special Instructions
24. See Special Instructions
25. See Special Instructions

move_addr_yn
^QSTNTXT_MOVERADDR
1. Enter new address
2. Don't know/Address not available yet

Page 532 of 537

ctrlnum
**NON-DISPLAYED ITEM**

lno
**NON-DISPLAY ITEM**

LNO
move_hno
? [F1]
What is the new address for ^MOVERTENSE_FIL?
Enter the House Number.

move_hnosuf
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Enter the House Number Suffix.

move_strname
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Enter the Street Name.

move_unitdes
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Enter the Apartment or Unit Number.

move_po
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Page 533 of 537

Enter the City.

move_st
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Enter the State.
AL. Alabama
AK. Alaska
AZ. Arizona
AR. Arkansas
CA. California
CO. Colorado
CT. Connecticut
DC. District of Columbia
DE. Delaware
FL. Florida
GA. Georgia
HI. Hawaii
ID. Idaho
IL. Illinois
IN. Indiana
IA. Iowa
KS. Kansas
KY. Kentucky
LA. Louisiana
ME. Maine
MD. Maryland
MA. Massachusetts
MI. Michigan
MN. Minnesota
MS. Mississippi
MO. Missouri
MT. Montana
NE. Nebraska
NV. Nevada
NH. New Hampshire
Page 534 of 537

NJ. New Jersey
NM. New Mexico
NY. New York
NC. North Carolina
ND. North Dakota
OH. Ohio
OK. Oklahoma
OR. Oregon
PA. Pennsylvania
RI. Rhode Island
SC. South Carolina
SD. South Dakota
TN. Tennessee
TX. Texas
UT. Utah
VT. Vermont
VA. Virginia
WA. Washington
WV. West Virginia
WI. Wisconsin
WY. Wyoming

move_county
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Enter the County.

MOVE_ZIP
? [F1]
(What is the new address for ^MOVERTENSE_FIL?)
Enter the Zip Code.

move_mo
When did ^THISTHESEPERSONSFIL move to this address?
Page 535 of 537

Enter the month.
0. Before ^MONTH1 ^CALENDAR_YRFIL
1. ^MONTH1 ^CALENDAR_YRFIL
2. ^MONTH2 ^CALENDAR_YRFIL
3. ^MONTH3 ^CALENDAR_YRFIL
4. ^MONTH4 ^CALENDAR_YRFIL
5. ^MONTH5 ^CALENDAR_YRFIL
6. ^MONTH6 ^CALENDAR_YRFIL
7. ^MONTH7 ^CALENDAR_YRFIL
8. ^MONTH8 ^CALENDAR_YRFIL
9. ^MONTH9 ^CALENDAR_YRFIL
10. ^MONTH10 ^CALENDAR_YRFIL
11. ^MONTH11 ^CALENDAR_YRFIL
12. ^MONTH12 ^CALENDAR_YRFIL
13. ^MONTH13 ^INTYEARFIL
14. ^MONTH14 ^INTYEARFIL
15. ^MONTH15^INTYEARFIL
16. ^MONTH16 ^INTYEARFIL
17. ^MONTH17 ^INTYEARFIL
18. ^MONTH18 ^INTYEARFIL

move_reason
Why did ^THISTHESEPERSONSFIL leave the household?
Mark all that apply.
5. Marital-status reasons (e.g., marriage, civil union, partnership, cohabitation, separation or divorce)
6. Job-related reasons
7. Attending college or boarding school, or other educational reason
8. Other family changes (e.g., change in custody, child moves out on his own, parent moved into nursing home)
10. Other

move_main_reason
What is the main reason ^THISTHESEPERSONSFIL left the household?
5. Marital-status reasons (e.g., marriage, civil union, partnership, cohabitation, separation or divorce)
6. Job-related reasons
7. Attending college or boarding school, or other educational reason
Page 536 of 537

8. Other family changes (e.g., change in custody, child moves out on his own, parent moved into nursing home)
10. Other

in_fr_area
Is this address within your assignment area?
1. Yes
2. No

MOVER_WARNING
WARNING: A mover will be spawned from this case.
Enter 1 to continue.
1. Enter 1 to continue

no_spwan_warning
No spawn will be created because this is a 'grandchild' case. Please contact your supervisor for further
instructions.
Enter 1 to continue.
1. Enter 1 to continue

Page 537 of 537