Form 1 Roster

CPS Roster

Okay, let’s get started. Please answer the questions as you would if an interviewer had come to your home.

Ask R1 – R11 for 1^st HH member. Record information on Household Roster. Then ask for next HH member. Repeat for every member of HH.

R1. NAME First I will ask you some questions about the people who live here. What are the names of all persons living or staying here? Let’s start with you.

R2. SEX What is [your/[NAME]’s] sex?

1. Male

2. Female

R3. REL

IF NOT RESPONDENT: How is [NAME] related to you?

1. Opposite sex spouse (husband/wife)

2. Opposite sex unmarried partner

3. Same sex spouse (husband/wife)

4. Same sex unmarried partner

5. Child

6. Grandchild

7. Parent

8. Brother/ sister

9. Other relative (aunt, uncle, cousin, in law)

10. Foster child

11. Housemate/roommate

12. Roomer/boarder

13. Other nonrelative

14. DK

15. REF

99. self

R4. AGE What is [your/NAME’s] date of birth?

R5. EDUCATION

What is the highest level of school [you have /[NAME has]] completed or the highest degree [you have/[NAME has]] received?

1. 1st, 2nd, 3rd, or 4th grade

2. 5th or 6th grade

3. 7th or 8th grade

4. 9th grade

5.10th grade, 11th grade

6. 12th grade, no diploma

7. High school graduate-high school diploma or equivalent

8. Some college – no diploma

9. Associates degree – occupational / vocational program

10. Associates degree – academic program

11. Bachelor’s degree (BA, BS, AB)

12. Master’s degree (MS, MA, MBA, MEd, MEng, MSW)

13. Professional degree (MD, DDS, DMV, LLB, JD)

14. Doctorate degree (PhD, EdD)

R6. HISPA (Are/Is)(Name/You) Spanish, Hispanic or Latino?

1. Yes

   

2. No

3. Don’t Know Go to R9. RACE

4. Refuse

R7. HISPB (Are/Is)(Name/you) Mexican, Mexican American, Chicano, Puerto Rican, Cuban American, or some other Spanish, Hispanic, or Latino Group?

1. Mexican

2. Mexican American

3. Chicano Go to R7. Race

4. Puerto Rican

5. Cuban American

6. Some Other > Go to R6. S_OROTSP

R8. O_HISP What is the name of (your/his/her) other Spanish, Hispanic, or Latino group?

R9. RACEA I am going to read you a list of five race categories. Please choose one or more races that (NAME/you) (considers yourself/consider NAME/considers himself/considers herself) to be: White; Black or African American; American Indian or Alaska Native; Asian; OR Native Hawaiian or Other Pacific Islander.

1. White

2. Black or African American

3. American Indian or Alaska Native Go to R11. Work

4. Asian

5. Native Hawaiian or Other Pacific Islander

6. Other – DO NOT READ > Go to R10. RACEB

R10. RACEB What is your race?

R11. WORK LAST WEEK, did (name/you) do ANY work for (pay/either pay or profit)?

1. Yes

2. No

3. Retired

4. Disabled

5. Unable to work