Instrument 7. 12-month post-TANF-exit survey

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OMB No.: XXXX-XXXX 
Expiration Date: DD/MM/YYYY 
 

Instrument 7. 12-month post-TANF-exit survey 





Welcome to the Temporary Assistance for Needy Families (TANF) Pilot Program 
12-month post-TANF-exit survey. 
  
To begin the form, click the “Next/Siguiente” button below. 
 
  
This survey works best for desktop computers, and works best in current versions of Microsoft Edge, Chrome and Firefox.
 
 
OMB No.: XXXX-XXXX 
Expiration Date: DD/MM/YYYY 
 
 
Please select the language to complete the survey in.
Seleccione el idioma en el que desea completar la encuesta.
m	English/Inglés	1
m	Spanish/Español	2	



 
COMPUTER ASSISTED WEB INTERVIEW (CAWI) ALL
COMPUTER ASSISTED TELEPHONE INTERVIEW (CATI) DO NOT DISPLAY 

How to complete the survey
Thank you for taking the time to complete this survey.
    • There are no right or wrong answers.
    • To answer a question, click the box that indicates your response or fill in your response.
    • To continue to the next webpage, press the "Next" button.
    • To go back to the previous webpage, click the "Back" button. Please note that this command is only available in some sections.
    • Do not use the navigation arrows in your browser.
    • If you need to stop before you have finished, you can close the survey and come back to it at any time. The responses you gave before leaving will be securely stored and available when you return to complete the survey. 
    • Select “Next” to begin the survey. 


Voluntary consent and verification 
PROGRAMMER NOTE: IF CATI, KEEP ALL TEXT BOLDED
Intro.*	[IF CATI: My name is [fill Interviewer Name] and I’m calling on behalf of the U.S. Department of Health and Human Services.] Recently, you should have received an invitation to complete a survey Mathematica is conducting for the U.S. Department of Health and Human Services. 
WHY ARE YOU BEING ASKED TO COMPLETE THIS SURVEY AND PARTICIPATE IN THE STUDY?
[IF 2026 ADMINISTRATION: Recently,][IF 2030 ADMINISTRATION: Around a year ago,] in [MONTH/YEAR], you completed a Study Information Form that explained you might be contacted for a study called the Temporary Assistance for Needy Families (TANF) Pilot Evaluation. This survey is part of that study. The study is funded by the Administration for Children and Families at the U.S. Department of Health and Human Services and will help us learn about how TANF programs can serve people better. We are hoping to hear about your experiences after participating in [State TANF program], including your jobs, your health, how you are doing, and your use of benefits. Mathematica will send you a $75 gift card once you complete the survey.   
HOW WILL YOU KEEP MY INFORMATION SAFE?
All information collected on this survey will be kept private to the extent permitted by law. We have obtained a Certificate of Confidentiality from the National Institutes of Health. This helps us protect participants’ privacy. This means no one can force the study team to give out information that identifies them, even in court. However, the certificate does not prevent us from making disclosures required by law. For example, if you report that you are going to hurt yourself or others, or that someone is hurting you, the study team may be required to report this to someone who can help make sure you are safe. Your name will not be attached to your responses, and no one outside the study team will see your responses, including your employer(s) or any programs that you may participate in. Your information will be combined with information from other individuals who complete this survey and no names or other identifying information will be reported. 
PROGRAMMER NOTE: NEW SCREEN

WHAT ARE THE RISKS OF COMPLETING THIS SURVEY AND PARTICIPATING IN THE STUDY?
Completing this survey and participating in the study is voluntary. You may be uncomfortable answering some of the questions on this survey. If that happens, you can skip those questions and not answer them. 
The study team will take many steps to keep all information private, but there is a small risk that someone else could see it. The data collected will include information about your employment history, economic stability, family characteristics, education and training, and health.
If you agree to participate in this study, you can withdraw from the study at a later time by calling Mathematica toll-free at 833-678-3825 and then writing a message that you do not wish to complete any additional study activities. You can send this message to Jennifer Herard-Tsiagbey, the study’s Data Collection Director, at [email protected]. Any information we collect about you before you withdraw from the study will be retained as part of the research.
If you have any questions, you can call Mathematica toll-free at 833-678-3825. 
PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather information from people who have recently participated in TANF. Public reporting burden for this collection of information is estimated to average 45 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0XXX and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact Mathematica toll-free at 833-678-3825 or [email protected]. 
[IF CATI: Do you have any questions before we begin?]
PROGRAMMER NOTE: NEW SCREEN
GLOBAL COMMENTS:
    • Code “MISSING OR REFUSED” as “Missing” (m) in CAWI and display and code as “Refused” (r) in CATI.
ASK ALL
CONSENT.* 	Do you agree to participate in this study and complete this survey? 
m	Yes 	1 INTRO1
m	No.	0 SKIP BOX CONSENT(DISP = 50)

PROGRAMMER SKIP BOX CONSENT
IF CONSENT = 0 aND MODE = WEB, GO TO ENd1.
If CONSENT = 0 AND MODE = CATI, GO TO THANKS.


PROGRAMMER NOTE: IF CONSENT = No (0) AND MODE = WEB, set case to screened.


CATI/CAWI: ALL
CATI: First we are going to ask you some questions to check that we are speaking with the correct person.
CAWI: First we are going to ask you some questions to check that we are surveying the correct person.

ALL
IF CAWI DO NOT SHOW DK OR REF

Intro1.	What is your date of birth?
|     |     | / |     |     | / |     |     |     |     | 
MONTH    DAY           YEAR 
(1-12)     (1-31)      (1927-2008) 



ALL
IF CAWI DO NOT SHOW DK OR REF

INTRO2.*	When you completed the study information form [IF 2030 ADMINISTRATION: about a year ago,] in [Month/year], what was your marital status? As a reminder, we are asking you this to confirm we are surveying the correct person.
m	MARRIED	1
m	SEPARATED	2	
m	DIVORCED	3	
m	WIDOWED	4
m	NEVER MARRIED	5	
m  DON’T KNOW	d	
m	MISSING OR REFUSED	m/r







INTRO3. Thank you for your time. We need to check our records before continuing the interview. Please contact Mathematica at 833-678-3825 to complete the survey. 




INTRO4.*	
	CATI: Thank you for your response.  I need to check our records before continuing the interview. Please hold on a moment while I get my supervisor. 
	CON’T	………………………………………………………………………………1		GO TO INTRO5


INTRO5.*	
	CATI ONLY: Can you tell me the name of the street that you lived on when you completed the study information form [IF 2030 administration: about a year ago,] in [MONTH/YEAR]?	
	[FILL WITH ADDRESS FROM PRELOAD]	
INSTRUCTION:  	If respondent’s answer matches the address on the screen, select “Addresses Match”. 
m	Addresses match	1 GO TO A2
m	Addresses do not match……………………………………………………………….2 GO TO INTRO6
m   DON’T KNOW…………………………………………………………………………………………………..d	 GO TO INTRO6
m	MISSING OR REFUSED…………………………………………………………………………………m/r GO TO INTRO6





INTRO6.*	
	I’m sorry. I need to check my records before I can interview you. We will call you back in X days to…




CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
CATI: Now I would like to ask some questions about work. 
CAWI: The next questions are about work. 
A2.	Are you currently working for pay?
	Working for pay can include regular paid jobs, odd jobs, temporary jobs, work done in your own business, jobs or tasks you find using a web or mobile app, “gig work”, “under the table or off the books” work, or any other types of work you have done for pay.  
YES	1	GO TO A3
NO	0 	GO TO A2a
DON’T KNOW	d 	GO TO A2a
MISSING OR REFUSED	m/r 	GO TO A2a

CATI/CAWI
A2 = 0, D, R, M
IF CAWI DO NOT SHOW DK OR REF
A2a.	Have you worked for pay at any time in the past 12 months?	
12 months ago was around MONTH/YEAR.
YES	1	GO TO A4b
NO	0 	GO TO [A15]
DON’T KNOW	d 	GO TO [A15]
MISSING OR REFUSED	m/r 	GO TO [A15]


programmer BOX A2a.1
CREATE SLOTS FOR 20 JOBS. 

PROGRAMMER: SET LIMIT OF 10 CURRENT JOBS AND 10 FORMER JOBS (TOTAL OF 20 JOBS)

JOB 1
JOB 2
A2 =1
IF CAWI DO NOT SHOW REF
A3.	CATI: [First I am going to ask about your current job or jobs.] Please tell me who you work for. 
          CAWI: [The next questions are about your current job or jobs.] Please tell us who you work for.
          CATI (PROBE AFTER 1st LOOP)/CAWI: This could be the name of a company, organization, person, or you could work for yourself or have your own business. If you currently work at more than one job, please start with the job where you usually work the most hours.
NAME OF EMPLOYER (SPECIFY)..1 
	(STRING 50)
SELF EMPLOYED (SPECIFY)...             2
	(STRING 50)
MISSING OR REFUSED	m/ r…GO TO A4b

CAWI AND CATI SOFT CHECK IF NO RESPONSE IS PROVIDED: Please enter the name of who you work for. If you don’t know the name, please enter a brief description of the company or business.


NAME OF EMPLOYER (SPECIFY)..1 
	(STRING 50)
SELF EMPLOYED (SPECIFY)...             2
	(STRING 50)
MISSING OR REFUSED	m/ r…GO TO A4b

CAWI AND CATI SOFT CHECK IF NO RESPONSE IS PROVIDED: Please enter the name of who you work for. If you don’t know the name, please enter a brief description of the company or business.


CATI/CAWI
If A2=1 and (A3 = 1 or 2)
IF CAWI DO NOT SHOW DK OR REF
A4.	
PROGRAMMER NOTE: For any “Self Employed” current jobs, display as “self-employed ([Text from specify])”.

So far you have told us that you work at…
LIST JOBS 1-X  [any previously entered jobs]
 Do you currently have any other paid jobs? As a reminder we are interested in hearing about regular paid jobs, odd jobs, temporary jobs, work done in your own business, jobs or tasks you find using a web or mobile app, “gig work”, “under the table or off the books” work, or any other types of work you have done for pay.  
YES	1	GO TO A3, JOB 2
NO	0   GO TO A4a
MISSING OR REFUSED	m/ r…GO TO A4a

IF A2=1 LOOP A3 AND A4 UNTIL A4=0,d, r, or m, or 10 current jobs entered. WHEN A4=0, r, or m GO TO A4a JOB 1.

YES	1  GO TO A3, JOB 3
NO	0   GO TO A4a
MISSING OR REFUSED	m/ r…GO TO A4a

IF A2=1 LOOP A3 AND A4 UNTIL A4=0,d, r, or m, or 10 current jobs entered. WHEN A4=0, r, or m GO TO A4a JOB 1.

A2 = 1 (Currently employed)

IF CAWI DO NOT SHOW DK OR REF

A4a. Have you had any other paid jobs in the past 12 months that you haven’t told me about?

Probe: When we say the past 12 months we mean since [Month/Year].

PROGRAMMER NOTE: For any “Self Employed” current jobs, display as “self-employed ([Text from specify])”.

CATI/CAWI: 
So far you have told us that you
work(ed) at…
LIST JOBS 1-X  [any previously entered jobs]

PROGRAMMER NOTE: Single punch question outside of former job loop. Only asked ONCE.
YES	1	GO TO A4b, JOB 1
NO	0	GO TO A5
DON’T KNOW	d	GO TO A5
MISSING OR REFUSED	..m/r	GO TO A5






JOB 1
JOB 2
A2a=1 (NOT CURRENTLY EMPLOYED BUT EMPLOYED IN THE PAST YEAR) or A4a=1 (HAD JOB IN LAST 12 MONTHS)
A4b.	CATI: Please tell me who you worked for in the past 12 months, that is, since [Month/Year of TANF Exit].
          CAWI: Please indicate who you worked for in the past 12 months, that is, since [Month/Year of TANF Exit].
          CATI (PROBE AFTER 1st LOOP)/CAWI: This could be the name of a company, organization, person, or you could work for yourself or have your own business. If you had more than one job, please start with the job where you worked the most hours.
NAME OF EMPLOYER (SPECIFY)..	1 
	(STRING 50)
SELF EMPLOYED (SPECIFY)...             2
	(STRING 50)
MISSING OR REFUSED	m/r

CAWI AND CATI SOFT CHECK IF NO RESPONSE IS PROVIDED: Please enter the name of who you work for. If you don’t know the name, please enter a brief description of the company or business.
NAME OF EMPLOYER (SPECIFY)..	1 
	(STRING 50)
SELF EMPLOYED (SPECIFY)...             2
	(STRING 50)
MISSING OR REFUSED	m/r

CAWI AND CATI SOFT CHECK IF NO RESPONSE IS PROVIDED: Please enter the name of who you work for. If you don’t know the name, please enter a brief description of the company or business.
(A2a=1 (NOT CURRENTLY EMPLOYED BUT EMPLOYED IN THE PAST YEAR) or A4a=1 (HAD JOB IN LAST 12 MONTHS)) and A4b = 1 or 2

IF CAWI DO NOT SHOW DK OR REF

A4c.	

Have you had any other paid jobs in the past 12 months  that you haven’t told me about?

Probe: When we say the past 12 months we mean since [Month/Year of TANF Exit].

PROGRAMMER NOTE: For any “Self Employed” former jobs, display as “self-employed ([Text from specify])”.
           
CATI/CAWI: 
So far you have told us that you
work(ed) at…
LIST JOBS 1-X  [any previously entered jobs]


YES	1	GO TO A4b, JOB 2
NO	0	GO TO A5
DON’T KNOW	d	GO TO A5
MISSING OR REFUSED	..m/r	GO TO A5

IF A4a = 1 OR A2a=1 LOOP A4b AND A4c UNTIL A4c=0,d, r, or m, or until 10 former jobs entered. WHEN A4C=0, d, r, or m GO TO A5.

YES	1	GO TO A4b, JOB 3
NO	0	GO TO A5
DON’T KNOW	d	GO TO A5
MISSING OR REFUSED	..m/r	GO TO A5

IF A4a = 1 OR A2a=1 LOOP A4b AND A4c UNTIL A4c=0,d, r, or m, or until 10 former jobs entered. WHEN A4C=0, d, r, or m GO TO A5.

PROGRAMMER: SET LIMIT OF 10 CURRENT JOBS AND 10 FORMER JOBS (TOTAL OF 20 JOBS)


JOB 1
JOB 2
CATI/CAWI
A2=1 OR A2a=1
IF CAWI DO NOT SHOW DK OR REF

IF MORE THAN ONE JOB REPORTED, FILL with A3 or A4b “NOW THINKING OF THE JOB YOU [DO/DID] for [NAME OF EMPLOYER/YOURSELF (A3 or A4b Self employed text fill)].” 
PROGRAMMER NOTE: If A3 or A4b = 2, fill with “Yourself”. 

A5. 	Now thinking of the job you [do/did] for [A3/A4b NAME OF EMPLOYER/YOURSELF (A3 or A4b Self employed text fill)], did you receive assistance from an organization to help get this job? 
YES (SPECIFY)..................................1
	(STRING 50)
NO…………………………..2
DON’T KNOW…………………………..d
MISSING OR REFUSED………m/r	
YES (SPECIFY)..................................1
	(STRING 50)
DID NOT RECEIVE ANY ASSISTANCE…………………………..2DON’T KNOW…………………………..d
MISSING OR REFUSED………m/r	
CATI/CATI 
A2=1 OR A2a=1
IF CAWI DO NOT SHOW DK OR REF
IF MORE THAN ONE JOB REPORTED, FILL with A3 or A4b “NOW THINKING OF THE JOB YOU [DO/DID] for [NAME OF EMPLOYER/YOURSELF (A3 or A4b Self employed text fill)].” 

PROGRAMMER NOTE: If A3 or A4b = 2, fill with “Yourself”. 
PROGRAMMER NOTE: Fill with “is/do” if current job (A3); fill with “was/did” if former job (A4b).
A5a.   Now thinking of the job you [do/did] for [A3/A4b NAME OF EMPLOYER/YOURSELF (A3 or A4b Self employed text fill)], what [is/was] your job title at this job? For example, you might be a warehouse worker, home health aide, delivery driver, cook, cashier, or truck driver.
JOB Title (SPECIFY)	1 
	(STRING 50)
DON’T KNOW	d
MISSING OR REFUSED	m/r

HARD CHECK: IF A5a = 1 AND SPECIFY FIELD IS BLANK, Please provide a job title in the Specify box, if you aren’t sure you can include a few words about what you [do/did].

HARD CHECK: IF A5a = m, Please provide a job title. If you aren’t sure you can include a few words about what you [do/did].



JOB Title (SPECIFY)	1 
	(STRING 50)
DON’T KNOW	d
MISSING OR REFUSED	m/r

HARD CHECK: IF A5a = 1 AND SPECIFY FIELD IS BLANK, Please provide a job title in the Specify box, , if you aren’t sure you can include a few words about what you [do/did].

HARD CHECK: IF A5a = m, Please provide a job title. If you aren’t sure you can include a few words about what you [do/did].
CATI/CAWI

A2=1 OR A2a=1

IF CAWI DO NOT SHOW DK OR REF


FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

A6.	When did you start working as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF]?

HARD CHECK IF A6 DATE IS IN THE FUTURE: “The date you provided has not happened yet. Please review your response before proceeding”


INTERVIEWER: RECORD MONTH AND YEAR. 
NOTE: ALLOW SKIP ON MONTH.
|     |     | / |     |     |     |     |
MONTH        YEAR
(1-12) 	(1990-current year)
DON’T KNOW	d
MISSING OR REFUSED	m/r

CAWI SOFT CHECK: IF MONTH IS PROVIDED BUT YEAR IS BLANK, “Please provide the year that you started working as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF].”
|     |     | / |     |     |     |     |
MONTH        YEAR
(1-12) 	(1990-current year)
DON’T KNOW	d
MISSING OR REFUSED	m/r

CAWI SOFT CHECK: IF MONTH IS PROVIDED BUT YEAR IS BLANK, “Please provide the year that you started working as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF].”
CATI/CAWI
A2=1 OR A2a=1
IF CAWI DO NOT SHOW DK OR REF
FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

A7.	Are you still working as [A5a JOB TITLE] for [A3/A4b FILL EMPLOYER NAME/YOURSELF]?
YES	1	GO TO A8
NO	0	GO TO A7a
DON’T KNOW	d
MISSING OR REFUSED	m/r
YES	1	GO TO A8
NO	0	GO TO A7a
DON’T KNOW	d
MISSING OR REFUSED	m/r
CATI/CAWI
A7 = 0 
IF CAWI DO NOT SHOW DK OR REF

FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

A7a.	When did you stop working as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF]?
	INTERVIEWER: RECORD MONTH AND YEAR.
SOFTCHECK IF A7a DATE IS BEFORE A6 DATE: “The date you provided occurred before you reported starting at this job. Please review your response before proceeding.” 

SOFT CHECK IF A7a DATE IS IN THE FUTURE: “The date you provided has not happened yet. Please review your response before proceeding.” 

SOFT CHECK IF MONTH IS PROVIDED BUT YEAR IS BLANK: “Please provide the year that you stopped working as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF].”

SOFT CHECK IF A7a is missing: “Please provide a response before moving on to the next question.”
|     |     | / |     |     |     |     |
MONTH        YEAR

 (1-12) 	(2025-current year)
STILL AT JOB	98
DON’T KNOW	d
MISSING OR REFUSED	m/r
|     |     | / |     |     |     |     |
MONTH        YEAR

 (1-12) 	(2025-current year)
STILL AT JOB	98
DON’T KNOW	d
MISSING OR REFUSED	m/r
CATI/CAWI

A2 = 1 OR A2a=1
IF CAWI DO NOT SHOW DK OR REF

FILL “ARE” IF A7=1, ELSE FILL “WERE”

FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 


A8.	Which of the following best describes your employment as [A5a JOB TITLE] at [A3/A4b EMPLOYER NAME/YOURSELF]?  [Were/Are] you working . . .
CATI: PROBE:	 A temporary help agency supplies workers to other companies on an as needed basis.
PROBE:	 Some companies provide employees or their services to others under contract. A few examples of services that can be contracted out include security, landscaping, or computer programming.
PROBE: 	Independent contractors, independent consultants, gig workers, and free-lance workers obtain customers on their own to provide a product or service and can have other employees working for them. For example, driving for Uber, delivering packages for Amazon or another delivery service, etc.
PROBE:	 Day laborers are people who work as needed. For example, day laborers may get work by waiting at a place where employers pick up people to work for a day or by posting paper or electronic job wanted ads and responding on a day-by-day basis.
PROBE:	 On-call workers are in a pool of workers who are ONLY called to work as needed, although they can be scheduled to work for several days or weeks in a row, for example, substitute teachers, and construction workers supplied by a union hiring hall.
CODE ONE ONLY
as a regular full-time employee?.......1
as a regular part-time employee?.....2
for a temporary help agency?...........3
as a gig worker, independent contractor, independent consultant, or freelance worker?...............................................4
as an on-call employee?...................5
for friends, family, or other people doing part-time tasks, day labor, or odd jobs?...6
or something else (PLEASE SPECIFY)?............................................99
	(STRING (100))
DON’T KNOW…………………………..d
MISSING OR REFUSED…………….m/r

SOFT CHECK: IF A8 = 9 AND SPECIFY FIELD IS BLANK, Please provide an answer in the Specify box, or click “Next” to move to the next question.
CODE ONE ONLY
as a regular full-time employee?.......1
as a regular part-time employee?.....2
for a temporary help agency?...........3
as a gig worker, independent contractor, independent consultant, or freelance worker?...............................................4
as an on-call employee?...................5
for friends, family, or other people doing part-time tasks, day labor, or odd jobs?...6
or something else (PLEASE SPECIFY)?............................................99
	(STRING (100))
DON’T KNOW…………………………..d
MISSING OR REFUSED…………….m/r

SOFT CHECK: IF A8 = 9 AND SPECIFY FIELD IS BLANK, Please provide an answer in the Specify box, or click “Next” to move to the next question.



JOB 1
JOB 2
CATI/CAWI
A2=1 OR A2a=1
IF CAWI DO NOT SHOW 9, DK OR REF
IF A7=1 FILL “DO”; ELSE, FILL “DID”
FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

A8a.	[Do/Did] you have taxes taken out of your paycheck for the work you [do/did] as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF]?
YES…………………………………….1
NO……………………………………...0
R VOLUNTEERS: WAS PAID IN CASH…………………………………..9
DON’T KNOW…………………………d
MISSING OR REFUSED………….m/r
YES…………………………………….1
NO……………………………………...0
R VOLUNTEERS: WAS PAID IN CASH…………………………………..9
DON’T KNOW…………………………d
MISSING OR REFUSED………….m/r
CATI/CAWI
A2=1 OR A2a=1
IF CAWI DO NOT SHOW DK OR REF
IF A7=1 FILL “DO”; ELSE FILL “DID”
FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

A9.	How many hours [do/did] you usually work in a week as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF]? Your best estimate is fine.

 |     |     | HOURS PER WEEK
(0-98)
99 OR MORE HOURS PER WEEK…99
DON’T KNOW…………………………..d
MISSING OR REFUSED……………m/r



|     |     | HOURS PER WEEK
(0-98)
99 OR MORE HOURS PER WEEK…99
DON’T KNOW…………………………..d
MISSING OR REFUSED……………m/r



CATI/CAWI
A2=1 OR A2a=1
IF CAWI DO NOT SHOW DK OR REF

FILL ”DO” IFA7=1, ELSE FILL ”DID”

FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

FILL “VARIES” / “ARE” / “MAKE” IF A7=1. ELSE FILL “VARIED” / “WERE” / “MADE”
A10.	Now thinking about your job as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF], how much [do/did] you get paid before taxes and deductions, at this job? Please include tips, commissions, and regular overtime.

CATI: PROBE: 	If your pay [varies/varied], please provide an average amount. If you [are/were] paid per job or for completing a particular task, please tell us the total amount you usually [make/made] per week or per month while doing this type of work.

CAWI: NOTE: 	If your pay [varies/varied], please provide an average amount. If you [are/were] paid per job or for completing a particular task, please tell us the total amount you usually [make/made] per week or per month while doing this type of work.

CATI: SOFTCHECK: IF THE RESPONDENT PROVIDES AN AMOUNT BUT DOES NOT PROVIDE A PAY PERIOD THEN PROBE: And, is that per hour, per week, per month, once every two weeks, twice a month, per year, day/daily, or something else?
CAWI: SOFTCHECK: IF THE RESPONDENT PROVIDES AN AMOUNT BUT DOES NOT PROVIDE A PAY PERIOD: Please select a pay period

CATI: SOFTCHECK: IF THE RESPONDENT SELECTS A PAY PERIOD BUT DOES NOT PROVIDE AN AMOUNT THEN PROBE: And how much did you get paid during this pay period? 
CAWI: SOFTCHECK: IF THE RESPONDENT SELECTS A PAY PERIOD BUT DOES NOT PROVIDE AN AMOUNT: Please enter an amount.
	ACCEPT MOST CONVENIENT PAY PERIOD.
	SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR, $400 DAY/DAILY, OR $8000 MONTH, SAY: “You responded with [A10 and A10 amount answer]. Is that correct?”
$ |     |     |     |,|     |     |     |.|     |     |	
AVERAGE
	
(0-999,999.99) AMOUNT
PER HOUR………………………1
PER WEEK………………………2
MONTH…………………………..3
ONCE EVERY TWO WEEKS….4
TWICE A MONTH……………….5
PER YEAR……………………….6
DAY/DAILY………………………7
OTHER (SPECIFY)…………….99
	(STRING (100))

DON’T KNOW…………………..d
MISSING OR REFUSED…….m/r

SOFT CHECK: IF A10 =99 AND SPECIFY FIELD IS BLANK, Please provide an answer in the Specify box, or click “Next” to move to the next question.


$ |     |     |     |,|     |     |     |.|     |     |
AVERAGE
	
(0-999,999.99) AMOUNT
PER HOUR………………………1
PER WEEK………………………2
MONTH…………………………..3
ONCE EVERY TWO WEEKS….4
TWICE A MONTH……………….5
PER YEAR……………………….6
DAY/DAILY………………………7
OTHER (SPECIFY)…………….99
	(STRING (100))

DON’T KNOW…………………..d
MISSING OR REFUSED…….m/r

SOFT CHECK: IF A10 =99 AND SPECIFY FIELD IS BLANK, Please provide an answer in the Specify box, or click “Next” to move to the next question.


CATI/CAWI
A2=1 OR A2a=1

IF CAWI DO NOT SHOW DK OR REF
FILL “ARE” IF A7=1, ELSE FILL “WERE” 
A11.	Which of the following benefits [are/were] available to you as [A5a JOB TITLE] for [A3/A4b EMPLOYER NAME/YOURSELF]? (CATI: READ EACH ITEM)…
CODE ALL THAT APPLY
Paid leave for holidays, vacation or illness?...............................................1
Health insurance or membership in an HMO or PPO plan?.......................2
Retirement benefits?........................3
None of the above……………………0
DON’T KNOW………………………….d
MISSING OR REFUSED..………….m/r

PROGRAMMER NOTE: Response option “0” is an exclusive response option.

CATI/CAWI
IF CAWI DO NOT SHOW DK OR REF

FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 

FILL “Have you been” IF A7=1, ELSE FILL “Were you”
A12. 	[Have you been/were you] promoted to a higher position with greater responsibility while working at this job?  
YES……………………………………...1
NO……………………………………….0
DON’T KNOW………………………….d
MISSING OR REFUSED…………..m/r
YES……………………………………...1
NO……………………………………….0
DON’T KNOW………………………….d
MISSING OR REFUSED…………..m/r
CATI/CAWI
ASK IF A3 = 1, A4B = 1, AND A7 = 1
FILL “[A5a JOB TITLE] AND [A3/A4b EMPLOYER NAME]” 
IF CAWI DO NOT SHOW DK OR REF
A13. 	How likely do you think it is that you will be promoted from [A5a JOB TITLE] at [A3/A4b EMPLOYER NAME],  in the next 12 months?
Very likely,……………………………..1
somewhat likely,………………………2
not very likely, or……………………..3
not likely at all?..................................4
DON'T KNOW…………………………..d
MISSING OR REFUSED…………...m/r




CATI/CAWI
A7=1
IF CAWI DO NOT SHOW DK OR REF
A14a. How much do you agree or disagree with the following statement?
This job offers opportunities that support my long-term career goals.

Strongly disagree……………………..1
Disagree………………………………..2
Agree……………………………………3
Strongly agree…………………………4
DON'T KNOW…………………………..d
MISSING OR REFUSED…………...m/r


CATI/CAWI
A7=1
IF CAWI DO NOT SHOW DK OR REF
A14b. How much do you agree or disagree with the following statement?
This job provides the income I need right now to support myself and my household.
Strongly disagree……………………..1
Disagree………………………………..2
Agree……………………………………3
Strongly agree…………………………4
DON'T KNOW…………………………..d
MISSING OR REFUSED…………...m/r



CATI/CAWI
A7=1
IF CAWI DO NOT SHOW DK OR REF
A14c. How much do you agree or disagree with the following statement?
This job offers a schedule that meets the needs of myself and my household.
Strongly disagree……………………..1
Disagree………………………………..2
Agree……………………………………3
Strongly agree…………………………4
DON'T KNOW…………………………..d
MISSING OR REFUSED…………...m/r





CATI/CAWI
A2 = 1
IF CAWI DO NOT SHOW DK OR REF
If number of CURRENT JOBS equals 1 fill “The Current job’, “job”
If number of CURRENT JOBS IS greater than 1 fill “All the current jobs’, “jobs”
A15.	Thinking about [the current job/all the current jobs] you told us about earlier, how satisfied are you with your current [job/jobs]? Would you say very satisfied, somewhat satisfied, somewhat unsatisfied, or very unsatisfied? 
										CODE ONE ONLY
VERY SATISFIED	1	
SOMEWHAT SATISFIED	2	
SOMEWHAT UNSATISFIED	3
VERY UNSATISFIED	4
DON’T KNOW	d	
MISSING OR REFUSED	m/r	


CATI/CAWI
A15 = 1, 2, 3, or 4
IF CAWI DO NOT SHOW DK OR REF
If number of CURRENT JOBS equals 1 fill “job”
If number of CURRENT JOBS IS greater than 1 fill “jobs”

A15a. You selected [fill A15 response]. Can you explain why you feel that way about your current [job/jobs]? 


(STRING 500)
DON’T KNOW	d
MISSING OR REFUSED………………………………………………………………………………….m/r

CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
A16.	Are you currently looking for a job?
YES	1
NO	0
DON’T KNOW	d
MISSING OR REFUSED	m/r	

CATI/CAWI
A16=0, d, M, r AND A2 = 0, D, M, R 
IF CAWI DO NOT SHOW DK OR REF
A16a.	How would you describe your current status? Are you . . .
	CATI INSTRUCTION: READ OUT
		CODE ALL THAT APPLY		
Temporarily laid off?	1
Retired?	2
In school or training?	3
Unable to work because you are caring for a family member?	4
Unable to work because of pregnancy?	5
Unable to work because of a sickness or a disability?	6
No longer looking for work because you could not find a job?	7
In another status not listed? (SPECIFY)	99
	 (STRING 250)
DON’T KNOW	d
MISSING OR REFUSED	m/r	

A17_Intro. 
Sometimes it can be challenging to make ends meet. These next questions ask about things you might have done in those situations.

A17.	In the past month, did you do any of the following because there wasn’t enough money?
	[PROGRAMMER: CATI – Gray question text from A17b-i.]

CODE ONE RESPONSE PER ROW


YES
NO
DK
REF
a. 	Cut the size of your meals or skip meals because you couldn’t afford enough food?	
1
0
d
m/r
b. 	Move in with other people, live in a shelter, or were homeless, even for a little while, because of financial problems?
1
0
d
m/r
c. 	Ask to borrow money from friends or family?
1
0
d
m/r
d. 	Go without a phone because you could not afford to pay the bill or buy extra cell phone data/minutes?
1
0
d
m/r
e. 	Took a payday loan or auto-title loan, or sold or pawned your belongings?	
1
0
d
m/r
f. 	Thought about going to the doctor, dentist or hospital, but decided not to because of the cost?
1
0
d
m/r
g. 	Go without prescription medicine because of the cost?
1
0
d
m/r
h. 	Go without paying utility bills?
1
0
d
m/r
i. 	Did not pay the full amount of the rent or mortgage because you could not afford it?
1
0
d
m/r




CATI/CAWI
all
IF CAWI DO NOT SHOW DK OR REF
The next few questions are about where you live and the type of housing you have right now.
A18.	CATI: Do you currently own your home or apartment or have a mortgage, rent it, pay some amount toward rent, live rent free with a friend or relative, or do you have some other arrangement?
	CAWI: Do you currently…
									CODE ONE ONLY 
OWN OR HAVE MORTGAGE	1
RENT	2 GO TO A18b
PAY SOME OF THE RENT……………………………………………………………………………....3 GO TO A18b
LIVE RENT FREE (SOMEONE ELSE RENTS/OWNS HOUSE OR APARTMENT)	4
LIVE IN SHELTER	5
LIVE ON STREETS	6
LIVE IN ABANDONED BUILDING/CAR	7
OTHER (SPECIFY)………………………………………………………………………………………..99 GO TO A18a
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A18=99
IF CAWI DO NOT SHOW DK OR REF
A18a. 	What is your other living arrangement? 
	__________________________
	(STRING 250)
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A18=2 or 3
IF CAWI DO NOT SHOW DK OR REF
A18b. 	Do you live in…
	CATI INSTRUCTION: READ OUT
public housing owned by a federal, state or local government agency, such as [STATE SPECIFIC PROGRAM] and/or housing where your rent is paid by the government, such as Section 8 vouchers,	1
	
private housing that you pay for without any help from the government	2
DON’T KNOW	d	
MISSING OR REFUSED	m/r
CATI/CAWI
all
IF CAWI DO NOT SHOW DK OR REF
	The next few questions are about whether you have a bank account and about any savings you might have.
A19. 	Do you currently have a checking or savings account at a bank or a credit union?
YES	1
NO	0
DON’T KNOW	d 
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
If A19 = 1
IF CAWI DO NOT SHOW DK OR REF
A20. 	About how much do you have in savings? Savings includes but is not limited to savings accounts, and covers any money you set aside for the future. Your best estimate is fine.
	
Less than $200	1
$200 to $500	2
$501 to $1000	3
$1001 to $2000	4
$2001 to $5000	5
$5001 to $10,000	6
More than $10,000	7
DON’T KNOW	d
MISSING OR REFUSED………………………………………………………………………………..m/r
The next set of questions is about sources of income and other supports that you and other members of your household may have received in the past month.

A21. 	In the past month, did you or anyone in your household receive any support from [STATE TANF CASH PROGRAM]?
									CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A21a
No…………………………………………………………………………………………………………....0 GO TO A22  
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A21=1
IF CAWI DO NOT SHOW DK OR REF 
A21a. 	Thinking about your entire household, about how much in total did your household receive from [STATE TANF CASH PROGRAM] in the past month?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A21b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A21b
CATI/CAWI
A21a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A21b. 	About how much did your entire household receive from [STATE TANF CASH PROGRAM]in the last month? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r
CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A22. 	In the past month, did you or anyone in your household receive any support from Supplemental Security Income, or SSI?
									CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A22a
No…………………………………………………………………………………………………………....0 GO TO A23  
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A22=1
IF CAWI DO NOT SHOW DK OR REF 
A22a. 	Thinking about your entire household, about how much in total did your household receive from SSI in the past month?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A22b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A22b
CATI/CAWI
A22a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A22b. 	About how much did your entire household receive from SSI in the last month? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r


A23. 	In the past month, did you or anyone in your household receive any support from Social Security Disability Insurance, or SSDI?
			CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A23a
No…………………………………………………………………………………………………………....0 GO TO A24  
DON’T KNOW D
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A23=1
IF CAWI DO NOT SHOW DK OR REF 
A23a. 	Thinking about your entire household, about how much in total did your household receive from SSDI in the past month?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A23b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A23b
CATI/CAWI
A23a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A23b. 	About how much did your entire household receive from SSDI in the last month? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A24. 	In the past month, did you or anyone in your household receive any support from food stamps or SNAP (also called [INSERT STATE NAME FOR PROGRAM], food assistance, or EBT)?
			CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A24a
No…………………………………………………………………………………………………………....0 GO TO A25 
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A24=1
IF CAWI DO NOT SHOW DK OR REF 
A24a. 	Thinking about your entire household, about how much in total did your household receive from food stamps or SNAP (also called [INSERT STATE NAME FOR PROGRAM], food assistance, or EBT) in the past month?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A24b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A24b
CATI/CAWI
A24a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A24b. 	About how much did your entire household receive from food stamps or SNAP (also called [INSERT STATE NAME FOR PROGRAM], food assistance, or EBT) in the last month? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A25. 	In the past month, did you or anyone in your household receive any support from WIC (Special Supplemental Nutrition Program for Women, Infants, and Children)?
			CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 
No…………………………………………………………………………………………………………....0 
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A26. 	In the past month, did you or anyone in your household receive any support from Unemployment Insurance?
									CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A26a
No…………………………………………………………………………………………………………....0 GO TO A27 
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r
CATI/CAWI
A26=1
IF CAWI DO NOT SHOW DK OR REF 
A26a. 	Thinking about your entire household, about how much in total did your household receive from Unemployment Insurance in the past month?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A26b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A26b
CATI/CAWI
A26a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A26b. 	About how much did your entire household receive from Unemployment Insurance in the last month? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A27. 	In the past month, did you or anyone in your household receive support for heating or cooling your home (also known as [INSERT STATE NAME FOR PROGRAM], Energy Assistance, LIHEAP, or HEAP)?
			CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A27a
No…………………………………………………………………………………………………………....0 GO TO A28
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A27=1
IF CAWI DO NOT SHOW DK OR REF 
A27a. 	Thinking about your entire household, about how much in total did your household receive for heating or cooling your home (also known as [INSERT STATE NAME FOR PROGRAM], Energy Assistance, LIHEAP, or HEAP) in the past month?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A27b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A27b

CATI/CAWI
A27a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A27b. 	About how much did your entire household receive for heating or cooling your home (also known as [INSERT STATE NAME FOR PROGRAM], Energy Assistance, LIHEAP, or HEAP) in the last month? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A28. 	In the past month, did you or anyone in your household receive child support payments?
									CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 GO TO A28a
No…………………………………………………………………………………………………………....0 GO TO A29 
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
A28=1
IF CAWI DO NOT SHOW DK OR REF 
A28a. 	Thinking about your entire household, about how much in total did your household receive in child support payments?
	If you are unsure of the exact amount, please provide your best estimate.
	PROGRAMMER: INSERT COMMA FIELD MASK
 Total amount                                                                                                               
(RANGE $0 – 9,999)

DON’T KNOW	d GO TO A28b
MISSING OR REFUSED……………………………………………………………………………….m/r GO TO A28b

CATI/CAWI
A28a=d or m/r
IF CAWI DO NOT SHOW DK OR REF 
A28b. 	About how much did your entire household receive in child support payments? Was it … 
Less than $100	1
$100 to $299	2
$300 to $499	3
$500 to $699	4
$700 to $999	5
$1000 or more	6
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r


CATI/CAWI
All
IF CAWI DO NOT SHOW DK OR REF 
A29. 	In the past month, did you or anyone in your household receive any housing choice vouchers, Section 8, project-based rental assistance, public housing, housing where an agency helps you pay the rent, or other housing assistance?
									CODE ONE ONLY 
Yes…………………………………………………………………………………………………………..1 
No…………………………………………………………………………………………………………....0 
DON’T KNOW	d
MISSING OR REFUSED……………………………………………………………………………….m/r

CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF 
PROGRAmMER NOTE: Grey out first paragraph of text for B-m
The next set of questions asks about things that may have affected your ability to work consistently. 

A30.	 	Now, please indicate which of the following has made it slightly hard, moderately hard, or very hard for you to work consistently over the past month. CATI: If something I say does not apply to you, you can say “I did not have that problem.” CAWI: If something does not apply to you, you can select “I did not have that problem”.
	Would you say that [FILL a-m] made it slightly hard, moderately hard, or very hard for you to work in the past month, or did you not have that problem?
								Select one per row

SLIGHTLY HARD
MODERATELY HARD
VERY HARD 
I DID NOT HAVE THAT PROBLEM
DK
REF
a. 	not having reliable transportation
1 
2 
3 
0 
d 
m/r 
b.	not having a driver’s license or a valid driver’s license
1 
2 
3 
0 
d 
m/r 
c.	not having stable housing
1 
2 
3 
0 
d 
m/r 
d.	a pregnancy or recent childbirth
1 
2 
3 
0 
d 
m/r 
e.	not having good enough care for a child or someone else in your household who needs care
1 
2 
3 
0 
d 
m/r 
f. 	not having the right clothes or tools for work
1 
2 
3 
0 
d 
m/r 
g.	not having the right skills or education for work
1 
2 
3 
0 
d 
m/r 
h.	having difficulty speaking or reading English
1 
2 
3 
0 
d 
m/r 
i.	having a criminal record
1 
2 
3 
0 
d 
m/r 







j. 	unsafe home or family environment
1 
2 
3 
0 
d 
m/r 











































CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
The following questions ask about your education and training experience.

B1.	What is the highest degree or year of school that you have completed?
Select one only
	Less than a high school diploma	1	
	GED	2
	Regular high school diploma (not a GED)	3	
	Some college	4
	A two-year degree (Associate’s degree)	5
	A four-year degree (Bachelor’s degree)	6
	A graduate or professional degree or higher	7
	DON’T KNOW	d	
	MISSING OR REFUSED	m/r		

CATI/CAWI
IF b1 = 1, 2, 3,  4, or 5
IF CAWI DO NOT SHOW DK OR REF
B1a.	Do you have a credential, vocational certificate, or license (for example, a cosmetology, paralegal, or electrical engineering program at a technical school or community college)?
YES	1
NO	0
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r

	
CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
B2.	Are you currently enrolled in any education or training programs? 
	This could include school, college, a GED course, ESL or adult education classes, trade school, vocational training, or any other type of formal education or training course.
Select one only
NOT currently enrolled in any training or educational program……………………………………….1
Currently enrolled in a training or education program………………………………………………….2
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r

CATI/CAWI
iF b2 = 2
IF CAWI DO NOT SHOW DK OR REF
B2a. 	What kind of education or training program(s) are you enrolled in? Is it…
	CATI INSTRUCTION: READ OUT
	Select all that apply
High school diploma	1
GED or General Education Development classes	2
ESL – English as a Second Language	3
Adult education classes for which you do not receive credits	4
A two-year degree program (for example, an Associate’s degree from a community college)
	5
A four-year degree program (for example, a Bachelor’s degree from a college or university)
	6
A credential, vocational certificate, or licensing program (for example, cosmetology; Certified Nursing Assistant (CNA); or a Commercial Driver’s License (CDL))	7
Apprenticeship program (for example, paid, hands-on training in a career like plumbing, IT support, or medical assisting, combined with classroom learning)	8
A graduate or professional program	9
Something else (SPECIFY:__________)…………………………………………………………………………………10
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r

CATI/CAWI
iF b2 = 2
IF CAWI DO NOT SHOW DK OR REF
IF more than 1 option selected in in B2a, fill “all” and “S” in “programs”.
B2b.	When do you expect to complete [all] the education or training program[s] you are currently enrolled in?
	­­­­­­­­­­­­­­­­­­­­ ______ MONTH 	 /	 ___________ YEAR
	(January-December)		(2026-2035)
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r
SOFT CHECK IF MONTH OR YEAR ARE MISSING: Please review your response before proceeding.

HARD CHECK IF DATE IS IN THE PAST: The date you provided has already passed. Please review your response before proceeding.

CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
B3. 	In the past 12 months, that is since [MONTH/YEAR], have you completed any education or training programs? This question applies to school, college, a GED course, trade school, vocational training, or any other type of formal education or training course that involves a diploma, degree, credential, or certificate at the end.
YES	1
NO	0
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r

CATI/CAWI
b3=1
IF CAWI DO NOT SHOW DK OR REF
B3a. 	What kind of education or training program did you complete? Is it…
	CATI INSTRUCTION: READ OUT
	Select all that apply
Regular high school	1
GED or General Education Development classes	2
ESL – English as a Second Language	3
Adult education classes for which you did not receive credits	4
A two-year degree program (for example, an Associate’s degree from a community college)
	5
A four-year degree program (for example, a Bachelor’s degree from a college or university)
	6
A credential, vocational certificate, or licensing program (for example, cosmetology; Certified Nursing Assistant (CNA); or a Commercial Driver’s License (CDL))	7
An apprenticeship program (for example, paid, hands-on training in a career like plumbing, IT support, or medical assisting, combined with classroom learning)	8
A graduate or professional program	9
Something else (SPECIFY:__________)…………………………………………………………………………………10
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r
CATI/CAWI
b3=1
if only one response selected in b3a: fill “a”/“the program”; if more than one response selected in b3a: fill “any”/”s”/“these programs” and display response option 2.
IF CAWI DO NOT SHOW DK OR REF
B3b. 	Did you receive [a/any] certificate[s], license[s], or diploma[s] from [the program/these programs]?
	Select one only
YES, I RECEIVED A CERTIFICATE, LICENSE, OR DIPLOMA	1
YES, I RECEIVED MORE THAN ONE CERTIFICATE, LICENSE, OR DIPLOMA	2
NO, I DID NOT RECEIVE A CERTIFICATE, LICENSE, OR DIPLOMA	0
DON’T KNOW………………………………………………………………………………………………d
MISSING OR REFUSED………………………………………………………………………………….m/r




CAWI/CATI
ALL
IF CAWI DO NOT SHOW DK OR REF
Next, we would like to ask a few questions about your background and family. 


CAWI/CATI
ALL
IF CAWI DO NOT SHOW DK OR REF
C1.	What is your current marital status—are you now married, separated, divorced, widowed, or have you never been married?
MARRIED	1
SEPARATED	2	
DIVORCED	3	
WIDOWED	4	
NEVER MARRIED	5	
DON’T KNOW	d	
MISSING OR REFUSED	m/r


CAWI/CATI
ALL
IF CAWI DO NOT SHOW DK OR REF
C2. 	Do you have a spouse or partner who lives in your household?
Please select “Yes” if you have a spouse or partner who usually lives with you, but is temporarily away right now (for example, because of military deployment, work, or school).
YES	1
NO…………………………………………………………………………………………… 0
DON’T KNOW	d	
MISSING OR REFUSED	m/r
CAWI/CATI
ALL
IF CAWI DO NOT SHOW DK OR REF
C3.	How many children under the age of 18 are living in your household? 
		Number of children under age 18  
 (0-15)
DON’T KNOW	d	
MISSING OR REFUSED	m/r
SOFT CHECK: IF C3 = M/R; Please provide a response before proceeding to the next question.


CAWI/CATI
iF C3 RESPONSE > 1
IF CAWI DO NOT SHOW DK OR REF
C3a.	Of the [FILL NUMBER OF CHILDREN FROM C3] children living in your house, how many are age 5 or younger?
  Number of children age 5 or under  
DON’T KNOW	d	
MISSING OR REFUSED	m/r
HARD CHECK: IF C3a > C3; The number of children age 5 or younger cannot be greater than the total number of children under age 18 in your household.
Please revise your answer to this question, or go back to the previous question and update the total number of children under age 18 living in your household.
CAWI/CATI
iF C3 RESPONSE = 1
IF CAWI DO NOT SHOW DK OR REF
C3b.	Is the child living in your house age 5 or younger?
YES	1
NO	0
DON’T KNOW	d	
MISSING OR REFUSED	m/r

CAWI/CATI
iF C3 RESPONSE > 0
IF CAWI DO NOT SHOW DK OR REF
If C3 = 1, Fill “Does the child”; if C3 > 1, Fill “Do the children”
If C3 = 1, do not show response option 2
if C3 > 1, fill “, all children are insured” for Response option 1 and “, none of the children are insured” for response option 0
C4.	[Does the child/Do the children] living in your household currently have health insurance coverage?
	Select one only
Yes[, all children are insured]…………………………………………………………………1
Some children are insured, some are not………………………………………………….2
No[, none of the children are insured]……………………………………………………….0
DON’T KNOW………………………………………………………………………………………………………….d	
MISSING OR REFUSED	m/r

CAWI/CATI
iF C4 = 1 or 2
IF CAWI DO NOT SHOW REF
If C3 = 1, Fill “does the child”; if C3 > 1, Fill “do the Children”
C4a.	What kind of health insurance coverage [does the child/do the children] living in your household have?
	Select all that apply
o Medical insurance provided by a private company (for example, Aetna, Blue Cross Blue Shield, United Health Care or Cobra)	1
o Medical insurance provided by a public program like [FILL STATE PROGRAMS] or the Children’s Health Insurance Program (CHIP)	2
m I don’t know	d
MISSING OR REFUSED	m/r







CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
	The following questions ask about your physical and emotional health, including how you’ve been feeling recently.
D1.	In general, would you say your physical health is: 
	CATI INSTRUCTION: READ OUT	CODE ONE ONLY
Excellent,	1	
Very good,	2	
Good,	3	
Fair, or	4	
Poor?	5	
DON’T KNOW	d	
MISSING OR REFUSED	m/r	


CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF 
D2.	 	Now, please indicate which of the following has made it slightly hard, moderately hard, or very hard for you to work consistently over the past month. CATI: If something I say does not apply to you, you can say “I did not have that problem.” CAWI: If something does not apply to you, you can select “I did not have that problem”.
								Select one per row

SLIGHTLY HARD
MODERATELY HARD
VERY HARD 
I DID NOT HAVE THAT PROBLEM
DK
REF
a.	Using alcohol or drugs
1 
2 
3 
0 
d 
m/r 
b. 	A chronic health condition or disability you have
1 
2 
3 
0 
d 
m/r 
c. 	A chronic health condition, disability, or behavioral problem that a child in your household has
1 
2 
3 
0 
d 
m/r 
d. 	A chronic health condition or disability that another adult in your household has
1 
2 
3 
0 
d 
m/r 


CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
D3. 	Do you currently have any kind of medical insurance for yourself? Your insurance may be provided by a private insurance company like Aetna, Blue Cross Blue Shield, United Health Care or Cobra, or provided by the government like [FILL STATE PROGRAMS].
Yes, I have medical insurance provided by a private company……………………………………….1 
Yes, I have insurance coverage provided by a government program………………………………..2	
No, I do not have any kind of medical insurance…………………………………………………….....0
DON’T KNOW	d	
MISSING OR REFUSED	m/r	


CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
D4.	In the past 12 months, that is since [Month/YEAR], have you received help for problems related to emotions, nerves, anger management, or mental health? This would include help dealing with depression, anxiety, or other conditions from a mental health center, a therapist, a psychologist or psychiatrist, social worker, counselor, doctor, or other provider. 
YES	1
NO	0
DON’T KNOW	d
REFUSED	r

CATI/CAWI
ALL
IF CAWI DO NOT SHOW DK OR REF
PROGRAMMER NOTE: Grey out CATI text for b-f
CATI: 	Now I will read you a list of statements about the last 30 days. Please tell me if the following applies to you all of the time, most of the time, some of the time, a little of the time, or none of the time.
D5. 		During the past month, about how often did you…1
Select one per row

ALL THE TIME
MOST OF THE TIME
SOME OF THE TIME
A LITTLE OF THE TIME 
NONE OF THE TIME
DK
REF
a. 	Feel so depressed that nothing could cheer you up?	
4 
3 
2 
1 
0 
d 
m/r 
b.	Feel hopeless?	
4 
3 
2 
1 
0 
d 
m/r 
c.	Feel restless or fidgety?	
4 
3 
2 
1 
0 
d 
m/r 
d.	Feel that everything was an effort?	
4 
3 
2 
1 
0 
d 
m/r 
e. 	Feel worthless?	
4 
3 
2 
1 
0 
d 
m/r 
f.	Feel nervous?	
4 
3 
2 
1 
0 
d 
m/r 

CATI/CAWI
ALL 
IF CAWI DO NOT SHOW DK OR REF
D6.	Taken all together, how would you say things are going these days? Would you say that you are… 
	CATI INSTRUCTION: READ OUT
Very happy,	1	
Pretty happy, or	2 	
Not too happy?	3 	
DON’T KNOW	d 	
MISSING OR REFUSED	m/r 	


E. updated contact information 
The following questions ask for your email address so the study team can send your $75 incentive as well as optional contact information to help us stay in touch with you. We may use this information to contact you in the future about potential study activities. 

CATI/CAWI
ALL 
IF CAWI DO NOT SHOW REF
E1.	What is your email address?
	We will use this email address to send you a digital gift card for completing today’s survey.  
 
Please check your inbox for an email from [email protected] over the next few days for more information about choosing your digital gift card.  
	
		EMAIL ADDRESS
(STRING 50)
MISSING OR REFUSED 	m/r	
	
HARD CHECK: IF E1 = M; This information will help us to contact you for future surveys and to send a digital gift card after you complete the survey. Please provide your best email address.


E1 = ANSWERED AND mode = cati
E1a.		
Please give me a moment to setup your payment. 
Por favor, deme un momento para mandarle su pago.
INSTRUCTION: 	click the link below to launch the rewards page.
[LAUNCH HYPERLINK]
Your payment is on the way right now. After our call, please check your inbox for an email from [CUSTOM]@mathematica-mpr.com. REPEAT EMAIL IF NEEDED.

PROGRAMMER set box e1A.
set M_FIRSTNAME AND M_LASTNAME from preloaded samplemembername.

CATI/CAWI
IF ADDRESS1 in Sample Preload file 
IF CAWI DO NOT SHOW REF
E2.	Please confirm your current address:
	[ADDRESS 1]
	Is that correct? 
Yes	…………………………………………………………………………………………….1 
No……………………………………………………………………………………………………………………………0
MISSING OR REFUSED 	m/r	



CATI/CAWI
IF ADDRESS1 not in SAMPLE preload file, or E2 = 0 or m/r
IF CAWI DO NOT SHOW REF
E2a.	What is your current address?
Street Address 1:	(STRING 100)
Street Address 2:	(STRING 100)
City:	(STRING 100)
State:	(STRING 2)
Zip: 	(STRING 5)

MISSING OR REFUSED 	m/r	
SOFT CHECK: IF RESPONDENT DOES NOT ENTER IN Street Address 1, City, State, or Zip; This information will help us to contact you for future surveys. Please provide your full address.
SOFT CHECK: IF RESPONDENT DOES NOT ENTER IN Street Address 2; Having your full address will help us to contact you for future surveys. If you have an apartment, unit, room, or floor number, please include it in the Street Address 2 field. If you do not have an apartment, unit, room, or floor number, please move on to the next question.



CATI/CAWI
IF PHONE1 IN SAMPLE PRELOAD FILE
IF CAWI DO NOT SHOW REF
E3.	Is [FILL PHONE1] still the best phone number to reach you at?
Yes	…………………………………………………………………………………………….1      E4a
No……………………………………………………………………………………………………………………………0      E3a
MISSING OR REFUSED 	m/r	E3a

SOFT CHECK: IF E3 = M; This information will help us to contact you for future surveys. Please provide a response.

CATI/CAWI
IF PHONE1 not in SAMPLE preload file, or E3 = 0 or m/r
IF CAWI DO NOT SHOW REF
E3a.*	What is your current telephone number?
	PHONE NUMBER
(201-989)  (200-999)   (0000-9999) 
I don’t have a phone	0	 E4a
MISSING OR REFUSED 	m/r	 E4a
SOFT CHECK: IF E3a = M; This information will help us to contact you for future surveys. Please provide your best phone number.


CATI/CAWI
IF E3=1 or E3a = RESPONSE
IF CAWI DO NOT SHOW REF
E3b.	Is it okay for us to text you at this number? Message and data rates may apply.
Yes	…………………………………………………………………………………………….1 
No……………………………………………………………………………………………………………………………0 
MISSING OR REFUSED	m/r	


CATI/CAWI
if E3a = Response
IF CAWI DO NOT SHOW REF
E4a.*	What is another phone number where you can be reached?
	PHONE NUMBER
(201-989)  (200-999)   (0000-9999)
I don’t have another phone number	0	E5
MISSING OR REFUSED 	m/r	E5

CATI/CAWI
IF E4A = RESPONSE
IF CAWI DO NOT SHOW REF
E4b.	Is it okay for us to text you at this number? Message and data rates may apply.
Yes	……………………………………………………………………………………………1     
No……………………………………………………………………………………………..0
MISSING OR REFUSED	m/r


CATI/CAWI
ALL
IF CAWI DO NOT SHOW REF
E5. 	In case Mathematica has trouble reaching you, we would like to have the names of three people who would most likely know where you are or who you keep in close contact with, such as a grandmother or grandfather, other relative, or friend. Mathematica will not contact these people for any other reason. 
	What is the full name of the first person we should contact?

		FIRST NAME
(STRING 50)

		MIDDLE INITIAL
(STRING 1)

		LAST NAME
(STRING 50)

MISSING OR REFUSED 	m/r	THANKS/END2
SOFT CHECK: IF E5 = M; This information will help us contact you for future surveys. Please provide the name of someone you keep in close contact with who we can contact if we have trouble reaching you to complete your next survey.

CATI/CAWI
IF E5 = RESPONSE
IF CAWI DO NOT SHOW REF
E5a.	What is their address?
Street Address 1:	(STRING 100)
Street Address 2:	(STRING 100)
City:	(STRING 100)
State:	(STRING 2)
Zip: 	(STRING 5)

MISSING OR REFUSED 	m/r	
CATI/CAWI
IF E5 = RESPONSE
IF CAWI DO NOT SHOW REF
E5b.	What is their relationship to you?
Select one only
SPOUSE/PARTNER	1
MOTHER	2
FATHER	3
SISTER/BROTHER	4
GRANDMOTHER/GRANDFATHER	5
SON/DAUGHTER	6
FRIEND	7
OTHER (SPECIFY)	99
Specify	(STRING 50)
MISSING OR REFUSED	m/r

IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE



CATI/CAWI
IF E5 = RESPONSE
IF CAWI DO NOT SHOW REF
E5c.	What is their telephone number?
	TELEPHONE NUMBER

(201-989)  (200-999)   (0000-9999)

MISSING OR REFUSED	m/r	

CATI/CAWI
IF E5c = RESPONSE
IF CAWI DO NOT SHOW REF
E5d.	Do they have another phone number where they can be reached?
	PHONE NUMBER
(201-989)  (200-999)   (0000-9999)

No……………………………………………………………………………………………...0      
MISSING OR REFUSED	m/r	

CATI/CAWI
IF E5 = RESPONSE
IF CAWI DO NOT SHOW REF
E5e.	What is their email address?

		EMAIL ADDRESS
(STRING 50)
MISSING OR REFUSED	m/r	E6

SECOND CONTACT
CATI/CAWI
IF E5 = RESPONSE
IF CAWI DO NOT SHOW REF
E6.	What is the full name of the second person we should contact?

		FIRST NAME
(STRING 50)

		MIDDLE INITIAL
(STRING 1)

		LAST NAME
(STRING 50)

MISSING OR REFUSED	m/r	END2
CATI/CAWI
IF E6 = RESPONSE
IF CAWI DO NOT SHOW REF
E6a.	What is their address?
Street Address 1:	(STRING 100)
Street Address 2:	(STRING 100)
City:	(STRING 100)
State:	(STRING 2)
Zip: 	(STRING 5)

MISSING OR REFUSED	m/r	

CATI/CAWI
IF E6 = RESPONSE
IF CAWI DO NOT SHOW REF
E6b.	What is their relationship to you?
Select one only
SPOUSE/PARTNER	1
MOTHER	2
FATHER	3
SISTER/BROTHER	4
GRANDMOTHER/GRANDFATHER	5
SON/DAUGHTER	6
FRIEND	7
OTHER (SPECIFY)	99
Specify	(STRING 50)
MISSING OR REFUSED	m/r

IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE

CATI/CAWI
IF E6 = RESPONSE
IF CAWI DO NOT SHOW REF
E6c.	What is their telephone number?
	TELEPHONE NUMBER

(201-989)  (200-999)   (0000-9999)

MISSING OR REFUSED	m/r	



CATI/CAWI
IF E6c = RESPONSE
IF CAWI DO NOT SHOW REF
E6d.	Do they have another phone number where they can be reached?
	PHONE NUMBER
(201-989)  (200-999)   (0000-9999)

No ……	0      
MISSING OR REFUSED	m/r	

CATI/CAWI
IF E6 = RESPONSE
IF CAWI DO NOT SHOW REF
E6e.	What is their email address?

		EMAIL ADDRESS
(STRING 50)
MISSING OR REFUSED…………………………………………………………………..m/r     E7

THIRD CONTACT
CATI/CAWI
IF E6 = RESPONSE
IF CAWI DO NOT SHOW REF
E7.		What is the full name of the third person we should contact?

		FIRST NAME
(STRING 50)

		MIDDLE INITIAL
(STRING 1)

		LAST NAME
(STRING 50)
MISSING OR REFUSED	m/r	END2
CATI/CAWI
IF E7 = RESPONSE
IF CAWI DO NOT SHOW REF
E7a.	What is their address?
Street Address 1:	(STRING 100)
Street Address 2:	(STRING 100)
City:	(STRING 100)
State:	(STRING 2)
Zip: 	(STRING 5)
MISSING OR REFUSED	m/r	

CATI/CAWI
IF E7 = RESPONSE 
IF CAWI DO NOT SHOW REF
E7b.	What is their relationship to you?
Select one only
SPOUSE/PARTNER	1
MOTHER	2
FATHER	3
SISTER/BROTHER	4
GRANDMOTHER/GRANDFATHER	5
SON/DAUGHTER	6
FRIEND	7
OTHER (SPECIFY)	99
Specify	(STRING 50)
MISSING OR REFUSED	m/r

IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE

CATI/CAWI
IF E7 = RESPONSE
IF CAWI DO NOT SHOW REF
E7c.	What is their telephone number?
	TELEPHONE NUMBER

(201-989)  (200-999)   (0000-9999)

MISSING OR REFUSED	m/r



CATI/CAWI
IF E7c= RESPONSE
IF CAWI DO NOT SHOW REF
E7d.	Do they have another phone number where they can be reached?
	PHONE NUMBER
(201-989)  (200-999)   (0000-9999)

No …............................................................................................................................0      
             MISSING OR REFUSED	m/r	

CATI/CAWI
IF E7 = RESPONSE
IF CAWI DO NOT SHOW REF
E7e.	What is their email address?

		EMAIL ADDRESS
(STRING 50)
MISSING OR REFUSED	m/r	END2

f. SUBMIT FORM
CONSENT = 0 AND MODE = WEB

END1. 	Thank you for your time. If you change your mind and would like to take the survey and participate in the study, please email us at [email protected] or call us at 833-678-3825. You may close this tab in your browser.

MODE = WEB AND DISP = 13 (COMPLETE)

END2. 	This completes the survey, thank you! Your responses are important! As a token of our appreciation, a $75.00 gift card will be emailed to you within two business days. If you have any questions or issues with redeeming your gift card, please email us at [email protected] or call us at 833-678-3825.
You may close this tab in your browser.