Not Assigned Family Income

Page 1 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.010_00.000 Instrument Variable Name: FINCINT QuestionnaireFileName: Family

QuestionText: * Read the following.

The next questions are about [fill1: your total/your total family] income in [fill2: last calendar year in 4-digit format] BEFORE TAXES.

Income is important in analyzing the health information we collect. For example, with this information, we can learn whether persons in one

income group use certain types of medical services more or less often than those in another group. Please be assured that, like all other

information you have provided, these answers will be kept strictly confidential.

1 Enter 1 to continue

UniverseText: All families

SkipInstructions: goto FSAL

Question ID: FIN.030_00.000 Instrument Variable Name: FSAL QuestionnaireFileName: Family

QuestionText: ? [F1]

[fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from wages and salaries?]

[fill3: When answering these questions, please remember that by "combined family income," I mean your income PLUS the

income of all family members living in this household (including cohabiting partners, and armed forces members living at

home).

Did any family members 18 and older, that is * Read names

(fill roster of people ge 18 years of age)

receive income in [fill2: last calendar year in 4-digit format] from...wages and salaries?]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with one or more persons 18 years of age or older

SkipInstructions: <1> [if a single-person family, store the person number in PSAL and goto FSEINC; else, goto PSAL]

<2,R,D> [goto FSEINC]

Page 2 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.040_00.000 Instrument Variable Name: PSAL QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons 18 years of age or older and at least one received income from wages and

salaries in the last calendar year

SkipInstructions: goto FSEINC

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.050_00.000 Instrument Variable Name: FSEINC QuestionnaireFileName: Family

QuestionText: [fill1: Did you receive income in [fill2: last calendar year in 4-digit format] from self-employment including business and

farm income?/ Did ALIAS receive income in [fill2: last calendar year in 4-digit format] from self-employment including

business and farm income?/Did any family members 18 and older, that is

*Read names

(fill roster of people ge 18 years of age)

receive income in [fill2: last calendar year in 4-digit format] from...self-employment including business and farm income?]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with one or more persons 18 years of age or older

SkipInstructions: <1> [if a single-person family, store the person number in PSEINC and goto FSSRR; else, goto PSEINC]

<2,R,D> [goto FSSRR]

Page 3 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.060_00.000 Instrument Variable Name: PSEINC QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons 18 years of age or older and at least one received income from self-employment

in the last calendar year

SkipInstructions: goto FSSRR

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.070_00.000 Instrument Variable Name: FSSRR QuestionnaireFileName: Family

QuestionText: ? [F1]

Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from Social

Security or Railroad Retirement?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PSSRR and goto FSSRRD; else, goto PSSRR]

<2,R,D> [goto FPENS]

Question ID: FIN.080_00.000 Instrument Variable Name: PSSRR QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received income from Social Security or Railroad Retirement

in the last calendar year

SkipInstructions: goto FSSRRD

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 4 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.082_00.000 Instrument Variable Name: FSSRRD QuestionnaireFileName: Family

QuestionText: Was [fill: your/any family member's *Read names

(fill roster of all persons selected at PSSRR and AGE LE 64)]

Social Security or Railroad Retirement income received as a disability benefit?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with persons less than 65 years of age who received Social Security or Railroad Retirement income in

the last calendar year

SkipInstructions: <1> [if only one person less than 65 years of age received Social Security or Railroad Retirement income, fill the

person number in PSSRRDB and goto PSSRRD; else, goto PSSRRDB]

<2,R,D> [goto FPENS]

Question ID: FIN.084_00.000 Instrument Variable Name: PSSRRDB QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who received Social Security or Railroad Retirement as a disability benefit?

(Anyone else?)

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons less than 65 years of age who received income from Social Security or

Railroad Retirement in the last calendar year and at least one received the income as a disability benefit

SkipInstructions: goto PSSRRD

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.086_00.000 Instrument Variable Name: PSSRRD QuestionnaireFileName: Family

QuestionText: Did [fill1: you/ALIAS] receive this benefit because [fill2: you are/he is/she is] disabled?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All persons less than 65 years of age who received Social Security or Railroad Retirement income as a disability

benefit in the last calendar year

SkipInstructions: repeat for all eligible persons, then goto FPENS

Page 5 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.090_00.000 Instrument Variable Name: FPENS QuestionnaireFileName: Family

QuestionText: Did [fill1: you/any family members living here] receive income in [fill2: last calendar year in 4-digit format] from any

disability pension [fill3: other than Social Security or Railroad Retirement]?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PPENS and goto FOPENS; else, goto PPENS]

<2,R,D> [goto FOPENS]

Question ID: FIN.100_00.000 Instrument Variable Name: PPENS QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

*Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received income from a disability pension (other than Social

Security or Railroad Retirement) in the last calendar year

SkipInstructions: goto FOPENS

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.102_00.000 Instrument Variable Name: FOPENS QuestionnaireFileName: Family

QuestionText: Did [fill1: you/any family members living here] receive income from any retirement or survivor pension other [fill2: than

Social Security or Railroad Retirement/than a disability pension/than Social Security, Railroad Retirement, or a disability

pension]?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in POPENS and goto FSSI; else, goto POPENS]

<2,R,D> [goto FSSI]

Page 6 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.104_00.000 Instrument Variable Name: POPENS QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received income from a retirement or survivor pension in the

last calendar year

SkipInstructions: goto FSSI

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.110_00.000 Instrument Variable Name: FSSI QuestionnaireFileName: Family

QuestionText: ? [F1]

Did [fill: you/any family members] receive Supplemental Security Income (SSI)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, fill the person number in PSSI and goto PSSID; else, goto PSSI]

<2,R,D> [goto FTANF]

Question ID: FIN.120_00.000 Instrument Variable Name: PSSI QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who in the family received this?

(Anyone else?)

*Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received Supplemental Security Income (SSI) in the last

calendar year

SkipInstructions: goto PSSID

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 7 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.122_00.000 Instrument Variable Name: PSSID QuestionnaireFileName: Family

QuestionText: Did [fill1: you/ALIAS] receive SSI because [fill2: you have/he has/she has] a disability?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All persons who received SSI in the last calendar year

SkipInstructions: repeat for all eligible persons, then goto FTANF

Question ID: FIN.150_00.000 Instrument Variable Name: FTANF QuestionnaireFileName: Family

QuestionText: *(book) F21 ? [F1]

At any time during [fill1: last calendar year in 4-digit format], even for one month, did [fill2: you/any family members living

here] receive any CASH assistance from a state or county welfare program, such as (* fill specific program name)?

* Please do not include food stamps, SSI, energy assistance, or medical assistance payments.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PTANF and goto FOWBEN; else, goto PTANF]

<2,R,D> [goto FOWBEN]

Question ID: FIN.160_00.000 Instrument Variable Name: PTANF QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who in the family received this?

(Anyone else?)

*Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received cash assistance from a state or county welfare program

in the last calendar year

SkipInstructions: goto FOWBEN

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 8 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.164_00.000 Instrument Variable Name: FOWBEN QuestionnaireFileName: Family

QuestionText: At any time during [fill1: last calendar year in 4-digit format], did [fill2: you/any family members living here] receive any

OTHER kind of welfare assistance such as help with getting a job, placement in education or job training programs, or help

with transportation or child care?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in POWBEN and goto FINTRST; else, goto POWBEN]

<2,R,D> [goto FINTRST]

Question ID: FIN.166_00.000 Instrument Variable Name: POWBEN QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received income from some "other" kind of welfare assistance

in the last calendar year

SkipInstructions: goto FINTRST

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.170_00.000 Instrument Variable Name: FINTRST QuestionnaireFileName: Family

QuestionText: Did [fill: you/any family members living here] receive income from interest bearing checking accounts, savings accounts,

IRAs or certificates of deposit, money market funds, treasury notes, bonds, or any other investments that earn interest?

* Do not include dividends

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PINTRST and goto FDIVD; else, goto PINTRST]

<2,R,D> [goto FDIVD]

Page 9 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.180_00.000 Instrument Variable Name: PINTRST QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received interest income in the last calendar year

SkipInstructions: goto FDIVD

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.190_00.000 Instrument Variable Name: FDIVD QuestionnaireFileName: Family

QuestionText: Did [fill: you/any family members living here] receive income from dividends from stocks or mutual funds, or net rental

income from property, royalties, estates or trusts?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PDIVD and goto FCHLDSP; else, goto PDIVD]

<2,R,D> [goto FCHLDSP]

Question ID: FIN.200_00.000 Instrument Variable Name: PDIVD QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s). Separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received dividend or net rental income in the last calendar year

SkipInstructions: goto FCHLDSP

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 10 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.210_00.000 Instrument Variable Name: FCHLDSP QuestionnaireFileName: Family

QuestionText: ? [F1]

Did [fill: you/any family members living here] receive income from child support?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PCHLDSP and goto FINCOT; else, goto PCHLDSP]

<2,R,D> [goto FINCOT]

Question ID: FIN.220_00.000 Instrument Variable Name: PCHLDSP QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate which child in the family this is for. If that child is no longer residing with this family, enter line number of

custodial parent.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least received income from child support in the last calendar year

SkipInstructions: goto FINCOT

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.230_00.000 Instrument Variable Name: FINCOT QuestionnaireFileName: Family

QuestionText: Did [fill: you/any family members living here] receive income from any other source such as alimony, contributions from

family/others, VA payments, Worker’s Compensation, or unemployment compensation?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PINCOT and goto FINCTOT; else, goto PINCOT]

<2,R,D> [goto FINCTOT]

Page 11 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.240_00.000 Instrument Variable Name: PINCOT QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who received this?

(Anyone else?)

* Indicate each family member with this income

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one received some "other" source of income in the last calendar year

SkipInstructions: goto FINCTOT

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.250_00.000 Instrument Variable Name: FINCTOT QuestionnaireFileName: Family

QuestionText: [fill1: When answering this next question, please remember to include your income PLUS the income of all family members living in this

household.]

What is your best estimate of [fill2: your total income/the total income of all family Members] from all sources, before taxes, in [fill3: last

calendar year in 4 digit format]?

* Enter ‘999,995’ if the reported income is greater than $999,995.

000000-999994 0-$999,994

999995 $999,995+

999997 Refused

999999 Don't know

UniverseText: All families

SkipInstructions: <0-999995> [goto HOUSEOWN]

<R,D> [goto FINC50]

Page 12 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.255_00.000 Instrument Variable Name: FINC50 QuestionnaireFileName: Family

QuestionText: Was your total [fill: /family] income from all sources less than $50,000 or $50,000 or more?

1 $50,000 or more

2 Less than $50,000

7 Refused

9 Don't know

UniverseText: All families where "don't know" or "refused" was the answer for total family income (FAMINC)

SkipInstructions: <1> [goto FINC35 ]

<2> [goto FINC100

<R,D> [goto HOUSEOWN]

Question ID: FIN.260_00.000 Instrument Variable Name: FINC35 QuestionnaireFileName: Family

QuestionText: Was your total [fill: /family] income from all sources less than $35,000 or $35,000 or more?

1 Less than $35,000

2 $35,000 or more

7 Refused

9 Don't know

UniverseText: All families where "less than $50,000" was the answer for FINC50

SkipInstructions: <1> [goto FINCPOV ]

<2,R,D> [goto HOUSEOWN]

Question ID: FIN.265_00.000 Instrument Variable Name: FINCPOV QuestionnaireFileName: Family

QuestionText: Was your total [fill1: /family] income from all sources less than [fill2: fill based on poverty threshold] or [fill2: fill based on poverty threshold] or more?

1 Less than [fill2: fill based on poverty threshold]

2 [fill2: fill based on poverty threshold] or more

7 Refused

9 Don't know

UniverseText: All families where "less than $35,000" was the answer for FINC35

SkipInstructions: <1,2,R,D> [goto HOUSEOWN]

Page 13 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.270_00.000 Instrument Variable Name: FINC100 QuestionnaireFileName: Family

QuestionText: Was your total [fill1: /family] income from all sources less than $100,000 or $100,000 or more?

1 Less than $100,000

2 $100,000 or more

7 Refused

9 Don't know

UniverseText: All families where "$50,000 or more" was the answer for FINC50

SkipInstructions: <1> [goto FINC75]

<2,R,D> [goto HOUSEOWN]

Question ID: FIN.275_00.000 Instrument Variable Name: FINC75 QuestionnaireFileName: Family

QuestionText: Was your total [fill1: /family] income from all sources less than $75,000 or $75,000 or more?

1 Less than $75,000

2 $75,000 or more

7 Refused

9 Don't know

UniverseText: All families where "$50,000 or more" was the answer for FINC50

SkipInstructions: <1,2,R,D> [goto HOUSEOWN]

Page 14 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.280_00.000 Instrument Variable Name: HOUSEOWN QuestionnaireFileName: Family

QuestionText: Is this house/apartment owned or being bought, rented, or occupied by some other arrangement by you [fill: /or someone in

your family]?

1 Owned or being bought

2 Rented

3 Other arrangement

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1,3,R,D> [goto FSSAPL]

<2> [goto FGAH]

Question ID: FIN.282_00.000 Instrument Variable Name: FGAH QuestionnaireFileName: Family

QuestionText: ? [F1]

[fill: Are you/Is anyone in your family] paying lower rent because the Federal, State, or local government is paying part of

the cost?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families that rent their house/apartment

SkipInstructions: goto FSSAPL

Question ID: FIN.300_00.000 Instrument Variable Name: FSSAPL QuestionnaireFileName: Family

QuestionText: [fill: Have you EVER applied for Supplemental Security Income or SSI, even if the claim was denied?/Have any family

members living here EVER applied for Supplemental Security Income (SSI)? This includes people who applied for benefits,

even if the claim was denied.]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PSSAPL and goto FSDAPL; else, goto PSSAPL]

<2,R,D> [goto FSDAPL]

Page 15 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.310_00.000 Instrument Variable Name: PSSAPL QuestionnaireFileName: Family

QuestionText: *Ask or verify. Enter applicable line number(s), separate with a comma.

Who in the family applied for it?

(Anyone else?)

* Indicate each family member who applied for SSI benefits.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one applied for SSI

SkipInstructions: goto FSDAPL

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Question ID: FIN.330_00.000 Instrument Variable Name: FSDAPL QuestionnaireFileName: Family

QuestionText: [fill: Have you EVER APPLIED for disability benefits from Social Security even if the claim was denied?/Have any family

members living here EVER applied for disability benefits from Social Security? This includes people who applied for

benefits, even if the claim was denied.]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All Families

SkipInstructions: <1> [if a single-person family, store the person number in PSDAPL and goto TANFMYR; else, goto PSDAPL]

<2,R,D> [goto TANFMYR]

Question ID: FIN.340_00.000 Instrument Variable Name: PSDAPL QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who in the family applied for it?

(Anyone else?)

* Indicate each family member who applied for Social Security Disability benefits.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one applied for Social Security Disability benefits

SkipInstructions: goto TANFMYR

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 16 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.350_00.000 Instrument Variable Name: TANFMYR QuestionnaireFileName: Family

QuestionText: ? [F1]

Earlier I recorded that [fill1: you/ALIAS] received cash assistance from programs such as welfare or public assistance in [fill2:

last calendar year in 4-digit format]. During [fill2: last calendar year in 4-digit format], about how many months did [fill1:

you/ALIAS] receive this assistance?

*Enter '1' if less than one month.

01-12 1-12 months

97 Refused

99 Don't know

UniverseText: All persons who received cash assistance from public assistance programs in the last calendar year

SkipInstructions: repeat for all eligible persons, then goto FFSTIP

Question ID: FIN.360_00.000 Instrument Variable Name: FFSTIP QuestionnaireFileName: Family

QuestionText: ? [F1]

[fill1: Were you/Was anyone in the family] authorized to receive food stamps (which includes a food stamp card or voucher,

or cash grants from the state for food) at anytime during [fill2: last calendar year in 4-digit format]?

*An authorized person is one whose name appears on a certification card.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families

SkipInstructions: <1> [if a single-person family, store the person number in PFSTP and goto FSTPMYR; else, goto PFSTP]

<2,R,D> [goto FINWIC]

Question ID: FIN.370_00.000 Instrument Variable Name: PFSTP QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who was authorized to receive food stamps?

* Indicate family members who were authorized to receive food stamps.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons and at least one was authorized to receive food stamps in the last calendar year

SkipInstructions: goto FSTPMYR

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.

Page 17 of 17

2007 NHIS Questionnaire - Family

Family Income

Document Version Date: 12-Jul-06

Question ID: FIN.380_00.000 Instrument Variable Name: FSTPMYR QuestionnaireFileName: Family

QuestionText: During [fill1: last calendar year in 4-digit format], about how many months [fill2: were you/was ALIAS] authorized to

receive food stamps?

* Enter '1' if less than 1 month

01-12 1-12 months

97 Refused

99 Don't know

UniverseText: All persons authorized to receive food stamps in the last calendar year

SkipInstructions: goto FINWIC

Question ID: FIN.384_00.000 Instrument Variable Name: FINWIC QuestionnaireFileName: Family

QuestionText: ? [F1]

At any time during [fill1: last calendar year in 4-digit format] did [fill2: you/anyone in your family] receive benefits from the

WIC program, that is, the Women, Infants and Children program?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with females 12-55 years of age or children 0-5 years of age

SkipInstructions: <1> [if a single-person family, store the person number in PWIC and goto FMSSN; else, goto PWIC]

<2,R,D> [goto FMSSN]

Question ID: FIN.385_00.000 Instrument Variable Name: PWIC QuestionnaireFileName: Family

QuestionText: * Ask or verify. Enter applicable line number(s), separate with commas.

Who in the family received this?

(Anyone else?)

* Indicate family members who were authorized to receive WIC benefits.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All families with two or more persons who are female and between the ages of 12-55 or children between the ages of

0-5, and at least one received WIC benefits in the last calendar year

SkipInstructions: goto FMSSN

NOTE: In the instrument, interviewers enter the line numbers associated with the persons reported by the respondent.

As shown above, each eligible person receives an edited response code in subsequent data processing.