Download:
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pdfItems Booklet for
Specification:
Section: Back
Mark One Only
INTRO_D
[fill TEMP2]
Some of the questions have already been answered.
Let me see where we should begin.
Item to begin: [fill loq]
PRESS ENTER TO CONTINUE
@
Mark One Only
INTRO
"Hello. I'm ... from the United States Census Bureau.
Here is my identification card (show ID card). We are
conducting a survey on the economic situation of people who
live in the United States. I have some questions to ask you."
o Ask respondent if he/she received advance letter;
if not, give letter to respondent before proceeding.
o Is the respondent ready to complete the interview?
(1) Inconvenient time. Try again later
(2) Reluctant Respondent - Hold for refusal followup
(3) Noninterview
(P) Proceed
@
Mark One Only
TYPEABC
ENTER NONINTERVIEW CODE
TYPE A
TYPE B
(1) No one home
(10) Vacant regular (REG)
(2) Temporarily absent
(11) Vacant - storage of household furniture
(3) Refused
(12) Unfit or to be demolished
(4) Unable to locate
(13) Under construction, not ready
(5) Language problem
(14) Converted to temp. business or storage
(6) Other Type A
(15) Unoccupied tent or trailer site
(16) Permit granted, construction not started
TYPE C
(17) Temp. occupied by persons with URE
(21) Demolished
(18) Occupied by persons under 15 years of age
(22) House or trailer moved (19) Other Type B
(23) Address outside segment
(24) Converted to permanent business or storage
(25) Merged
(26) Condemned
(27) Unused Serial #/Listing sheet line
(28) Removed during subsampling
(29) Unit already had a chance of selection
(30) Other Type C
@
Mark One Only
SPCIFY
Specify the kind of "Other" Noninterview
@
Wednesday, August 27, 2003
Page 1 of 340
Survey:
Section: Section: Front
Items Booklet
Mark All That Apply
NI_RACE
Enter your best guess as to the Race of the reference person.
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) White
(2) Black/African American
(3) American Indian or Alaska Native
(4) Asian
(5) Native Hawaiian or Other Pacific Islander
(6) Other
(D) Don't Know
@
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NI_SEX
Enter your best guess as to the sex of the reference person.
[fill ENTERFIL]
(1) Male
(2) Female
@
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NI_SIZE
ASK OR VERIFY WITH SOME KNOWLEDGEABLE INDIVIDUAL
Enter your best guess as to the total number of people in the household.
Count all children and adults.
[fill ENTERFIL]
@
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NI_TENUR
ASK OR VERIFY WITH A KNOWLEDGEABLE INDIVIDUAL,
OR ENTER YOUR BEST GUESS.
Are the living quarters -(1) Owned or being bought by the occupant(s)?
(2) Rented?
(3) Or occupied without payment of rent?
@
Mark One Only
TYPEADIS
YOU MUST DISCUSS THIS CASE WITH YOUR SUPERVISOR
BEFORE TRANSMITTING IT AS A TYPE A NONINTERVIEW.
PRESS ENTER TO CONTINUE
@
Page 2 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Front
Mark One Only
STATEREF
REFERENCE: PERMISSIBLE STATE CODES
AL=Alabama
IA=Iowa
NJ=New Jersey VT=Vermont
AK=Alaska
KS=Kansas
NM=New Mexico VA=Virginia
AZ=Arizona
KY=Kentucky
NY=New York
WA=Washington
AR=Arkansas
LA=Louisiana
NC=N. Carolina WV=W.Virginia
CA=California ME=Maine
ND=N. Dakota
WI=Wisconsin
CO=Colorado
MD=Maryland
OH=Ohio
WY=Wyoming
CT=Connecticut MA=Massachusetts OK=Oklahoma
DE=Delaware
MI=Michigan
OR=Oregon
DC=Dist. Colum. MN=Minnesota
PA=Pennsylvania
FL=Florida
MS=Mississippi RI=Rhode Island
GA=Georgia
MO=Missouri
SC=S. Carolina
HI=Hawaii
MT=Montana
SD=S. Dakota
ID=Idaho
NE=Nebraska
TN=Tennessee
IL=Illinois
NV=Nevada
TX=Texas
IN=Indiana
NH=New Hampshire UT=Utah
PRESS "ENTER" TO CONTINUE
@
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HHCOMP
[reference] [display HH_COMP]
PRESS "ENTER" TO CONTINUE
@
Mark One Only
HHNAME
[reference] [display T_HHROS]
PRESS "ENTER" TO CONTINUE @
Wednesday, August 27, 2003
Page 3 of 340
Survey:
Section: Section: Coverage
Items Booklet
Mark One Only
BEGINT
We will begin the interview with questions about
who lives here, their ages, how they're related to each
other, and other information of that sort. Then, I will
ask you questions about your jobs and any other sources of
income. Then I'll have questions about anyone else who's
at least 15 years old.
PRESS ENTER TO CONTINUE
@
Mark One Only
VERADD
I have your address listed as:
ADDRESS: [fill HNO] [fill HNOSUF] [fill STRNAME]
[fill UDESIG]
[fill GQUNITINFO]
[fill NONCITYADD]
[fill PO], [fill ST] [fill ZIP5:0]-[fill ZIP4:0]
[fill DESCTEMP1]
[fill DESCTEMP2]
[fill BLDGNAME]
Is that your exact address?
H
(1) Yes, address is EXACTLY CORRECT as listed
(2) Address is MOSTLY CORRECT, but needs some minor changes
(3) INCORRECT ADDRESS - terminate interview, find correct address
@
Multiple Entry
CHNGADD
ENTER ADDRESS OR (S) FOR SAME, IF NO CHANGE NEEDED
ENTER (X) TO BLANK-OUT THE CURRENT INFORMATION
HOUSE NUMBER: SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF] [fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
[fill GQ UNIT DESIG:]
[fill UDESIG] [fill GQUNITINFO]
@UNITDES
[fill @GQUINFO]
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME: [fill BLDGNAME]
@BLDGNAME
Page 4 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Coverage
Mark One Only
MAILADDR
Is this also your mailing address?
H
ADDRESS: [fill HNO] [fill HNOSUF] [fill STRNAME]
[fill UDESIG]
[fill GQUNITINFO]
[fill NONCITYADD]
[fill PO], [fill ST] [fill ZIP5:0]-[fill ZIP4:0]?
(1) Yes
(2) No
@
Multiple Entry
CHNGMAIL
ENTER CORRECTED MAILING ADDRESS OR (S) FOR SAME IF CORRECT
ENTER (X) TO BLANK OUT THE CURRENT INFORMATION
H
HOUSE NUMBER: SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF] [fill STRNAME]
@MHHNO
@MHHNOSUF
@MSTRNAME
UNIT DESIG:
[fill GQ UNIT DESIG:]
[fill UDESIG] [fill GQUNITINFO]
@MUNITDES
[fill @MGQUINFO]
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@MNOCITY
CITY: [fill PO]
@MPO
STATE:[fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@MST
@MZIP5 @MZIP4
Mark One Only
OLDCON
IF THIS ADDRESS IS A
- GROUP QUARTERS,
- MOBILE HOME,
- TRAILER, TENT, BOAT, OR
- A UNIT NOT LOCATED IN A STRUCTURE,
ENTER (N) WITHOUT ASKING THE FOLLOWING QUESTION.
Was this structure originally built before April of 2000?
(1) Yes
(2) No
(N) Not Asked
@
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ATADR
Are there any other living quarters
- either occupied or vacant - at this address?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 5 of 340
Survey:
Section: Section: Coverage
Items Booklet
Mark One Only
WARNING3
YOU ARE ABOUT TO BEGIN ASKING QUESTIONS ABOUT ONE OR MORE
ADDITIONAL LIVING ARRANGEMENTS AT THIS LOCATION TO
DETERMINE IF THEY QUALIFY AS EXTRA UNITS!!!
IF YOU HAVE ACCIDENTALLY REACHED THIS SCREEN, PRESS "F1"
TO BACKUP TO THE PREVIOUS SCREEN AND CORRECT AN EARLIER ENTRY.
TO BEGIN COLLECTING INFORMATION FOR ADDITIONAL LIVING
ARRANGEMENTS AT THIS LOCATION, ENTER (P) TO PROCEED.
@
Multiple Entry
OTHADD
What is the exact address of this other living quarters?
ENTER (S) FOR SAME
HOUSE NUMBER: SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF] [fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
GQ UNIT DESIG:
[fill UDESIG] [fill GQUNITINFO]
@UNITDES
@GQUINFO
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME: [fill BLDGNAME]
@BLDGNAME
Mark One Only
BNDARY
ARE THE ADDITIONAL LIVING QUARTERS IN THE
SAME STRUCTURE AS THE SAMPLE UNIT?
(1) Address is within same structure
(2) Address is outside of the same structure
@
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GRPQTR
ARE THE ADDITIONAL LIVING QUARTERS IN A GROUP QUARTERS?
H
(1) Yes
(2) No
@
Page 6 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Coverage
Mark One Only
LVEAT1
Do the occupants or intended occupants of the
additional living quarters live separately
from all other persons on the property?
(1) Yes
(2) No
@
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ACCES1
Do the occupants or intended occupants of the
additional living quarters have direct access from
the outside or through a common hall?
(1) Yes
(2) No
@
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NOINCL
THIS ADDITIONAL LIVING QUARTERS IS NOT AN EXTRA UNIT,
DO NOT INCLUDE MEMBERS OF THIS OTHER LIVING QUARTERS
AS MEMBERS OF THE CURRENT HOUSEHOLD.
(P) Proceed
@
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INCLUD
THE OTHER LIVING QUARTERS IS NOT CONSIDERED TO BE
AN EXTRA UNIT. INCLUDE THE PERSONS WHO OCCUPY THAT LIVING
ARRANGEMENT AS MEMBERS OF THE ASSIGNED HOUSEHOLD.
(P) Proceed
@
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XTRA
THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT.
DO NOT INCLUDE MEMBERS OF THIS EXTRA UNIT AS MEMBERS
OF THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY.
ADD THE EXTRA UNIT TO YOUR LISTING SHEET ACCORDING TO
THE INSTRUCTIONS IN YOUR LISTING AND COVERAGE MANUAL.
(P) Proceed
@
Wednesday, August 27, 2003
Page 7 of 340
Survey:
Section: Section: Coverage
Items Booklet
Mark One Only
GQSEG
IF YOU NOTICE MORE UNITS IN THE GQ THAN ARE LISTED,
ENTER THE FOLLOWING NOTE IN THE FOOTNOTE SECTION OF
THE LISTING SHEET:
"FOUND MORE UNITS AT INTERVIEW ADD TO LISTING SHEET WHEN UPDATING"
(P) Proceed
@
Multiple Entry
OTHAD2
What is the exact address of this other living quarters?
ENTER (S) FOR SAME
HOUSE NUMBER: SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF] [fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
GQ UNIT DESIG:
[fill UDESIG] [fill GQUNITINFO]
@UNITDES
@GQUINFO
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME: [fill BLDGNAME]
@BLDGNAME
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ONLIST
IS THIS ADDRESS ALREADY LISTED ON YOUR LISTING SHEET?
(1) Other Address on listing sheet
(2) Other Address NOT on listing sheet
@
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INSPACE
ARE THE ADDITIONAL LIVING QUARTERS WITHIN THE SAME STRUCTURE AND
WITHIN THE SAME SPACE AS THE SAMPLE UNIT?
(1) Yes
(2) No
@
Page 8 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Coverage
Mark One Only
LVEAT2
Do the occupants or intended occupants of the
additional living quarters live separately
from all other persons on the property?
(1) Yes
(2) No
@
Mark One Only
ACCES2
Do the occupants or intended occupants of the
other living quarters have direct access from
the outside or through a common hall?
H
(1) Yes
(2) No
@
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NOINCL2
THIS ADDITIONAL LIVING QUARTERS IS NOT CONSIDERED TO BA AN EXTRA UNIT.
INCLUDE THE PERSONS WHO OCCUPY THAT LIVING ARRANGEMENT AS MEMBERS OF
THE ASSIGNED HOUSEHOLD.
(P) Proceed
@
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INCLD2
THE ADDITIONAL LIVING QUARTERS IS NOT CONSIDERED TO BE
AN EXTRA UNIT. INCLUDE THE PERSONS WHO OCCUPY THAT
LIVING ARRANGEMENT AS MEMBERS OF THE ASSIGNED HOUSEHOLD.
(P) Proceed
@
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XTRA2
THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT.
DO NOT INCLUDE MEMBERS OF THIS EXTRA UNIT AS MEMBERS
OF THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY.
ADD THE EXTRA UNIT TO YOUR LISTING SHEET ACCORDING TO
THE INSTRUCTIONS IN YOUR LISTING AND COVERAGE MANUAL.
(P) Proceed
@
Wednesday, August 27, 2003
Page 9 of 340
Survey:
Section: Section: Coverage
Items Booklet
Multiple Entry
OTHAD3
What is the exact address of this other living quarters?
ENTER (S) FOR SAME
HOUSE NUMBER: SUFFIX:
STREET NAME:
[fill HNO]
[fill HNOSUF] [fill STRNAME]
@HHNO
@HHNOSUF
@STRNAME
UNIT DESIG:
GQ UNIT DESIG:
[fill UDESIG] [fill GQUNITINFO]
@UNITDES
@GQUINFO
NON-CITY STYLE ADDR / PO BOX: [fill NONCITYADD]
@NONCITY
CITY: [fill PO] STATE: [fill ST] ZIP CODE: [fill ZIP5] [fill ZIP4]
@PO
@ST
@ZIP5 @ZIP4
DESCRIPTION:
[fill PHYSDES]
@PHYSDES
BUILDING NAME: [fill BLDGNAME]
@BLDGNAME
Mark One Only
ATADR_R
ADDRESS: [fill HNO] [fill HNOSUF] [fill STRNAME]
[fill DESCTEMP1]
[fill DESCTEMP2]
[fill UDESIG]
[fill CO]
[fill PO] [fill ST] [fill ZIP5:0]-[fill ZIP4:0]
Are there any other living quarters
- either occupied or vacant at this original address?
(1) Yes
(2) No
@
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INADD
ARE THE ADDITIONAL LIVING QUARTERS WITHIN THE BASIC ADDRESS
OF THE ORIGINAL SAMPLE UNIT?
(1) Yes
(2) No
@
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LVEAT3
Do the occupants or intended occupants of the
additional living quarters live separately
from all other persons on the property?
(1) Yes
(2) No
@
Page 10 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Coverage
Mark One Only
ACCES3
Do the occupants or intended occupants of the
additional living quarters have direct access from
the outside or through a common hall?
H
(1) Yes
(2) No
@
Mark One Only
NOINCL3
THIS ADDITIONAL LIVING QUARTERS IS NOT AN EXTRA UNIT,
DO NOT INCLUDE MEMBERS OF THIS ADDITIONAL LIVING QUARTERS
AS MEMBERS OF THE CURRENT HOUSEHOLD.
(P) Proceed
@
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INCLD3
THE ADDITIONAL LIVING QUARTERS IS NOT CONSIDERED TO BE
AN EXTRA UNIT. INCLUDE THE PERSONS WHO OCCUPY THAT LIVING
ARRANGEMENT AS MEMBERS OF THE ASSIGNED HOUSEHOLD.
(P) Proceed
@
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XTRA3
THIS ADDITIONAL LIVING QUARTERS IS AN EXTRA UNIT.
DO NOT INCLUDE MEMBERS OF THIS EXTRA UNIT AS MEMBERS
OF THE CURRENT UNIT. THEY MUST BE INTERVIEWED SEPARATELY.
ADD THE EXTRA UNIT TO YOUR LISTING SHEET ACCORDING TO
THE INSTRUCTIONS IN YOUR LISTING AND COVERAGE MANUAL.
(P) Proceed
@
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BCINFO
FOR TYPE B and C NONINTERVIEWS, COLLECT THE
FOLLOWING INFOMATION.
Was the noninterview status determined by observation only
or did someone provide you with information about the
housing unit?
(1) By observation only
(2) Information provided by someone else
@
Wednesday, August 27, 2003
Page 11 of 340
Survey:
Section: Section: Coverage
Items Booklet
Multiple Entry
BCINFO2
ENTER (R) FOR SPECIFIC ITEMS BELOW IF THEY ARE REFUSED
Name of person providing noninterview status:
Firstname: @FN Lastname: @LN
Title of contact person (relative, neighbor, etc.): @CPRELA
Contact person's address:
Street name: @R1
Street name: @R2
City: @PO State: @ST Zip Code: @ZP5 @ZP4
Telephone Number: Area: @AR Number: @NUM Extension: @EXT
Mark One Only
ACCESS
ASK IF NOT APPARENT
[fill ORIGUNITFIL]
Do you have direct access to your home, either from the outside
or through a common hall?
H
(1) Yes
(2) No
@
Mark One Only
MERGE
This household must be merged with the household through
which access is gained. Refer to Interviewer's manual
to determine if the merged household is in or out of
the SIPP sample.
(1) Merged -- in SIPP sample
(2) Merged -- NOT in SIPP sample
@
Page 12 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Coverage
Mark One Only
LIVQRT
ENTER TYPE OF LIVING QUARTERS:
HOUSING UNIT
(1) House, apartment, flat
(2) HU in nontransient hotel, motel, etc.
(3) HU permanent, in transient hotel, motel, etc.
(4) HU in rooming house
(5) Mobile home or trailer with no permanent room added
(6) Mobile home or trailer with one or more permanent
rooms added
(7) HU not specified above
GROUP QUARTERS UNIT
(8) Quarters not HU in rooming or boarding house
(9) Unit not permanent in transient hotel, motel, etc.
(10) Unoccupied tent or trailer site
(11) Student quarters in college dormitory
(12) GROUP QUARTERS UNIT not specified above
@
Mark One Only
UNITS
ASK IF NOT APPARENT
How many housing units, both occupied and vacant,
are there in this structure?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
One, detached
One, attached
Two
3-4
5-9
10-19
20-49
50 or more
@
Mark One Only
TENURE
Are your living quarters -READ ANSWER CATEGORIES
(1) Owned or being bought by you or someone
in your household,
(2) Rented, or
(3) Occupied without payment of rent?
@
Wednesday, August 27, 2003
Page 13 of 340
Survey:
Section: Section: Demographics
Page 14 of 340
Items Booklet
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
PREROST
First I need to make a list of all the people who live or
stay here at this address.
Be sure to include:
- People who stay here only some of the time,
- non-relatives who live here,
- and of course any babies and small children.
Please mention someone even if you're not sure they should be
included.
PRESS "ENTER" TO CONTINUE
@
Multiple Entry
ROST
Let's start with you. What is your name? Please give |SEX
me the names of everyone else who lives or stays here |(M) Male
most of the time. Anyone else?
|(F) Female
ENTER (N) FOR NO MORE
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX @1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX @2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX @3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX @4REL
|(7) Other Relative
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX @5REL
|(Include in-laws)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX @6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX @7REL
|(9) House/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX @8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX @9REL
|(11)Other
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX @10REL | non-relative
Multiple Entry
ROST2
Please give me the names of everyone else who
|SEX
lives or stays here most of the time. Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX @1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX @2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX @3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX @4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX @5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX @6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX @7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX @8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX @9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX @10REL |
Wednesday, August 27, 2003
Page 15 of 340
Survey:
Section: Section: Demographics
Items Booklet
ROST3
Multiple Entry
Please give me the names of everyone else who
|SEX
lives or stays here most of the time. Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX @1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX @2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX @3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX @4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX @5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX @6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX @7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX @8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX @9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX @10REL |
Mark One Only
USUAL
|NAME
I need to be sure I'm including the
|Display ROST, ROST2, & ROST3
correct people in this survey. You have |
mentioned ***READ NAMES***.
|
H |
Is this the address where
|
[fill YOUALLFIL] live and sleep
|
most of the time?
|
|
(1) Yes
|
(2) No
|
|
@1
|
Mark All That Apply
NOTHERE
|LN NAME
Who doesn't live or sleep here
|Display ROST, ROST2, & ROST3
most of the time? Anyone else?
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@DEL [fill ERRROFIL]
|
Page 16 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Multiple Entry
NITESTAY
First time asked:
During a typical week over the last month or so, how many
nights did [fill NAMEFIL] stay here overnight,
or was there no usual pattern?
Subsequent times asked:
(How about/And) [ADROSTNAME]...?
(During a typical week over the last month or so, how many
nights did [fill ADROSTNAME] stay here overnight,
or was there no usual pattern?)
(11)
(12)
(13)
(14)
Three or fewer
Four or more
No usual pattern
Other {pop-up SPECIFY: @SP}
@1
Mark One Only
ASKURE
Is there another place where [fill NAMEFIL] lives and
sleeps most of the time?
(1) Yes
(2) No
@
Mark One Only
AWAYSCH
ASK IF NECESSARY:
Is [fill ADROSTNAME]. . .
. . . a student away attending school,
. . . non-married,
. . . whose permanent residence is here?
(1) Yes to all 3
(2) No
@
Mark One Only
AWAYTRV
ASK IF NECESSARY:
Does [fill ADROSTNAME] usually live here but is away
traveling for work, or on vacation, or in a hospital?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 17 of 340
Survey:
Section: Section: Demographics
Items Booklet
MSNGSTAY
Mark One Only
Sometimes we miss people when
|NAME
it's not totally clear where they
|Display verified roster
live. Just to make sure,
|
[fill OTHERTHANFIL] have I missed…
|
H
|
(1) Yes (2) No
|
|
…Anyone who is staying here until
|
they find a place to live?
@STAY|
|
…(Have I missed) Any lodgers,
|
boarders or persons you employ who
|
live here?
@LODGE|
|
…(Have I missed) Anyone who
|
may have another place to live, but who |
stays here often or has some space or a |
room here?
@OTH |
ADSTAY
Multiple Entry
|SEX
Who is that? Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX @1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX @2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX @3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX @4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX @5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX @6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX @7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX @8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX @9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX @10REL |
Mark One Only
MSNGLODGE
Sometimes we miss people when
|NAME
it's not totally clear where they
|Display verified roster
live or stay. Just to make sure,
|
[fill OTHERTHANFIL] have I missed…
|
H |
(1) Yes (2) No
|
|
…Anyone who is staying here until
|
they find a place to live?
fill<@STAY>|
|
…(Have I missed) Any lodgers,
|
boarders or persons you employ who
|
live here?
@LODG |
|
…(Have I missed) Anyone who
|
may have another place to live, but who |
stays here often or has some space or a |
room here?
@OTH |
Page 18 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Multiple Entry
ADLODGE
|SEX
Who is that? Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX @1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX @2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX @3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX @4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX @5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX @6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX @7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX @8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX @9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX @10REL |
Mark One Only
MSNGOTH
Sometimes we miss people when
|NAME
it's not totally clear where they
|Display verified roster
live or stay. Just to make sure,
|
[fill OTHERTHANFIL] have I missed…
|
H |
(1) Yes
|
(2) No
|
|
…Anyone who is staying here until
|
they find a place to live?
fill<@STAY>|
|
…(Have I missed) Any lodgers,
|
boarders or persons you employ who
|
live here?
Fill<@LODGE>|
|
…(Have I missed) Anyone who
|
may have another place to live, but who |
stays here often or has some space or a |
room here?
@OTH |
Wednesday, August 27, 2003
Page 19 of 340
Survey:
Section: Section: Demographics
Items Booklet
ADOTH
Multiple Entry
|SEX
Who is that? Anyone else?
|(M) Male
|(F) Female
ENTER (N) FOR NO MORE.
|
ENTER SEX AND RELATIONSHIP TO YOU IF OFFERED.
|Relationship to YOU
|(0) Respondent
First
Middle Last
Maiden/Other Sex Rel |(1) Spouse
to |(2) Unmarried Partner
"you"|(3) Child
@1FNAME @1MNAME @1LNAME @1OTNAME @1SEX @1REL
|(4) Grandchild
@2FNAME @2MNAME @2LNAME @2OTNAME @2SEX @2REL
|(5) Parent
@3FNAME @3MNAME @3LNAME @3OTNAME @3SEX @3REL
|(6) Brother/Sister
@4FNAME @4MNAME @4LNAME @4OTNAME @4SEX @4REL
|(7) Other Relative(e.g
@5FNAME @5MNAME @5LNAME @5OTNAME @5SEX @5REL
|uncle, cousin, in-law)
@6FNAME @6MNAME @6LNAME @6OTNAME @6SEX @6REL
|(8) Foster Child
@7FNAME @7MNAME @7LNAME @7OTNAME @7SEX @7REL
|(9) Housemate/Roommate
@8FNAME @8MNAME @8LNAME @8OTNAME @8SEX @8REL
|(10)Roomer/Boarder
@9FNAME @9MNAME @9LNAME @9OTNAME @9SEX @9REL
|(11)Other non-relative
@10FNAME @10MNAME @10LNAME @10OTNAME @10SEX @10REL |
Mark One Only
USUAL1
First time asked:
Is this the address where [fill ADROSTNAME] lives
and sleeps most of the time?
Subsequent times asked:
(How about/And) [ADROSTNAME]...?
(Is this the address where [fill ADROSTNAME] lives
and sleeps most of the time?)
(1) Yes
(2) No
@
Multiple Entry
NITESTA1
During a typical week over the last month or so, how many
nights did [fill ADROST2NAME] stay here overnight, or was there
no usual pattern?
(11)
(12)
(13)
(14)
Three or fewer
Four or more
No usual pattern
Other {pop-up: SPECIFY: @SP}
@1
Mark One Only
ASKURE1
Is there another place where [fill ADROSTNAME] lives and
sleeps most of the time?
(1) Yes
(2) No
@
Page 20 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
AWAYSCH1
ASK IF NECESSARY:
Is [fill ADROST2NAME]...
... a student away attending school,
... non-married,
... whose permanent residence is here?
(1) Yes to all 3
(2) No
@
Mark One Only
AWAYTRV1
ASK IF NECESSARY:
Does [fill ADROSTNAME] usually live here but is away
traveling for work, or on vacation, or in a hospital?
(1) Yes
(2) No
@
Mark All That Apply
STUDCK
|LN NAME
|Display ADROST1 where AD1FLAG eq <1>
TO THE BEST OF YOUR KNOWLEDGE, DOES |& (AWAYSCH ne <1> or AWAYTRV ne <1>)
ANYONE NOW ON THIS LIST MEET ALL 3 |
OF THESE CRITERIA?
|Display ADROST2 where AD2FLAG2 eq <1>
|& (AWAYSCH1 ne <1> or AWAYTRV1 ne<1>)
- NON-MARRIED STUDENT,
|
- LIVING HERE TEMPORARILY WHILE
|
ATTENDING SCHOOL,
|
- WITH A PERMANENT RESIDENCE
|
ELSEWHERE?
|
|
IF YES TO ALL 3, ENTER LINE NUMBER(S) |
ENTER (N) FOR NONE OR NO MORE
|
|
@KEY
|
|
Mark One Only
MSNGCI12
Mark One Only
CHECKPT
|
According to the rules of this survey,
***READ ALL NAMES*** will be
included in this interview.
|
|
PRESS (P) TO PROCEED
TO THE NEXT SCREEN
|
@
|
Wednesday, August 27, 2003
|
|
|
|
Page 21 of 340
Survey:
Section: Section: Demographics
Items Booklet
NOHHRESP
Mark One Only
Since you do not stay or live here most |Display T_NOHHRESP
of the time, who can answer the remaining |
household questions?
|
***READ NAMES***?
|
|
@
|
MAXPER
Mark One Only
A MAXIMUM OF 30 PEOPLE MAY BE INTERVIEWED IN
ANY HOUSEHOLD. THE LIMIT HAS BEEN REACHED.
NO QUESTIONS WILL BE ASKED FOR ANY ADDITIONAL PEOPLE.
PRESS ENTER TO CONTINUE
@
OTHRRP
Mark One Only
ALL PEOPLE LISTED HAVE ANOTHER RESIDENCE WHERE THEY DO
USUALLY LIVE. THEY WILL NOT BE INCLUDED IN THIS
INTERVIEW. TAKE ONE OF THE FOLLOWING ACTIONS -PRESS F1 TO BACK UP AND CORRECT
ENTER (B) IF NO OTHER ADULT MAINTAINS THIS ADDRESS
AS HIS/HER USUAL PLACE OF RESIDENCE. -- THIS DESIGNATES
THIS ADDRESS AS A TYPE B NONINT.
@
SEX
Mark One Only
ASK IF NOT APPARENT:
[if INDEX eq <1>]
(How about/And) [fill TEMPNAME]...?
([fill C_AREIS] [fill TEMPNAME] Male or Female?)
[else]
[fill C_AREIS] [fill TEMPNAME] Male or Female?
(1) Male
(2) Female
@
REFPER2
Mark All That Apply
Who [fill OWNRENTFIL] this home |LN NAME
that is, what name or names are on the |Display HH Roster
[fill DEEDLEASEFIL]?
|
|
IF RESPONDENT CAN'T IDENTIFY OWNER/RENTER,|
ENTER LINE NUMBER OF HEAD OF HOUSEHOLD. |
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
|
@KEY
|
Page 22 of 340
|
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
RELRP
SHOW FLASHCARD A
First time asked:
What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Spouse(Husband/Wife)
Unmarried Partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative (Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative
@
Mark One Only
CHANGE
PLEASE VERIFY THE INFORMATION DISPLAYED IS CORRECT
[PRESS "SHIFT-F6" TO DISPLAY FULL ROSTER IF NEEDED]
**THIS INFORMATION CANNOT BE CHANGED AFTER THIS POINT IN THE INTERVIEW**
ENTER (P) TO PROCEED IF ALL APPEARS CORRECT
OTHERWISE, ENTER LINE NUMBER WHERE A CHANGE IS NEEDED. @
IF NECESSARY, SAY: I need to verify some of the information
I have collected for: ***READ ROSTER NAME(S)***
Display CHNG template
LN NAME
1 JOSEPH
2 HELEN
C
M
JONES
JONES
Wednesday, August 27, 2003
SEX
REL TO
REF PERSON
M
F
REF
SPOUSE
Page 23 of 340
Survey:
Section: Section: Demographics
Items Booklet
Mark One Only
CHG_WHAT
What change is needed for: [fill NAMEFIL]
PRESS "SHIFT-F6" TO DISPLAY FULL ROSTER IF NEEDED
(M) Mistake -- no changes needed
(2) Name
(3) Sex
(4) Relationship to Reference Person
@
Display CHNG template
LN NAME
1 JOSEPH
2 HELEN
SEX
JONES
JONES
REL TO
REF PERSON
M
F
REF
SPOUSE
Multiple Entry
FIXNAME
What is the name of the person living or staying
here? Please include middle initial and maiden or other name.
PRESS ENTER IF NO MIDDLE OR MAIDEN NAME
FIRST NAME
@FNAME
MIDDLE INITIAL
@MNAME
LAST NAME
@LNAME
MAIDEN/OTHER NAME
@OTNAME
Mark One Only
FIXRELRP
SHOW FLASHCARD A
First time asked:
What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(What is [fill PTEMPNAME]
relationship to [fill YOUFIL]?)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Spouse(Husband/Wife)
Unmarried Partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person(Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
@
Page 24 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
CHG_MORE
Are any more changes needed for: [fill CHGNAMEFIL]
H
(1) Yes
(2) No
@
Mark One Only
SPOUSE1
DO NOT READ TO RESPONDENT UNLESS NECESSARY
Is one of the following SEX entries incorrect?
LINE NAME
Display reference person and sex
Display spouse and sex
SEX
(1) To correct LINE [fill REFPER]'s SEX entry
(2) To correct LINE [fill L_NO]'s SEX entry
(3) Neither sex entry is incorrect
@
Mark One Only
SPOUSE2
ASK IF NECESSARY:
You said [fill TEMPNAME]
[fill AREIS] [fill PNAME(REFPER)] spouse.
Is that correct?
(1) Yes
(2) No
@
Mark One Only
SPOUSE3
DO NOT READ TO RESPONDENT UNLESS NECESSARY
Earlier I recorded
[fill TEMPNAME] [fill WASWERE]
[fill PNAME(REFPER)] spouse.
You have just reported
[fill NAME(SPIX)] [fill AREIS] also
[fill PNAME(REFPER)] spouse.
Which is correct?
(1) [fill TEMPNAME] is the correct spouse.
Change relationship entry of [fill NAME SPIX)]
(2) [fill NAME SPIX)] is the correct spouse.
Change relationship entry of [fill NAME L_NO)]
@
Wednesday, August 27, 2003
Page 25 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
SPOUSE4
SHOW FLASHCARD A
What is [fill PNAME(INDEX4)]
relationship to [fill NAME(REFPER)]?
(3)
(4)
(5)
(6)
(7)
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person(Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
@
Mark One Only
DAD1
You have reported both
[fill NAME(DADIX)]
and
[fill NAME(L_NO)]
are parents of
[fill NAME(REFPER)]
Is that correct?
(1) No, change relationship to reference person code for
[fill NAME(L_NO)]
(2) No, change relationship to reference person code for
[fill NAME(DADIX)]
(3) Yes, this is correct.
(One is natural father, one is step-father, for example)
@
Mark One Only
DAD2
SHOW FLASHCARD A
What is [fill PNAME(INDEX2)]
relationship to [fill NAME(REFPER)]?
(2)
(3)
(4)
(5)
(6)
(7)
Unmarried partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person (Uncle,cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
@
Page 26 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
MOM1
You have reported both
[fill NAME(MOMIX)]
and
[fill NAME(L_NO)]
are parents of
[fill NAME(REFPER)]
Is that correct?
(1) No, change relationship to reference person code for
[fill NAME(L_NO)]
(2) No, change relationship to reference person code for
[fill NAME(MOMIX)]
(3) Yes, this is correct.
(One is natural mother, one is step-mother, for example)
@
Mark One Only
MOM2
SHOW FLASHCARD A
What is [fill PNAME(INDEX2)]
relationship to [fill NAME(REFPER)]?
(2)
(3)
(4)
(5)
(6)
(7)
Unmarried partner
Child (Biological, Step, or Adopted)
Grandchild
Parent(Mother/Father)
Brother/Sister
Other Relative of Reference Person (Uncle, cousin,
mother-in-law, father-in-law, etc.)
(8) Foster Child
(9) Housemate/Roommate
(10) Roomer/Boarder
(11) Other non-relative or Reference Person
@
Mark One Only
RPDAD
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
@
Wednesday, August 27, 2003
Page 27 of 340
Survey:
Section: Section: Demographics
Items Booklet
Mark One Only
RPDAD2
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
2
[if RPDAD@1 eq <2>]
[fill ISREFPERFIL] also [if L_NO eq <1>]your[else]his[endif] adopted child?
(1) Yes
(2) No
@
Mark One Only
RPMOM
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
@
Mark One Only
RPMOM2
[fill ISREFPERFIL] [fill PTEMPNAME]
biological, step, or adopted child?
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
2
[fill ISREFPERFIL] also <1>]your[else]her[endif] adopted child?
(1) Yes
(2) No
@
Multiple Entry
DOB
What is [fill PTEMPNAME] date of birth?
(1)
(2)
(3)
(4)
January
February
March
April
ENTER MONTH:
ENTER DAY:
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
@BMONTH
@BDAY
ENTER 4 DIGIT YEAR: @BYEAR
Page 28 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
VERAGE
That would make [fill TEMPNAME] [fill TEMP_P]. Is that correct?
(1) Yes
(2) No
@
Multiple Entry
FIXDOB
What is [fill PTEMPNAME] date of birth?
(1)
(2)
(3)
(4)
January
February
March
April
ENTER MONTH:
ENTER DAY:
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
@MO
@DAY
ENTER 4 DIGIT YEAR: @YR
Mark One Only
DOBA
[fill C_AREIS] [fill TEMPNAME] now:
(1) [fill AGE1] or
(2) [fill AGE2] years old?
(N) Neither is correct
@
Mark One Only
AGEGES
About how old would you say [fill TEMPNAME] [fill AREIS]?
ENTER BEST ESTIMATE OF AGE:
@
Mark One Only
FRGES
ENTER YOUR BEST ESTIMATE OF
[fill F_NAME] [fill L_NAME]'s AGE:
@
Wednesday, August 27, 2003
Page 29 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
UNDERAGE
YOU MUST RESTART THIS INTERVIEW
BOTH THE HOUSEHOLD REFERENCE PERSON AND
THE HOUSEHOLD RESPONDENT MUST BE 15 YEARS OF
AGE OR OLDER.
YOU REPORTED THAT THE [fill TEMP2] IS UNDER 15.
IF NO ONE IN THE HOUSEHOLD IS 15 YEARS OF AGE OR
OLDER, THE HOUSEHOLD IS A TYPE B (CODE 18)
NONINTERVIEW.
PRESS ENTER TO TERMINATE THIS INTERVIEW AND RESTART.
@
Mark One Only
ZEROCHK
[fill READFIL]
YOUR ENTRY OF 0 ON THE [fill AGEFRGES] SCREEN INDICATES THAT
YOUR BEST ESTIMATE OF THIS PERSON'S AGE IS -UNDER THE AGE OF 1 YEAR.
IF THIS IS NOT CORRECT, PRESS F1 TO BACK UP AND
ENTER A NEW ESTIMATE.
IF THIS IS CORRECT, PRESS ENTER TO PROCEED.
@
Mark One Only
MARRIED
First time asked:
[fill C_AREIS] [fill TEMPNAME] currently married, widowed,
divorced, separated or [fill HAVHAS] [fill HESHE] never married?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_AREIS] [fill TEMPNAME] currently married, widowed,
divorced, separated or [fill HAVHAS] [fill HESHE] never married?)
H
(1) Married
(2) Widowed
(3) Divorced
(4) Separated
(5) Never Married
@
Page 30 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
LNSP
Mark One Only
ASK IF NECESSARY:
|LIST OF OTHER ADULTS
|LINE NAME
Is [fill PTEMPNAME] spouse a
|Display >SPLN< template
member of this household?
|
|
IF NO, ENTER (N)
|
IF YES, ENTER THE SPOUSE'S LINE NUMBER |
|
ENTER (M) FOR MORE
|
|
@
|
MSCHECK
Mark One Only
ASK IF NECESSARY
We have recorded that [fill TEMPNAME] is married but [fill HISHER]
spouse does not live here (four or more nights per week).
Is that correct?
(1) Correct, married spouse absent
(2) Incorrect marital status entered
MARRIED2
Mark One Only
[fill C_AREIS] [fill TEMPNAME] currently married, widowed,
divorced, separated or [fill HAVHAS] [fill HESHE] never married?
H
(2)
(3)
(4)
(5)
Widowed
Divorced
Separated
Never Married
@
Mark One Only
SPSSX1
DO NOT READ TO RESPONDENT UNLESS NECESSARY
Is one of the following SEX entries incorrect?
LN NAME
SEX
[fill <[L_NO] [F_NAME]
[LNSP] [NAME(LNSP)]
[SX]
[SEXFIL]>
(1) To correct Line [fill L_NO]'s SEX entry
(2) To correct Line [fill LNSP]'s SEX entry
(3) Neither SEX entry is incorrect
@
Wednesday, August 27, 2003
Page 31 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
SPSSX2
ASK IF NECESSARY:
You said [fill NAME(LNSP)]
is [fill PTEMPNAME] spouse.
Is that correct?
(1) Yes
(2) No
@
Mark One Only
EVRWID
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] ever been widowed?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_HAVHAS] [fill TEMPNAME] ever been widowed?)
(1) Yes
(2) No
@
Mark One Only
EVRDIV
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] ever been divorced?
H
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_HAVHAS] [fill TEMPNAME] ever been divorced?)
(1) Yes
(2) No
@
Mark One Only
LNMOM
ASK IF NECESSARY:
|LISTING OF ELIGIBLE FEMALES
Is [fill PTEMPNAME] mother
|LINE NAME
a member of this household?
|Display >MOMS< template
|
IF NO, ENTER (N)
|
IF YES, ENTER THE MOTHER'S LINE NUMBER |
|
ENTER (M) FOR MORE
|
|
@
|
Page 32 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
TYPMOM
First time asked:
[fill C_AREIS] [fill TEMPNAME] [fill MOMSFIL]
biological, step, adopted or foster child?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME] [fill MOMSFIL]
biological, step, adopted or foster child?)
(1)
(2)
(3)
(4)
Biological or natural child
Stepchild
Adopted child
Foster child
@
Mark One Only
TYPMOM2
First time asked:
[fill C_AREIS] [fill TEMPNAME] [fill MOMSFIL]
biological, step, adopted or foster child?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME] [fill MOMSFIL]
biological, step, adopted or foster child?)
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
(4) Foster child
2
[fill C_AREIS] [fill TEMPNAME] also
[fill MOMSFIL] adopted child?
(1) Yes
(2) No
@
Multiple Entry
ADDMMYYM
What month and year did [fill MOMFIL] adopt
[fill TEMPNAME]?
MONTH: @MO
YEAR: @YR
Wednesday, August 27, 2003
Page 33 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
LNDAD
ASK IF NECESSARY:
|LISTING OF ELIGIBLE MALES
|LINE NAME
Is [fill PTEMPNAME] father
|Display >DADS< template
a member of this household?
|
|
IF NO, ENTER (N)
|
IF YES, ENTER THE FATHER'S LINE NUMBER |
ENTER (M) FOR MORE
|
|
@
|
Mark One Only
TYPDAD
First time asked:
[fill C_AREIS] [fill TEMPNAME] [fill DADSFIL]
biological, step, adopted or foster child?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME] [fill DADSFIL]
biological, step, adopted or foster child?)
(1)
(2)
(3)
(4)
Biological or natural child
Stepchild
Adopted child
Foster child
@
Mark One Only
TYPDAD2
First time asked:
[fill C_AREIS] [fill TEMPNAME] [fill DADSFIL]
biological, step, adopted or foster child?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME] [fill DADSFIL]
biological, step, adopted or foster child?)
(1) Biological or natural child
(2) Stepchild
(3) Adopted child
(4) Foster child
2
[fill C_AREIS] [fill TEMPNAME] also
[fill DADSFIL] adopted child?
(1) Yes
(2) No
@
Page 34 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
ADDMMYYD
Multiple Entry
What month and year did [fill DADFIL] adopt
[fill TEMPNAME]?
MONTH: @MO
YEAR: @YR
LNGD
Mark One Only
[fill OTHERTHANFIL]
Who in this household is responsible for
[fill TEMPNAME]?
ENTER (N) IF NOT LISTED
@
AF_HH
Mark One Only
Did [fill / ever serve on active duty
in the U.S. Armed Forces?
(1) Yes
(2) No
@
AF_WHO1
Mark All That Apply
Who?
| LINE
NAME
|
ENTER ALL THAT APPLY
|
ENTER (N)FOR NONE OR NO MORE
RE-ENTER PRECODE TO DELETE
|
|
@PER [fill TEMPNAME]
|
|
|
Mark One Only
AFEVER
First time asked:
Did [fill TEMPNAME]] ever serve on active duty in the U.S. Armed Forces?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
(Did [fill TEMPNAME]] ever serve on active duty in the U.S. Armed Forces?)
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 35 of 340
Survey:
Section: Section: Demographics
Mark All That Apply
Items Booklet
AFWHEN
First time asked:
When did [fill TEMPNAME] serve on active duty?
AFTER EACH RESPONSE ASK: Any other times?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
(When did [fill TEMPNAME] serve on active duty?
AFTER EACH RESPONSE ASK: Any other times?)
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
[fill <@AFSRV1
[fill <@AFSRV2
[fill <@AFSRV3
[fill <@AFSRV4
[fill <@AFSRV5
[fill TEMP2]>]
[fill TEMP3]>]
[fill TEMP4]>]
[fill TEMP5]>]
[fill TEMP6]>]
@KEY
Mark One Only
AFNOW
First time asked:
[fill C_AREIS] [fill TEMPNAME] now on active duty?
Subsequent times asked:
(How about/And) [fill TEMPNAME]....
([fill C_AREIS] [fill TEMPNAME] now on active duty?)
(1) Yes
(2) No
@
Page 36 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
EDUC
First time asked:
SHOW FLASHCARD B
[fill OTHTHANVOCFIL] is the highest level of school
[fill TEMPNAME] [fill HAVHAS] completed or the highest degree
[fill HESHE] [fill HAVHAS] received?
Subsequent times asked:
SHOW FLASHCARD B (How about/And) [fill TEMPNAME]...?
([fill OTHTHANVOCFIL] is the highest level of school
[fill TEMPNAME] [fill HAVEHAS] completed or the highest degree
[fill HESHE] [fill HAVHAS] received?)
H
(31) Less than 1st grade
(35) 9th grade
(32) 1st, 2nd, 3rd or 4th grade
(36) 10th grade
(33) 5th or 6th grade
(37) 11th grade
(34) 7th or 8th grade
(38) 12th grade, no diploma
(39) HIGH SCHOOL GRADUATE (diploma or GED or equivalent)
(40) Some college credit, but less than 1 year
(41) 1 or more years of college, no degree (regular Jr.coll./coll./univ.)
(43) Associate (2-yr) college degree (include academic/occupational degree)
(44) Bachelor's degree (for example: BA, AB, BS)
(45) Master's degree (for example: MA, MS, MENG, Med, MSW, MBA)
(46) Professional School degree (for example: MD(doctor),DDS(dentist),JD(lawyer))
(47) Doctorate degree (for example: Ph.D., Ed.D.)
@1
Mark One Only
EDUCB
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] completed high school by means of
a GED or other equivalency test or program?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
[fill C_HAVHAS] [fill TEMPNAME] completed high school by means of a GED
or other equivalency test or program?
(1) Yes
(2) No
@
Mark One Only
EDUCB2
ASK OR VERIFY:
Did [you/NAME] get [YOUR/HISHER] high school diploma by graduating
from high school, or by passing a GED exam (or other equivalent)?
Subsequent times asked:
How about [YOU/NAME]?
(Did [you/NAME] get [YOUR/HISHER] high school diploma by graduating
from high school, or by passing a GED exam (or other equivalent)?)
(1) Graduated from high school
(2) GED or other test
@
Wednesday, August 27, 2003
Page 37 of 340
Survey:
Section: Section: Demographics
Items Booklet
VOCAT
Mark One Only
First time asked:
[fill HAVHAS] [fill TEMPNAME] ever attended a
vocational, technical, trade, or business school
beyond high school?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill HAVHAS] [fill TEMPNAME] ever attended a
vocational, technical, trade, or business school
beyond high school?)
"BUSINESS SCHOOLS" TEACH SKILLS OR TRADES SUCH AS SECRETARIAL TRAINING,
BOOKKEEPING, COMPUTER PROGRAMMING, ETC. DO *NOT* INCLUDE BUSINESS PROGRAMS
IN COLLEGES AND UNIVERSITIES LEADING TO ACADEMIC DEGREES.
(1) Yes
(2) No
@
Mark One Only
YESVOC
First time asked:
[fill C_HAVHAS] [fill TEMPNAME] received a diploma or
certificate from a vocational, technical, trade, or business
school?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_HAVHAS] [fill TEMPNAME] received a diploma or
certificate from a vocational, technical, trade, or business
school?)
(1) Yes
(2) No
@
Mark One Only
ORIGIN
First time asked:
[fill C_AREIS] [fill TEMPNAME] Spanish, Hispanic or Latino?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
([fill C_AREIS] [fill TEMPNAME] Spanish, Hispanic or Latino?)
READ IF NECESSARY: such as Mexican, Mexican-American, Chicano, Puerto Rican,
Cuban, or some other Spanish, Hispanic, or Latino group.
(1) Yes
(2) No
@
Page 38 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
HISPAN
First time asked:
[fill C_AREIS] [fill TEMPNAME] Mexican, Mexican American, Chicano,
Puerto Rican, Cuban, Cuban American, or some other Spanish, Hispanic,
or Latino group?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...
([fill C_AREIS] [fill TEMPNAME] Mexican, Mexican American, Chicano,
Puerto Rican, Cuban, Cuban American, or some other Spanish, Hispanic,
or Latino group?)
IF MULTIPLE ANSWER, PROBE: Which group [fill DODOES] [fill HESHE]
most closely identify with?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Mexican
Mexican American
Chicano
Puerto Rican
Cuban
Cuban American
Other Spanish, Hispanic, or Latino group
@
Mark One Only
OROTSP
What is the name of [fill PTEMPNAME] other Spanish, Hispanic, or Latino group?
(1)
(2)
(3)
(4)
Argentinean
(15) Dominican
(29) Portuguese
Baleric Islander
(16) Ecuadorian
(30) Salvadoran
Basque
(17) Filipino
(31) Sephardic
Belize, British,
(18) Guatemalan
(32) South American
Honduran or Belice (19) Guamanian or
(33)South American Indian
(5) Bolivian
Chamorro
(34) Spanish
(6) Brazilian
(20) Haitian
(36) Spanish American
(7) Canary Islander
(21) Hispanic
Indian
(8) Castilian
(22) Honduran
(37) Spanish Basque
(9) Catalan
(23) Latin American (38) Spaniard
(10) Central American
(24) Latino
(39) Uruguayan
(11) Central American
(25) Nicaraguan
(40) Venezuelan
Indian
(26) Panamanian
(41) Both Spanish,
(12) Chilean
(27) Paraguayan
Hispanic, or Latino
(13) Colombian
(28) Peruvian
(42) Other
(14) Costa Rican
@
Wednesday, August 27, 2003
Page 39 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
OROTSS
What is the name of [fill PTEMPNAME] other Spanish, Hispanic, or Latino group?
(1)
(2)
(3)
(4)
Argentinean
(15) Dominican
(29) Portuguese
Baleric Islands
(16) Ecuadorian
(30) Salvadoran
Basque
(17) Filipino
(31) Sephardic
Belize, British,
(18) Guatemalan
(32) South American
Honduras or Belice (19) Guamanian or
(33) South American Indian
(5) Bolivian
Chamorro
(34) Spanish
(6) Brazilian
(20) Haitian
(36) Spanish American
(7) Canary Islands
(21) Hispanic
Indian
(8) Castilian
(22) Honduran
(37) Spanish Basque
(9) Catalan
(23) Latin American (38) Spaniard
(10) Central American
(24) Latino
(39) Uruguayan
(11) Central American
(25) Nicaraguan
(40) Venezuelan
Indian
(26) Panamanian
(41) Both Spanish,
(12) Chilean
(27) Paraguayan
Hispanic, or Latino
(13) Colombian
(28) Peruvian
(42) Other
(14) Costa Rican
42 SPECIFY: @SP
Mark All That Apply
RACE
SHOW FLASHCARD C
First time asked:
Please choose one or more races (from this card) that [fill NAME1FIL]
[fill NAME2FIL] to be.
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(What race(s) [fill DODOES] [fill NAME3FIL] [fill NAME2FIL]
to be?)
PROBE IF RESPONSE IS "HISPANIC" OR "LATINO", OR A SPECIFIC HISPANIC ORIGIN
(E.G. "MEXICAN", "CUBAN")
ENTER ALL THAT APPLY/ENTER (N) FOR NO MORE/RE-ENTER PRECODE TO DELETE
H
(1) White
(2) Black or African American
(3) American Indian or Alaska Native
(4) Asian
(5) Native Hawaiian or Other Pacific Islander
(6) Other - DO NOT READ
@KEY
[fill ERRORFIL]
Page 40 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark All That Apply
RACEAS
Which of the following Asian groups [fill CONSIDERFIL]?
READ EACH ITEM
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian - DO NOT READ
@
Mark All That Apply
RACEPI
Which of the following Native Hawaiian or Other Pacific Islander
groups [fill CONSIDERFIL]?
READ EACH ITEM
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
(1)
(2)
(3)
(4)
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander - DO NOT READ
@
Mark One Only
RACEOT
READ ONLY IF NECESSARY:
What is [fill PTEMPNAME] other race?
(1) Aleut
(16) Cuban or Cuban (29) Native American
(2) African American
American
(30) Native Hawaiian
(3) American Nation,
(17) Eskimo
or Other Pacific
Ethnic Group or Tribe (18) European
Islander
(4) American
(19) Filipino
(31) Negro
(5) American Indian
(20) German
(32) Puerto Rican
or Alaska Native
(21) Guamanian or
(33) Samoan
(6) Anglo-Saxon
Chamorro
(34) Scotch-Irish
(7) Arab
(22) Hispanic
(35) Spanish
(8) Asian
(23) Jamaican
(36) Vietnamese
(9) Asian Indian
(24) Japanese
(37) West Indian
(10) Black
(25) Korean
(38) White
(11) Brazilian
(26) Latin American (39) No race given
(12) Caucasian
(27) Latino
(40) Other - DO NOT READ
(13) Chicano
(28) Mexican or
(14) Chinese
Mexican American @
(15) Creole
Wednesday, August 27, 2003
Page 41 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
RACEOS
READ ONLY IF NECESSARY:
What is [fill PTEMPNAME] race?
(1) Aleut
(16) Cuban or Cuban (29) Native American
(2) African American
American
(30) Native Hawaiian
(3) American Nation,
(17) Eskimo
or Other Pacific
Ethnic Group or Tribe (18) European
Islander
(4) American
(19) Filipino
(31) Negro
(5) American Indian
(20) German
(32) Puerto Rican
or Alaska Native
(21) Guamanian or
(33) Samoan
(6) Anglo-Saxon
Chamorro
(34) Scotch-Irish
(7) Arab
(22) Hispanic
(35) Spanish
(8) Asian
(23) Jamaican
(36) Vietnamese
(9) Asian Indian
(24) Japanese
(37) West Indian
(10) Black
(25) Korean
(38) White
(11) Brazilian
(26) Latin American (39) No race given
(12) Caucasian
(27) Latino
(40) Other - DO NOT READ
(13) Chicano
(28) Mexican or
(14) Chinese
Mexican American [40]
(15) Creole
SPECIFY: @SP
Mark One Only
BORNUS
[fill WASEVERYONEFIL] born in the United States?
H
READ IF NECESSARY: Consider persons born in a U.S. Island
area -- such as Puerto Rico, Guam, the U.S. Virgin Islands, or
Northern Marianas -- to have been born in the United States.
(1) Yes
(2) No
@
Mark All That Apply
BORNOUT
|LN NAME
Who was born outside the United States? |Display HH Roster
Anyone else?
|
H|
READ IF NECESSARY: Consider persons
|
born in a U.S. Island area, such as
|
Puerto Rico, Guam, the U.S. Virgin
|
Islands, or Northern Marianas to have |
been born in the United States.
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
Page 42 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Mark One Only
CITIZEN
First time asked:
[fill AREIS] [fill TEMPNAME] a citizen of the United States?
(1) Yes
(2) No
@
Subsequent times asked:
(How about/And) [fill TEMPNAME]. . . ?
([fill AREIS] [fill TEMPNAME] a citizen of the United States?)
(1) Yes
(2) No
@
Multiple Entry
NATCIT
First time asked:
How did [fill TEMPNAME] become a U.S. citizen?
H
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(How did [fill TEMPNAME] become a U.S. citizen?)
(1) Naturalized
(2) Through [fill HISHER] (or spouse's) military service
in U.S. Armed Forces
(3) Adopted by U.S. citizen parent or parents
(4) Born in a U.S. Island Area or born in the United States
(5) Born abroad of U.S. citizen parent or parents
(6) Other
{pop-up} SPECIFY @SP
@1
Mark One Only
CITPAR
First time asked:
At the time of [fill PTEMPNAME] birth, was either of
[fill HISHER] parents a U.S. citizen?
Subsequent times asked:
(How about/And) [fill TEMPNAME]...?
(At the time of [fill PTEMPNAME] birth, was either of
[fill HISHER] parents a U.S. citizen?)
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 43 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
HHSPEAK1
DO NOT READ TO RESPONDENT: SO FAR, HAS ANY PART OF THIS INTERVIEW
BEEN CONDUCTED IN A LANGUAGE OTHER THAN ENGLISH?
(DO NOT COUNT AMERICAN SIGN LANGUAGE AS NON-ENGLISH LANGUAGE)
(1) Yes
(2) No, all in English
@
Mark One Only
HHSPEAK2
[fill INTROFIL]
speak a language other than English at home?
DO NOT COUNT AMERICAN SIGN LANGUAGE AS NON-ENGLISH LANGUAGE
H
[fill UNDER5FIL]
(1) Yes
(2) No, only English
@
Mark One Only
HHSPEAK3
[fill C_DODOES] [fill TEMPNAME] speak a language other than
English at home?
DO NOT COUNT AMERICAN SIGN LANGUAGE AS NON-ENGLISH LANGUAGE
H
(1) Yes
(2) No
@
Mark All That Apply
WHOSPEAK
Who is that?
|LNO
NAME
|{list all hh members age 5+}
(Who[fill OTHERTHANFIL] speaks a language |{if HHSPEAK1 eq <1>, do not display
other than English at home?)
|the respondent, and do not allow
Anyone else?
|respondent's line # to be entered.}
H|
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL PEOPLE LISTED
|
ENTER (N) AFTER LAST ENTRY
|
RE-ENTER PRECODE TO DELETE
|
|
@
Page 44 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Demographics
Multiple Entry
LANG1
{first time asked:}
[fill ASKFIL]
What language [fill DODOES] [TEMPNAME] speak at home?
{subsequent times asked}
[fill ASKFIL]
How about/And [TEMPNAME]...? (What language does [TEMPNAME] speak at home?)
IF MORE THAN ONE, MARK THE "MAIN" OTHER LANGUAGE
H
ASIAN AND PACIFIC ISLAND LANGUAGES:
(1) Spanish
(10) Chinese (e.g. Cantonese, Mandarin)
OTHER EUROPEAN LANAGUAGES: (11) Japanese
(2) French (include Creole) (12) Korean
(3) German
(13) Tagalog, Filippino
(4) Greek
(14) Vietnamese
(5) Italian
OTHER LANGUAGES:
(6) Polish
(15) Arabic
(7) Portuguese
(16) Hindi, Urdu
(8) Russian
(17) African lang.(e.g. Swahili, Yoruba)
(9) Serbo-Croatian (include (18) American Indian, Alaska Native lang.
Bosnian, Yugoslavian)
(e.g. Cherokee, Navajo, Yupik)
(19) All other non-English languages (specify)
@
@SP
Mark One Only
HOWWELL
First time asked:
[fill INTROFIL]
How well [fill DODOES] [TEMPNAME] speak English –
would you say very well, well, not well, or not at all?
Subsequent times asked:
How about/And [TEMPNAME]...?
(How well [fill DODOES] [TEMPNAME] speak English –
would you say very well, well, not well, or not at all?)
(1) Very well
(2) Well
(3) Not well
(4) Not at all
@
Mark One Only
AFHHLD
DO NOT READ TO RESPONDENT
ALL OF THE ADULTS IN THIS HOUSEHOLD ARE MEMBERS OF THE
ARMED FORCES.
THE HOUSEHOLD IS CLASSIFIES AS A TYPE B NONINTERVIEW.
PRESS "ENTER" TO FINISH THE CASE.
@
Wednesday, August 27, 2003
Page 45 of 340
Survey:
Section: Section: Demographics
Mark One Only
Items Booklet
INCSCRN1A
In order to make the interview as efficient as possible,
I am going to ask a question about household income. Is
[fill YOURCOMBINEFIL] total annual income
[fill [<>/] below
$[fill INCFILL] or above $[fill INCFILL]?
(1) Below ($0 - $[fill INCFILL])
(2) Above ($[fill INCFILL2] or more)
@
Mark One Only
INCSCRN2
Even though your income was above that amount, at any time
since [fill MONTH1] 1st, did [fill YOUANYONEFIL] receive
any kind of welfare or public assistance benefits from a
federal, state, or county program?
(1) Yes
(2) No
@
Page 46 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
LFINTRO
BEGINNING INTERVIEW FOR: [fill NAME]
if PELIG(L_NO) eq <5> or PELIG(L_NO) eq <9>
SOME OF THESE QUESTIONS HAVE BEEN ANSWERED. PRESS F3
TO RESUME INTERVIEW AT THE NEXT UNANSWERED QUESTION.
else if LNORESP ne <1>
IF NEW RESPONDENT, BRIEFLY EXPLAIN INTERVIEW TO THE NEW
RESPONDENT.
If HHSTAT eq <3> (new person)
I'm going to ask you about [fill TEMP] work
situation between [fill MONTH1] 1st and today, but
first. . .
else
[fill FIRSTFIL] I'd like to ask you about [fill TEMP] work
situation between [fill MONTH1] 1st and today.
PRESS "ENTER" TO CONTINUE
@
Mark One Only
PDJBTHN
[fill TEMP]
[fill TEMP2]
[fill TEMP3]
[fill TEMP4]
[fill TEMP5]
Did [fill TEMPNAME] have at least one paid job, either full or
part time, at any time between [fill MONTH1] 1st and today?
H
[fill BIGTEMP]
(1) Yes
(2) No
@
Mark One Only
NOPDJB
Did [fill TEMPNAME] do any work at all that
earned some money?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 47 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
JBORSE
Was that for an employer or [fill WASWERE] [fill TEMPNAME]
self-employed or did [fill HESHE] have some other arrangement?
OTHER ARRANGEMENTS INCLUDE ODD JOBS, ON-CALL WORK, DAY LABOR,
ONE-TIME JOBS, AND INFORMAL ARRANGEMENTS LIKE BABYSITTING,
LAWN MOWING, OR LEAF RAKING FOR NEIGHBORS.
H
(1) Employer
(2) Self-Employed
(3) Both employer and self-employed
(4) Some other arrangement
@
Mark One Only
UNPAID
Did [fill TEMPNAME] do any unpaid work
in a family business or farm?
(1) Yes
(2) No
@
Mark One Only
NOWRK
What is the main reason [fill TEMPNAME] did not work
at a job or business between [fill MONTH1] 1st
and today?
(1) Temporarily unable to work because of an injury
(2) Temporarily unable to work because of an illness
(3) Unable to work because of chronic health condition
or disability
(4) Retired
(5) Pregnancy/childbirth
(6) Taking care of children/other persons
(7) Going to school
(8) Unable to find work
(9) On layoff (temporary or indefinite)
(10) Not interested in working at a job
(11) Other
@
Mark One Only
ONOWRK
ENTER THE SPECIFIC "OTHER" REASON DID NOT WORK
@
Mark One Only
WCYN3
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Page 48 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
UECYN3
(At any time since [fill MONTH1] 1st)
Did [fill HESHE] receive any money
from unemployment compensation?
(1) Yes
(2) No
@
Multiple Entry
UECYNTP3
What type was it?
ENTER (N) FOR NO MORE
(1) Regular
(2) Supplemental
(3) Other, including union benefits
@1 @2 @3
Mark One Only
LAYOFF
Did [fill TEMPNAME] spend any time on layoff from a
job since [fill MONTH1] 1st?
H
(1) Yes
(2) No
@
Mark One Only
LAYDT
When [fill TEMPNAME] [fill WASWERE] laid off,
did [fill HISHER] employer give [fill HIMHER] a date
to return to work?
(1) Yes
(2) No
@
Mark One Only
LAY6M
[fill C_WASWERE] [fill HESHE] given any indication
that [fill HESHE] would be recalled to work within
6 months of being laid off?
(1) Yes
(2) No
@
Mark One Only
LKWRK
Did [fill TEMPNAME] spend any time looking for work
since [fill MONTH1] 1st?
H
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 49 of 340
Survey:
Section: Section: Labor Force 1
Items Booklet
Mark All That Apply
WKSLKG
SHOW CALENDAR ON FLASHCARD E
Please look at the calendar. In which weeks [fill WASWERE]
[fill TEMPNAME] [fill LAYOFFFIL]?
ENTER THE NUMBERS BESIDE THE WEEKS, EVEN IF ONLY ONE DAY
OF THAT WEEK WAS SPENT LOOKING OR ON LAYOFF.
ENTER (A) IF ALL WEEKS / ENTER (N) AFTER LAST REPORTED WEEK
[fill WK(<1>)] [fill WK(<7>)] [fill WK(<13>)]
[fill WK(<2>)] [fill WK(<8>)] [fill WK(<14>)]
[fill WK(<3>)] [fill WK(<9>)] [fill WK(<15>)]
[fill WK(<4>)] [fill WK(<10>)] [fill WK(<16>)]
[fill WK(<5>)] [fill WK(<11>)] [fill WK(<17>)]
[fill WK(<6>)] [fill WK(<12>)] [fill WK(<18>)]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
@KEY
TAKJOB
Mark One Only
if LAYOFFLG eq <1> and (LAYDT eq <1> or LAY6M eq <1>) and LKWRK eq <1>
Could [fill TEMPNAME] have started a job during any
of those weeks if one had been offered or could
[fill HESHE] have returned to work if [fill HESHE]
had been recalled?
[else]
[if LKWRK eq <1>]
Could [fill TEMPNAME] have started a job during any of
those weeks if one had been offered?
[else]
Could [fill TEMPNAME] have returned to work during
any of those weeks if [fill HESHE] had been recalled?
(1) Yes
(2) No
@
NOTAKE
Mark One Only
Why was that?
H
(1)
(2)
(3)
(4)
Waiting for a new job to begin
Own temporary illness
School
Other
@
Mark One Only
EMPNUM
[fill TEMP2]
[fill TEMP3]
How many employers [fill HAVHAS] [fill TEMPNAME] had
between [fill MONTH1] 1st and today?
@
Page 50 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
CONCHK1
Did [fill TEMPNAME] have a definite arrangement with
one or more employers to work on an ongoing basis?
(1) Yes
(2) No
(3) Not Sure or Don't Know
@
Mark One Only
EMPNUM2
How many employers did [fill TEMPNAME] have
between [fill MONTH1] 1st and today?
@
Mark One Only
EMPNUM2A
How many employers did [fill TEMPNAME] have
between [fill MONTH1] 1st and today?
ENTER (N) FOR NONE
@
Mark One Only
CONCHK2
Did [fill TEMPNAME] have a definite arrangement with
any of [fill HISHER] [fill EMPNUM] employers
to work on an ongoing basis?
(1) Yes
(2) No
(3) Not Sure or Don't Know
@
Mark One Only
WRKTYPE
Did [fill TEMPNAME] generally do the same type of work for
[fill HISHER] [fill TEMP2] employers?
(READ IF NECESSARY: For example: construction work, private
household work, sales, consulting.)
(1) Yes
(2) No
@
EMPNAM
Enter Text
[fill TEMP]
What is the name of [fill TEMP2]
[fill TEMP3] [fill TEMP4]
H
@
Wednesday, August 27, 2003
Page 51 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
STRTJB
Did [fill TEMPNAME] start working for
[fill EMPNAM] at some time between [fill MONTH1] 1st and today?
(1) Yes
(2) No
@
Multiple Entry
STRTREFP
Please look at the calendar and tell me the month and day
[fill TEMPNAME] began.
MONTH: @MON
DAY: @DAY
Mark One Only
STRTBEFR
Please tell me the year [fill TEMPNAME] began.
YEAR: @YR
Mark One Only
STRTMONJB
And in what month was that?
MONTH: @
Mark One Only
STRTJYR
What is your BEST estimate of the year when
[fill TEMPNAME] began employment with
[fill EMPNAM]?
YEAR: @
Mark One Only
STRTJMTH
What is your BEST estimate of the month
[fill TEMPNAME] began?
MONTH @
Mark One Only
STRTJDY
What is your BEST estimate of the day of the month
when [fill TEMPNAME] began?
DAY: @
Mark One Only
BEFORE
Was it before [fill MONTH1] 1st?
(1) Yes
(2) No
@
Page 52 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
STLEMP
[fill C_AREIS] [fill HESHE] employed by [fill EMPNAM] now?
H
(1) Yes
(2) No
@
Multiple Entry
ENDJB
When did [fill HISHER] employment with
[fill EMPNAM] end?
MONTH: @MON
DAY: @DAY
Mark One Only
ENDJMTH
What is your best estimate of the month
when [fill TEMPNAME] ended employment with
[fill EMPNAM]?
MONTH: @
Mark One Only
ENDJDY
What is your best estimate of the day of the month when
[fill TEMPNAME] ended employment with
[fill EMPNAM]?
DAY:
@
Mark One Only
RSEND
What is the main reason [fill HESHE] stopped working
for [fill EMPNAM]?
(1) On Layoff
(2) Retirement or old age
(3) Childcare problems
(4) Other family/personal obligations
(5) Own Illness
(6) Own Injury
(7) School/Training
(8) Discharged/Fired
(9) Employer Bankrupt
(10) Employer sold business
(11) Job was temporary and ended
(12) Quit to take another job
(13) Slack work or business conditions
(14) Unsatisfactory work arrangements (hours, pay, etc.)
(15) Quit for some other reason
@
Mark One Only
WCYN1
Since [fill MONTH1] 1st, did [fill HESHE] receive any money from
workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 53 of 340
Survey:
Section: Section: Labor Force 1
Items Booklet
Mark One Only
UECYN1
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1) Yes
(2) No
@
Multiple Entry
UECYNTP1
What type was it?
ENTER (N) FOR NO MORE
(1) Regular
(2) Supplemental
(3) Other, including union benefits
@1 @2 @3
Mark One Only
ALLBUSNUM
How many businesses did [fill TEMPNAME]
have, alone or jointly, between [fill MONTH1] 1st
and today?
CONSIDER A PROFESSIONAL PRACTICE OR A FARM TO BE A BUSINESS.
[fill TEMP]
H
@
Mark One Only
What is the name of [fill TEMP2]
[fill TEMP3]
|
[fill TEMP4]
|
|
@
|
ALLBUS
|{display T_PREVBUS template}
Mark One Only
REALBIZ
Did [fill TEMPNAME] take an active part in
this business or did [fill HESHE] own it
as an investment only?
H
(1) Active participant
(2) Both participant and investment
(3) Investment only
@
Mark One Only
STRTBUS
Did [fill TEMPNAME] start [fill ALLBUS]
at some time between [fill MONTH1] 1st
and today?
(1) Yes
(2) No
@
Page 54 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Multiple Entry
STRTBSRP
Please look at the calendar and tell me the month and day
[fill TEMPNAME] started this business.
MONTH: @MON
DAY: @DAY
Mark One Only
STRTBSBF
Please tell me the year [fill TEMPNAME] started
this business.
YEAR: @YR
Mark One Only
STRTMONBS
And in what month was that?
MONTH: @
Mark One Only
STRTBYR
Business: [fill ALLBUS]
What is your BEST estimate of the year when
[fill TEMPNAME] started this business?
YEAR: @
Mark One Only
STRTBMTH
Business: [fill ALLBUS]
What is your BEST estimate of the month
when [fill TEMPNAME] started this business?
MONTH: @
Mark One Only
STRTBDY
Business: [fill ALLBUS]
What is your BEST estimate of the day of the month
when [fill TEMPNAME] started this business?
DAY:
@
Mark One Only
BEFORE2
Was it before [fill MONTH1] 1st?
(1) Yes
(2) No
@
Mark One Only
BIZNOW
[fill C_DODOES] [fill TEMPNAME] still own this business?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 55 of 340
Survey:
Section: Section: Labor Force 1
Multiple Entry
Items Booklet
ENDBS
When was the last day that [fill TEMPNAME]
had this business?
MONTH: @MON
DAY: @DAY
Mark One Only
ENDBMTH
What is your best estimate of the last month
when [fill TEMPNAME] [fill WASWERE]
had this (business), [fill ALLBUS]?
MONTH: @
Mark One Only
ENDBDY
What is your best estimate of the last day when
[fill TEMPNAME] [fill WASWERE]
had this (business), [fill ALLBUS]?
DAY: @
Mark One Only
RENDB
Business: [fill ALLBUS]
What is the main reason [fill HESHE] gave up or ended
the [fill ALLBUS]?
(1) Retirement or old age
(2) Childcare Problems
(3) Other Family/Personal Problems
(4) Own Illness
(5) Own Injury
(6) School/Training
(7) Went Bankrupt/Business Failed
(8) Sold Business or Transferred Ownership
(9) To start other business/take job
(10) Season ended for a Seasonal Business
(11) Quit for Some Other Reason
@
Mark One Only
OENDB
ENTER THE SPECIFIC "OTHER" REASON ENDED BUSINESS
@
Mark One Only
WCYN2
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Page 56 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
LNGJOB
For which of these [fill JOBCNTR]
| Display ELST1 template
employers did [fill HESHE] work the most |
hours between [fill MONTH1] 1st and today?|
H|
@
|
Mark One Only
LNGJOB2
For which of these [fill TEMP2] employers | Display ELST2 template
did [fill HESHE] work the next most hours |
between [fill MONTH1] 1st and today?
|
H|
@
|
Mark One Only
INTRJ
The next questions refer to [fill PTEMPNAME]
employment with [fill EMPNAM].
PRESS "ENTER" TO CONTINUE
@
Mark One Only
CLWRK
ASK OR VERIFY
[fill TEMP2] [fill EMPNAM]:
H
(1) A Government organization (includes Armed Forces),
(2) A Private, For Profit, Company,
(3) A Non-Profit Organization, including tax exempt
and charitable organizations, OR
(4) A family business or farm?
@
Mark One Only
FAMWRK
[fill TEMP2] [fill TEMPNAME] paid for [fill HISHER]
work in the family business or farm?
(1) Yes
(2) No
@
Mark One Only
KINDG
EMPLOYER: [fill EMPNAM]
ASK OR VERIFY
[fill TEMP2] that Federal Government, State Government,
or Local Government or active-duty Armed Forces?
H
(1) Federal (civilian only)
(2) State
(3) Local (County, City, Township)
(4) Armed Forces (active duty only)
@
Wednesday, August 27, 2003
Page 57 of 340
Survey:
Section: Section: Labor Force 1
Items Booklet
Mark One Only
FNCGV
Employer: [fill EMPNAM]
What [fill TEMP2] the main function or activity of the
government organization that [fill TEMPNAME]
[fill TEMP3] for?
H
@
Mark One Only
KNDIN
Employer: [fill EMPNAM]
What [fill TEMP3] [fill TEMP2]
[fill TEMP4] [fill TEMP7]
H
@
Mark One Only
TYPIN
EMPLOYER: [fill EMPNAM]
ASK OR VERIFY
[fill TEMP2] it mainly -H
(1)
(2)
(3)
(4)
(5)
Manufacturing
Wholesale Trade
Retail Trade
Service
Or Something Else?
@
Mark One Only
KNDWK
Employer: [fill EMPNAM]
What kind of work [fill TEMP2] [fill HESHE]
[fill TEMP4], that is, what [fill TEMP3] [fill HISHER] occupation?
READ IF NECESSARY:
For example: Bookkeeper, plumber, press operator
[r]H[n]
@
Mark One Only
ACTVT
Employer: [fill EMPNAM]
What [fill TEMP2] [fill HISHER] usual activities or
[fill TEMP4]
READ IF NECESSARY: For example: Keeping account books,
repairing pipes, operating printing press
H
@
Page 58 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
YRSINOCC
Multiple Entry
Employer: [fill EMPNAM]
Considering [fill HISHER] entire working-life, how many
years [fill TEMP2] [fill TEMPNAME] been in [fill TEMP3]
occupation or line of work?
H
@NMR
(1) MONTHS
(2) YEARS
@MY
Mark One Only
JOBHRS
Employer: [fill EMPNAM]
[fill TEMP]
[fill TEMP2]
[fill TEMP3]
H
ENTER (V) IF HOURS VARY
@
Mark One Only
PTYN
[fill DOESDIDFIL] [fill TEMPNAME] usually work 35 hours or more per
week for [fill EMPNAM]?
(1) Yes
(2) No
@
Mark One Only
UNION
Employer: [fill EMPNAM]
[if TEMP4 ne <>][fill TEMP4] [endif][fill TEMP2] [fill TEMPNAME]
a member of either a labor union or an employee
association like a union?
H
(1) Yes
(2) No
@
Mark One Only
CNTRC
Employer: [fill EMPNAM]
[fill ISWASFIL] [fill HESHE] COVERED by either a union
contract or something like a union contract?
H
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 59 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
EMPLOC
ASK OR VERIFY:
[fill TEMP2] [fill EMPNAM] operate in more than one location?
(1) Yes
(2) No
@
Mark One Only
EMPSIZE
About how many people [fill AREWEREFIL]
employed by [fill EMPNAM][if EMPLOC ne <2>] at the location where
[fill TEMPNAME] [fill WORKFIL][endif]?
H
...less than 10, 10 to 25, 25 to 100,
100 to 500, 500 to 1,000, or more than 1,000?
(1)
(2)
(3)
(4)
(5)
(6)
Under 10
10 to 24
25 to 99
100 to 499
500 to 999
1,000 or more
@
Mark One Only
EMPALL
ASK IF NECESSARY:
About how many people [fill AREWEREFIL] employed
by [fill EMPNAM] at ALL LOCATIONS together?
... less than 10, 10 to 25, 25 to 100,
100 to 500, 500 to 1,000, or more than 1,000?
(1)
(2)
(3)
(4)
(5)
(6)
Under 10
10 to 24
25 to 99
100 to 499
500 to 999
1,000 or more
@
Mark One Only
EMPASSIST1
Did a state or local welfare office help you in any way to
get this job?
(1) Yes
(2) No
@
Page 60 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
EMPASSIST2
Did [fill WELFAREPAYFIL]
money to cover all or part of [fill PTEMPNAME]
hiring, training, or wages?
(1) Yes
(2) No
(3) Don't know/not sure
@
Multiple Entry
I recorded that [fill TEMPNAME] had
**READ BUSINESS NAMES**
since [fill MONTH1] 1st. Which two of
these businesses produced the highest
earnings before expenses during this
time period?
|
|
@1
@2
|
BIGBUS
| Display BLST1 template
|
|
|
|
Mark One Only
INTRB
The next questions refer to [fill PTEMPNAME] business
[fill ALLBUS].
PRESS "ENTER" TO CONTINUE
@
Mark One Only
LSTBS
BUSINESSES OWNED BY OTHER HOUSEHOLD MEMBERS| Display BLST2 template
DO NOT READ TO RESPONDENT
|
|
Have questions about the number of
|
employees, and whether or not the business |
is incorporated already been answered by |
somebody for this business: [fill ALLBUS]?|
|
(1) Yes
|
(2) No
|
|
@
|
Mark One Only
KNDBS
ASK OR VERIFY
Business: [fill ALLBUS]
[if CNTNGTBS eq <1>]
You said that [fill TEMPNAME] had various businesses. What
kind of businesses were these?
[else]
What kind of business [fill TEMP2] this?
[endif]
H
READ IF NECESSARY: What [fill TEMP3] the business do or make?
@
Wednesday, August 27, 2003
Page 61 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
TYPBS
ASK OR VERIFY
Business: [fill ALLBUS]
[fill TEMP2] [fill TEMP3] mainly -(1)
(2)
(3)
(4)
(5)
Manufacturing
Wholesale Trade
Retail Trade
Service
Or Something Else?
@
Mark One Only
OCCBS
Business: [fill ALLBUS]
What kind of work [fill TEMP3] [fill TEMPNAME] do,
that is, what [fill TEMP2] [fill HISHER] occupation?
READ IF NECESSARY: For example: sales manager, dentist, farmer
H
@
Mark One Only
DUTYB
Business: [fill ALLBUS]
What [fill TEMP2] [fill HISHER] usual activities
or duties in [fill TEMP3]?
READ IF NECESSARY: For example: managing sales staff,
repairing teeth, farming
H
@
Mark One Only
HRSBS
[fill DURINGWKSFIL]
how many hours per week did [fill HESHE]
usually work AT ALL ACTIVITIES for [fill ALLBUS]?
H
ENTER (V) IF HOURS VARY
@
Mark One Only
BPTYN
[fill DOESDIDFIL] [fill TEMPNAME] usually work 35
hours or more per week for [fill ALLBUS]?
(1) Yes
(2) No
@
Page 62 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
GRSSB
Business: [fill ALLBUS]
Do you think the earnings before expenses from
[fill TEMP4] were $2500 or more over the [fill TEMP3]
that [fill HESHE] [fill TEMP2] [fill TEMP5]?
H
(1) Yes
(2) No
@
Mark One Only
GROSB
Business: [fill ALLBUS]
Do you think that the earnings before expenses from
[fill TEMP4] will be $2500 or more during the next
12 months?
H
(1) Yes
(2) No
@
Mark One Only
EMPB
Between [fill MONTH1] 1st and today,
what was the maximum number of employees, including
[fill TEMPNAME], working for this business at any one time?
Was that less than 10, 10 to 25, 25 to 100, 100 to 500,
500 to 1,000, or more than 1,000?
(1)
(2)
(3)
(4)
(5)
(6)
Under 10
10 to 24
25 to 99
100 to 499
500 to 999
1,000 or more
@
Mark One Only
INCPB
Business: [fill ALLBUS]
[fill TEMP2] this business incorporated?
H
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 63 of 340
Survey:
Section: Section: Labor Force 1
Items Booklet
PROPB
Mark One Only
Business: [fill ALLBUS]
[fill TEMP2] [fill TEMPNAME] own this business [fill SELF]
or [fill TEMP3] it a partnership?
H
(1) Alone
(2) Partnership
@
HPRTB
Mark One Only
Business: [fill ALLBUS]
[fill TEMP2] any other member of this household
an owner or partner in this business?
(1) Yes
(2) No
@
Mark All That Apply
Business: [fill ALLBUS]
PARTB
| Display T_HHROS template
|
Who [fill TEMP2] that?
|
|
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
|
@KEY
|
|
|
|
Mark One Only
HRSALL
During the weeks that [fill TEMPNAME] worked between | Display T_HRSALL template
[fill MONTH1] 1st and today at
|
**READ LIST**, how many hours per week
|
did [fill TEMPNAME] usually work at all [fill JOBFIL]|
activities?
|
|
ENTER (V) IF HOURS VARY
|
|
@ hours
|
Mark One Only
LMPNOW
Did [fill TEMPNAME] receive any
| Display T_LMPNOW template
severance pay or lump sum payments from |
a pension or retirement plan when
|
[fill HESHE][fill LEFTJOBFIL][fill ORFIL] |
[fill LEFTBUSFIL][if LEFTBUSFIL ne <>]? |
|
(1) Yes
|
(2) No
|
|
@
|
Page 64 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
LMPFUTR
[fill C_DODOES] [fill TEMPNAME] ever expect to receive
any such payments from [fill JOBFIL][fill ORFIL][fill BUSFIL]?
(1) Yes
(2) No
@
Multiple Entry
LUMPTYP
What type of payment?
ENTER ALL THAT APPLY
ENTER (N) NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Lump sum from pension/retirement plan
Severance pay
Deferred payment(s) payable at some later date
Something else [if @4 eq <4>]SPECIFY: @SP
@KEY
Mark All That Apply
CONWKSWRK
SHOW CALENDAR ON FLASHCARD E
FULL CALENDAR WEEK = SUNDAY THROUGH SATURDAY
Please look at the calendar. In which weeks did [fill TEMPNAME]
work at a job or business or do any work at all for pay or profit?
READ IF NECESSARY: Count PAID vacation and PAID sick time as weeks
worked
ENTER THE NUMBERS OF THE WEEKS
ENTER (A) IF ALL WEEKS
ENTER (N) FOR NONE OR NO MORE WEEKS
[fill WK(<1>)]
[fill WK(<2>)]
[fill WK(<3>)]
[fill WK(<4>)]
[fill WK(<5>)]
[fill WK(<6>)]
[fill WK(<7>)] [fill WK(<13>)]
[fill WK(<8>)] [fill WK(<14>)]
[fill WK(<9>)] [fill WK(<15>)]
[fill WK(<10>)] [fill WK(<16>)]
[fill WK(<11>)] [fill WK(<17>)]
[fill WK(<12>)] [fill WK(<18>)]
(19) After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Mark One Only
FPAWOP
HAND RESPONDENT CALENDAR/FULL CALENDAR WEEK = SUNDAY THROUGH SATURDAY
Since [fill MONTH1] 1st,
were there any full calendar weeks
when [fill TEMPNAME] did not work at all?
H
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 65 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
FPAWAY
Did [fill TEMPNAME] get paid for ALL those weeks [fill HESHE]
did not work?
H
(1) Yes
(2) No
@
Mark All That Apply
FPABWK
SHOW CALENDAR ON FLASHCARD E
In which weeks [fill WASWERE]'nt [fill TEMPNAME] paid?
ENTER THE NUMBERS OF THE WEEKS ABSENT WITHOUT PAY
ENTER (A) IF ALL WEEKS
ENTER (N) AFTER LAST WEEK IS ENTERED
H
[fill WK(<1>)] [fill WK(<7>)] [fill WK(<13>)]
[fill WK(<2>)] [fill WK(<8>)] [fill WK(<14>)]
[fill WK(<3>)] [fill WK(<9>)] [fill WK(<15>)]
[fill WK(<4>)] [fill WK(<10>)] [fill WK(<16>)]
[fill WK(<5>)] [fill WK(<11>)] [fill WK(<17>)]
[fill WK(<6>)] [fill WK(<12>)] [fill WK(<18>)]
(19) After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Mark One Only
FPABRE
What was the main reason [fill TEMPNAME] [fill WASWERE]n't
paid during [fill THATWKFIL]?
H
(1) On layoff (temporary or indefinite)
(2) Slack work or business conditions
(3) Own injury
(4) Own illness/medical problems
(5) Pregnancy/childbirth
(6) Taking care of children
(7) On vacation/personal days
(8) Bad weather
(9) Labor dispute
(10) New job to begin within 30 days
(11) Participated in a job-sharing arrangement
(12) Other
@
Mark One Only
FPOTHR
ENTER THE SPECIFIC "OTHER" REASON ABSENT WITHOUT PAY
@
Mark One Only
WCYN4
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Page 66 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
UECYN4
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1) Yes
(2) No
@
Multiple Entry
UECYNTP4
What type was it?
ENTER (N) FOR NO MORE
(1) Regular
(2) Supplemental
(3) Other, including union benefits
@1 @2 @3
Mark One Only
PPAWOP
SHOW CALENDAR ON FLASHCARD E
FULL CALENDAR WEEK = SUNDAY THROUGH SATURDAY
During the weeks that [fill TEMPNAME] [fill WASWERE]
employed, were there any full calendar weeks when [fill HESHE]
did not work at all?
H
IF THE RESPONDENT NEEDS TO KNOW WHAT CALENDAR WEEKS TO CHOOSE
FROM, READ THE RESPONDENT THE FOLLOWING WEEKS:
[fill table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
[fill table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
[fill table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
[fill table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
[fill table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
[fill table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
(1) Yes
(2) No
@
[@] [equiv FPAWOP] <1> <2,D,R> [goto LF67] [etc ]
Mark One Only
PPAWAY
Did [fill TEMPNAME] get paid for ALL those weeks
[fill HESHE] did not work?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 67 of 340
Survey:
Section: Section: Labor Force 1
Mark All That Apply
Items Booklet
PPABWK
Please look at the calendar. In which weeks [fill WASWERE]n't
[fill TEMPNAME] paid?
ENTER THE NUMBERS OF THE WEEKS ABSENT WITHOUT PAY
ENTER (A) IF ALL WEEKS
ENTER (N) AFTER LAST WEEK IS ENTERED
[fill table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
[fill table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
[fill table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
[fill table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
[fill table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
[fill table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Mark One Only
PPABRE
What was the main reason [fill TEMPNAME] [fill WASWERE]n't
paid during [fill THATWKFIL]?
H
(1) On layoff (temporary or indefinite)
(2) Slack work or business conditions
(3) Own injury
(4) Own illness/medical problems
(5) Pregnancy/childbirth
(6) Taking care of children
(7) On vacation/personal days
(8) Bad weather
(9) Labor dispute
(10) New job to begin within 30 days
(11) Participated in a job-sharing arrangement
(12) Other
@
Mark One Only
WCYN5
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Mark One Only
UECYN5
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1) Yes
(2) No
@
Page 68 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Multiple Entry
UECYNTP5
What type was it?
ENTER (N) FOR NO MORE
(1) Regular
(2) Supplemental
(3) Other, including union benefits
@1 @2 @3
Mark One Only
PPLOOK
At any time since [fill MONTH1] 1st did [fill TEMPNAME]
spend any time on layoff from a job?
H
IF THE RESPONDENT NEEDS TO KNOW WHAT CALENDAR WEEKS TO CHOOSE
FROM, READ THE RESPONDENT THE FOLLOWING WEEKS:
[fill table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
[fill table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
[fill table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
[fill table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
[fill table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
[fill table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
(1) Yes
(2) No
@
Mark One Only
PPLAYDT
When [fill TEMPNAME] [fill WASWERE] laid off, did
[fill HISHER] employer give [fill HIMHER] a date
to return to work?
(1) Yes
(2) No
@
Mark One Only
PPLAY6M
[fill C_WASWERE] [fill HESHE] given any indication
that [fill HESHE] would be recalled to work within 6
months of being laid off?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 69 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
PPLKWRK
[if PPLOOK ne <1>]
During the weeks when [fill HESHE] did not have a job
or business, did [fill TEMPNAME] spend any time looking
for work?
[else]
During those weeks did [fill TEMPNAME] spend any time
looking for work?
[endif]
H
(1) Yes
(2) No
@
Mark All That Apply
PPLKWK
In which of those weeks [fill WASWERE] [fill TEMPNAME]
[fill LOOKINGFIL]?
H
ENTER THE NUMBERS BESIDE THE WEEKS, EVEN IF ONLY
ONE DAY OF THAT WEEK WAS SPENT LOOKING OR ON LAYOFF.
ENTER (A) IF ALL WEEKS
ENTER (N) AFTER LAST REPORTED WEEK
[fill table3(<1>):l] [fill table3(<7>):l] [fill table3(<13>):l]
[fill table3(<2>):l] [fill table3(<8>):l] [fill table3(<14>):l]
[fill table3(<3>):l] [fill table3(<9>):l] [fill table3(<15>):l]
[fill table3(<4>):l] [fill table3(<10>):l] [fill table3(<16>):l]
[fill table3(<5>):l] [fill table3(<11>):l] [fill table3(<17>):l]
[fill table3(<6>):l] [fill table3(<12>):l] [fill table3(<18>):l]
[if M5WRK eq <1>](19) After [fill MONTH5] 1st
@KEY [fill ERRORFIL]
Mark One Only
PPTAKJOB
[if PPLOOK eq <1> and (PPLAYDT eq <1> or PPLAY6M eq <1>) and
PPLKWRK eq <1>]
Could [fill TEMPNAME] have started a job during
those weeks if one had been offered or could [fill HESHE]
have returned to work if [fill HESHE] had been recalled?
[else]
[if PPLKWRK eq <1>]
Could [fill TEMPNAME] have started a job during any of
those weeks if one had been offered?
[else]
Could [fill TEMPNAME] have returned to work during any
of those weeks if [fill HESHE] had been recalled?
(1) Yes
(2) No
@
Page 70 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
PPNOTAKE
Why was that?
H
(1)
(2)
(3)
(4)
Waiting for a new job to begin
Own temporary illness
School
Other
@
Mark One Only
NOTHER
ENTER THE SPECIFIC "OTHER" REASON COULD NOT TAKE JOB
@
Mark One Only
SOMWRK
During the weeks that [fill TEMPNAME] did not
have a job or a business, did [fill HESHE] do
any work at all that earned some money?
H
(1) Yes
(2) No
@
Multiple Entry
MTHWRK
In which of the months [fill MONTH1] through
[fill MONTH4] did [fill HESHE] do that work?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1) Yes
(2) No
[fill MONTH1]: @1
[fill MONTH2]: @2
[fill MONTH3]: @3
[fill MONTH4]: @4
Mark One Only
WCYN6
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Mark One Only
UECYN6
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 71 of 340
Survey:
Section: Section: Labor Force 1
Multiple Entry
Items Booklet
UECYNTP6
What type was it?
ENTER (N) FOR NO MORE
(1) Regular
(2) Supplemental
(3) Other, including union benefits
@1 @2 @3
Mark One Only
PTWRK
[fill JUSTCNTFIL]
|Display T_HRSALL template
[fill JUSTCNTFIL2]
|
Were there any weeks when [fill HESHE] |
worked less than 35 hours?
|
H|
INCLUDE HOURS WORKED AT ALL JOBS/BUSINESSES|
COMBINED
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark One Only
PTRESN
I have recorded that there were weeks in which [fill TEMPNAME]
worked less than 35 hours. What was the main reason [fill HESHE]
worked less than 35 hours in those weeks?
H
(1) Could not find full-time job
(2) Wanted to work part-time
(3) Temporarily unable to work full-time because of injury
(4) Temporarily unable to work full-time because of illness
(5) Unable to work full-time because of chronic
health condition/disability
(6) Taking care of children/other persons
(7) Full-time workweek is less than 35 hours
(8) Slack work or material shortage
(9) Participated in a job-sharing arrangement
(10) On vacation
(11) In school
(12) Other
@
Page 72 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Mark One Only
PTRESNB
What was the main reason [fill TEMPNAME] worked
less than 35 hours in those weeks?
H
(1) Could not find full-time job
(2) Wanted to work part-time
(3) Temporarily unable to work full-time because of injury
(4) Temporarily unable to work full-time because of illness
(5) Unable to work full-time because of chronic
health condition/disability
(6) Taking care of children/other persons
(7) Full time workweek is less than 35 hours
(8) Slack work or material shortage
(9) Participated in a job-sharing arrangement
(10) On vacation
(11) In school
(12) Other
@
Mark One Only
PTSPEC
ENTER THE SPECIFIC "OTHER" REASON FOR PART TIME WORK
@
Mark One Only
SITNOWCT
ASK OR VERIFY
[fill C_DODOES] [fill HESHE] work at a job,
a business, or something else to earn money NOW?
(1) Yes
(2) No
(3) Not sure or Don't know
@
Mark One Only
SITNOW
What best describes [fill HISHER] situation now?
READ ALL ANSWERS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Looking for work
On layoff from a job
Waiting for a new job to begin
Retired
Taking care of home and family (including pregnancy)
In school
Not able to work because of illness or disability
Or something else?
@
Mark One Only
OTHSIT
ENTER THE SPECIFIC "OTHER" SITUATION
@
Wednesday, August 27, 2003
Page 73 of 340
Survey:
Section: Section: Labor Force 1
Mark One Only
Items Booklet
DISABL
[fill LASTTIMEFIL] a physical,mental or
other health condition that limits the kind
or amount of work [fill HESHE] can do at a
job or business [fill PUNCTUATIONFIL]
[fill CONDITIONFIL]
(1) Yes
(2) No
@
Mark One Only
DISPREV
[if NOWRK eq <3>]Earlier I recorded that [fill TEMPNAME] [fill HAVHAS]
a health condition or disablity that limits [fill HISHER]
ablilty to work.[endif]
Does [fill PTEMPNAME] health or condition prevent
[fill HIMHER] from working at a job or business?
(1) Yes
(2) No
@
Mark One Only
EVERET
[fill C_HAVHAS] [fill HESHE] ever retired, for any reason,
from a job or business[fill TEMP]?
(1) Yes
(2) No
@
Mark One Only
WCYN7
Since [fill MONTH1] 1st, did [fill HESHE] receive any money
from workers' compensation as a result of any kind of job-related
injury or illness?
(1) Yes
(2) No
@
Mark One Only
UECYN7
(At any time since [fill MONTH1] 1st)
Did [fill TEMPNAME] receive any money from
unemployment compensation?
(1) Yes
(2) No
@
Page 74 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 1
Multiple Entry
UECYNTP7
What type was it?
ENTER (N) FOR NO MORE
(1) Regular
(2) Supplemental
(3) Other, including union benefits
@1 @2 @3
Mark One Only
HPDJBTHN
Guidelines for new welfare-related work situations:
If the person himself/herself earns any money at all (including
compensation in the form of a paycheck, a welfare check, or any other
form of payment) then enter this work the same way as for any
other paid job. Such work makes the person a worker.
This definition means that the kinds of work on the following list
of allowable activities to permit receipt of welfare payments are to
be treated the same as any other work for pay or profit:
-
work done solely in exchange for a welfare check
unsubsidized employment
subsidized private-sector employment
subsidized public-sector employment
PRESS "ENTER" TO EXIT HELP @
Wednesday, August 27, 2003
Page 75 of 340
Survey:
Section: Section: General Income 1
Mark One Only
Items Booklet
OTHINT
Next are questions about [fill PTEMPNAME] other sources of
income since [fill MONTH1] 1st.
PRESS "ENTER" TO CONTINUE
@
Mark One Only
VAYN
Did [fill TEMPNAME] receive any payments from the VA - that is,
the Department of Veterans Affairs?
(1) Yes
(2) No
@
Multiple Entry
VAYNTYPE
What type of payment?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Service-connected disability compensation
Survivor Benefits
Veteran's Pension
Other VA Payments {pop up SPECIFY: @sp}
DO NOT READ:
(5) Military retirement pay
(6) GI Bill benefits
(7) Insurance proceeds
@KEY
Mark One Only
VAMILRET
Just to be sure -- was that regular military retirement,
disability compensation, or a survivor benefits?
(1) Military retirement
(2) Disability compensation
(3) Survivor benefits
@
Mark One Only
VAQUES
[fill C_AREIS] [fill TEMPNAME] required to fill out an
annual income questionnaire in order to receive
VA benefits?
(1) Yes
(2) No
@
Page 76 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
Mark One Only
SSYN
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any Social Security payments?
H
(1) Yes
(2) No
@
Multiple Entry
SSCLDYN
(Since [fill MONTH1] 1st,)
| {display >GDLST< Template}
Did [fill TEMPNAME] receive any
|
Social Security Income on behalf of:
|
***READ NAME(S) OF CHILD(REN)***?
|
H|
(1) Yes (2) No
@CHILD
|
|
Did [fill TEMPNAME] receive any Social
|
Security income for [fill SELF]?
|
H|
(1) Yes (2) No
@SELF
|
Mark One Only
DISYN
Earlier I recorded that [fill TEMPNAME]
[fill HAVHAS] a health condition which limits
the kind or amount of work [fill HESHE] can do.
(Since [fill MONTH1] 1st,)
Did [fill HESHE] receive any income
[fill OTHERTHANFIL]
because of [fill HISHER] health condition?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 77 of 340
Survey:
Section: Section: General Income 1
Multiple Entry
Items Booklet
DISTYP
What kind of income was that? Anything else?
H
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE/RE-ENTER PRECODE TO DELETE
(1) Workers' Compensation
(2) Payments from a sickness, accident, or disability insurance policy
(3) Employer disability payments
(4) Pension from company or union including income from profit-sharing
plans
(5) Federal Civil Service or other Federal civilian employee pension
(6) State government pension
(7) Local government pension
[fill <(8) U.S. Military retirement pay>/<>]
(9) U.S. Government Railroad Retirement
(10) Black Lung payments
(11) Supplemental Security Income (SSI)
(12) Other (SPECIFY: @SP)
@KEY
{pop-up}
Did [fill TEMPNAME] purchase that policy on [fill HISHER] own?
(1) Yes (2) No @13
@KEY
Mark One Only
RETYN
Earlier I recorded that [fill TEMPNAME] retired from a
previous job.
[fill OTHERTHANFIL]
[fill SSHLTHFIL] [fill DIDFIL]
[fill HESHE] receive any [fill OTHERFIL] retirement income (since
[fill MONTH1] 1st)?
(1) Yes
(2) No
@
Multiple Entry
RETTYP
What kind of income was that? Anything else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
REENTER PRECODE TO DELETE
(1) Pension from company or union
including income from profit-sharing plans
(2) Federal Civil Service or other Federal civilian employee pension
(3) State government pension
(4) Local government pension
[fill <(5) U.S. Military retirement pay>/<>]
(6) U.S. Government Railroad Retirement
(7) National Guard or Reserve Forces retirement
(8) Supplemental Security Income
(9) Other {pop up SPECIFY: @SP}
@KEY [fill ERRORFIL]
Page 78 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
Mark One Only
LIFEYN
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any retirement income from
a paid-up life insurance policy or any other annuities?
H
(1) Yes
(2) No
@
Mark One Only
LIFEREG
Did [fill TEMPNAME] receive any retirement income from
a paid-up life insurance policy or any other annuities?
H
(1) Yes
(2) No
1
Does that come as a regular series of payments, or a
single lump sum?
(1) Regular series
(2) Lump sum
@
Mark One Only
SURYN
[fill OTHERTHANFIL]
[fill SSHLTHRETFIL]
(Since [fill MONTH1] 1st,)
[fill DIDFIL] [fill TEMPNAME] recieve any [fill OTHERFIL]
income as a result of being a [fill WIDOWFIL]?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 79 of 340
Survey:
Section: Section: General Income 1
Multiple Entry
Items Booklet
SURTYP
What kind of income was that? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
REENTER PRECODE TO DELETE
(1) Pension from company or union including
income from profit-sharing plans
(2) Veterans' compensation or pension
(3) Federal Civil Service or other Federal civilian employee pension
(4) U.S. Government Railroad Retirement
(5) State government pension
(6) Local government pension
(7) Income from paid-up life insurance policies or annuities
[fill <(8) U.S. Military retirement pay> / <>]
(9) Black Lung benefits
(10) Worker's Compensation
(11) Payments from estate or trust
(12) National Guard or Reserve Forces retirement
(13) Other {pop up SPECIFY: @SP}
@KEY [fill ERRORFIL]
Mark One Only
FCCYN
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any foster child care payments?
(1) Yes
(2) No
@
Mark One Only
CSYN
(Since [fill MONTH1] 1st,)
| NAMES OF CHILDREN
Did [fill TEMPNAME] receive any
| {display children}
child support payments
|
or other financial help from
|
[fill THEIRFILL][fill MOMDADFILL]?
|
**READ NAME(S) OF CHILD(REN)**
|
|
|
(1) Yes
|
(2) No
|
(3) No, absent parent is deceased |
(volunteered)
|
|
@
|
Mark One Only
ALIYN
(Since [fill MONTH1] 1st,)
[fill ALIMONY]
[fill TEMPNAME] receive any
payments from [fill FORMERFIL] spouse,
such as alimony?
(1) Yes
(2) No
@
Page 80 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
INCASE
Mark One Only
(Just to be sure we don't miss anything…) | CHILD(REN)
At any time since [fill MONTH1] 1st,
|{display TEMPNAME's children}
did [fill TEMPNAME] [fill CHILDFIL] receive |
any kind of welfare or public assistance from |
a state or local welfare office -|
any food or housing benefits,
|
welfare-to-work assistance, Medicaid-type |
coverage, emergency help, or anything like |
that?
|
|
(1) Yes
|
(2) No
|
|
@
|
INCASESP
Mark One Only
(Just to be sure we don't miss anything…)
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
[fill CHILDFIL] receive any kind of government
welfare or public assistance -- any food or housing benefits,
welfare-to-work assistance, Medicaid-type
coverage, emergency help, or anything like
that?
(1) Yes
(2) No
1
What kind of assistance was that?
@
ALSO RECORD THIS INCOME SOURCE AT THE
APPROPRIATE SPECIFIC QUESTION, TO FOLLOW
PUBHSE1
Mark One Only
Is this public housing - that is, is it owned by a local housing
authority or other public agency?
DO NOT INCLUDE MILITARY HOUSING
H
(1) Yes
(2) No
@
Mark One Only
VERYRNT
I have recorded that the rent here is lower because the Federal,
State, or Local government is paying part of the cost is that still true?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 81 of 340
Survey:
Section: Section: General Income 1
Items Booklet
GVTRNT1
Mark One Only
Is the rent here lower because the Federal, State, or Local
government is paying part of the cost?
DO NOT INCLUDE MILITARY HOUSING
H
(1) Yes
(2) No
@
WRSECT8
Mark One Only
Is this through Section 8 or through some other government program?
(1) Section 8
(2) Some other government program
(D) Don't know; not sure
@
HOWLONG
Multiple Entry
When was the last time [fill TEMPNAME] did NOT live
in public or subsidized housing?
ENTER (A) FOR ALWAYS LIVED IN PUBLIC OR SUBSIDIZED HOUSING
H
MONTH: @MONTH
YEAR: @YEAR
WHENAPP
Multiple Entry
When did [fill TEMPNAME] move into public or subsidized housing
on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MONTH
YEAR: @YEAR
MTHRNT
Mark One Only
Excluding any rent subsidies, how much
[fill DOYOUFIL] currently pay in monthly rent?
H
(N) NONE
@
Mark One Only
UTILYN
[fill DOESFIL] pay [fill SEPARATELYFIL]
for water, electricity, gas, or oil?
(1) Yes
(2) No
@
Page 82 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
WAITLIST
Mark One Only
[fill AREYOUFIL] on a waiting list for public or
subsidized housing?
(1) Yes
(2) No
@
EGYASSYN
Mark One Only
[fill HAVEYOUFIL] received any energy assistance from the Federal,
State, or Local government since [fill MONTH1] 1st?
H
(1) Yes
(2) No
@
EGYPAYMT
Multiple Entry
Was this assistance received in the form of...
H
(1) Yes (2) No
...checks sent to the household?
@1
...coupons or vouchers sent to the household?
@2
...payments sent directly to the utility company,
fuel dealer, or landlord?
@3
Mark One Only
HOTLUNYN
[fill /<>]
|marked in I_WHOHOTLN or I_WHOHOTLN2}
|
Since [fill MONTH1] 1st, did
|
[fill DIDCLDFIL] usually get the
|
lunch that [fill THEIRFIL]
|
school provides?
|
|
ENTER (1) IF [fill NUMFIL] CHILD
|
USUALLY BOUGHT THE SCHOOL LUNCH
|
OR RECEIVED FREE LUNCH
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
WHOHOTLN
Which children usually got the school lunch? | CHILDREN BETWEEN AGES 5 AND 18
H| LN NAME
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
| {display >KIDS< template}
|
|
@KEY
Wednesday, August 27, 2003
Page 83 of 340
Survey:
Section: Section: General Income 1
Items Booklet
FREELNYN
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
H
(1) Yes
(2) No
@
FREREDLN
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
(1) Yes
(2) No
1
ASK OR VERIFY:
Were they free or reduced-price?
H
(1) Free lunch
(2) Reduced-price lunch
@
Mark One Only
BRKFSTYN
[fill /<>]
|marked in I_WHOBRK or I_WHOBRK2}
|
Since [fill MONTH1] 1st, did
|
[fill DIDCLDFIL] usually get the
|
breakfast that [fill THEIRFIL]
|
school provides?
|
H |
ENTER (1) IF [fill NUMFIL] CHILD
|
USUALLY BOUGHT THE SCHOOL BREAKFAST
|
OR RECEIVED FREE BREAKFAST
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
WHOBRK
Which children usually got the school
| CHILDREN BETWEEN AGES 5 AND 18
breakfast?
| LN NAME
H| {display >KIDS< template}
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
Page 84 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
FREEBRK
Mark One Only
Were any of the breakfasts free or reduced-price because
[fill CHILDFIL] qualified for the
School Breakfast Program?
H
(1) Yes
(2) No
@
FREREDBK
Mark One Only
Were any of the breakfasts free or reduced-price because
[fill CHILDFIL] qualified for the
School Breakfast Program?
(1) Yes
(2) No
1
ASK OR VERIFY:
Were they free or reduced-price?
H
(1) Free breakfast
(2) Reduced-price breakfast
@
Mark One Only
SSIYN
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any income from
a program called Supplemental Security Income that is, SSI[fill FORSELFFIL]
H
(1) Yes
(2) No
@
Multiple Entry
SSICLDYN
(Since [fill MONTH1] 1st,)
| {display >GDLST< Template}
Did [fill TEMPNAME] receive any
|
Supplemental Security Income--that is,
|
SSI-- on behalf of:
|
***READ NAME(S) OF CHILD(REN)***?
|
H|
(1) Yes (2) No
@CHILD
|
|
Did [fill TEMPNAME] receive any SSI
|
income for [fill SELF]?
|
H|
(1) Yes (2) No
@SELF
|
Wednesday, August 27, 2003
Page 85 of 340
Survey:
Section: Section: General Income 1
Multiple Entry
Items Booklet
STSSIYN
[fill EARLIERFIL]
Did [fill TEMPNAME] receive SSI payments from the Federal government,
from the State or local welfare office, or from both?
H
(1) Federal government
(2) State or local welfare office
(3) Both, Federal and State
@1
popup:
ASK OR VERIFY
Did [fill TEMPNAME] receive separate Federal and State payments,
or were they combined in one payment?
(1) Separate payments
(2) Combined in one payment
@2
Mark One Only
FSYN
(Since [fill MONTH1] 1st,)
[fill C_WASWERE] [fill TEMPNAME] [fill WIFEHUSBANDFIL]
authorized to receive food stamps?
H
(1) Yes
(2) No
@
Mark One Only
WICYN
(At any time since [MONTH1] 1st,)
|NAMES
Did TEMPNAME receive benefits
|(display children's names
from WIC - the Women, Infants,and
| under the age of 18
Children nutrition program
| for whom R is a mom, dad
[fill BEHALFFIL)
H | or guardian)
|
(1) Yes
|
(2) No
|
|
@
|
|
|
Mark One Only
WICEVER
[fill C_HAVHAS] [fill TEMPNAME] ever received benefits from
WIC - the Women, Infants, and Children
nutrition program?
H
(1) Yes
(2) No
@
Page 86 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
Mark One Only
WICEVERYN
[fill C_HAVHAS] [fill TEMPNAME] ever received benefits from
WIC - the Women, Infants, and Children
nutrition program?
H
(1) Yes
(2) No
1
How about since [fill MONTH1]1st
(Did[fill HESHE]receive any WIC benefits at
any time since [fill MONTH1] 1st)
(1) Yes
(2) No
@
Mark One Only
PACASH1
(Since [fill MONTH1] 1st,)
|NAMES
Did [fill TEMPNAME] [fill ORCHILDFIL]
|(display children's names
receive any CASH assistance from
| under the age of 18
a state or county welfare program,such as | for whom R is a mom, dad
[fill STPROGFIL] [fill ORTANFFIL] or AFDC? | or guardian
|
(1) Yes
H |
(2) No
|
@
Multiple Entry
PATANF
Which program was that? (What do you call it?)
Anything else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) [TANFFIL1]
[fill <(2) [TANFFIL2]>/<>]
[fill <(3) [TANFFIL3]>/<>]
[fill <(4) TANF, Temporary Assistance for Needy Families>/<>]
(5) AFDC or ADC
(6) Other {pop-up} SPECIFY
@SP
@KEY [fill ERRORFIL]
Mark One Only
PACASH2
How about General Assistance or General Relief
[fill STATEFIL] (since [fill MONTH1] 1st)?
H
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 87 of 340
Survey:
Section: Section: General Income 1
Mark One Only
Items Booklet
PACASH3
(Did [fill TEMPNAME] receive) any short-term cash assistance
(since [fill MONTH1] 1st) to tide [fill HIMHER] over when
[fill HESHE] needed it to help [fill HIMHER] stay off welfare,
or for an emergency?
(1) Yes
(2) No
@1
Mark One Only
PACSH3SP
(Did [fill TEMPNAME] receive) any short-term cash assistance
(since [fill MONTH1] 1st) to tide [fill HIMHER] over when
[fill HESHE] needed it to help [fill HIMHER] stay off welfare,
or for an emergency?
(1) Yes
(2) No
1
Can you give me a label for this assistance, so I'll know how to refer
to it later?
IF RESPONDENT DOES NOT PROVIDE A NAME/DESCRIPTION,
ENTER "SHORT-TERM CASH ASSSISTANCE"
@
Mark One Only
PSSTHRU
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any child support as a bonus or pass-through
from a state or county welfare program, or any disregard payments?
H
(1) Yes
(2) No
@
Mark One Only
PAINTRO
People in need don't always receive unrestricted cash payments
from the government - they may receive money for specific
activities or other kinds of help.
PRESS "ENTER" TO CONTINUE @
Mark One Only
PAOTHR1
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any transportation assistance to help
[fill HIMHER] get to work, school, training, or doctor's appointments -such as gas vouchers, bus passes or help repairing a car?
(1) Yes
(2) No
@
Page 88 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
Mark One Only
PAOTHR2
How about child care services or assistance (since [fill MONTH1] 1st,)
so [fill HESHE] could go to work or school or training?
(1) Yes
(2) No
@
Mark One Only
PAOTHR3
Did [fill TEMPNAME] receive any food assistance
[fill FOODFIL] (since [fill MONTH1] 1st)?
(1) Yes
(2) No
@
Mark One Only
PAOTHR4
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any clothing assistance or clothes, such as
assistance to buy uniforms, or work clothes [fill CLOTHESFIL]?
(1) Yes
(2) No
@
Mark One Only
PAOTHR5
(At any time since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any
assistance to help pay for housing[fill ENERGYFIL]?
(1) Yes
(2) No
@
Mark One Only
PAOTHR6
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any other type of state or county welfare
program assistance [fill [CHILDFIL]?
DO NOT RECORD MEDICAL ASSISTANCE HERE.
(1) Yes
(2) No
@1
Wednesday, August 27, 2003
Page 89 of 340
Survey:
Section: Section: General Income 1
Mark One Only
Items Booklet
PAOTH6SP
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive any other type of welfare program
assistance [fill [CHILDFIL]?
(1) Yes
(2) No
1
What kind of welfare assistance was that?
(What's it called?)
IF RESPONDENT DOES NOT PROVIDE A DESCRIPTION,
ENTER "OTHER WELFARE ASSISTANCE"
@
Mark One Only
WELACTV1
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
attend [fill ATTENDCLASSFIL] to improve basic reading
or math skills?
(1) Yes
(2) No
@
Multiple Entry
WELACTV2
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]...
(1) Yes
(2) No
...attend job readiness training to learn about resume writing,
job interviewing, or building self-esteem?
@1
...attend a job search program or job club, or use a job resource
center to find out about jobs, to schedule interviews,
or to fill out applications?
@2
...attend training to learn a specific job skill, such as computers,
car repair, nursing, day care work, or some other job skill? @3
Mark One Only
WELACTV3
Did [fill TEMPNAME] [TRAINJOBFIL] because the state or county
welfare office required it, or because [fill HESHE] chose to do it,
or for BOTH reasons?
(1) Required to [fill TRAINJOBFIL]
(2) Chose to [fill TRAINJOBFIL2]
(3) Both required and chose
@
Page 90 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 1
Mark One Only
WELACTV4
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
participate in a work experience program, such as a
community service job?
(1) Yes
(2) No
@
Mark One Only
WORKEXP1
Did you already tell me about this
| {display employers from EMP roster
work when you reported [fill PTEMPNAME] | and ODDNAME}
[fill JOBFIL] for
|
***READ LIST OF EMPLOYERS***?
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
WHICHEXP1
Which job?
|LN JOB NAME
(Which job did [fill HESHE] do because |Display E_NO and EMPNAME
of an arrangement with a state or
|If ODDNAME ne <> and ODDNAME onpath,
county welfare office?)
|display (JOBCNT+<1>) and ODDNAME
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
@KEY
Mark One Only
WORKEXP2
Earlier you told me [fill TEMPNAME] worked | {display employers from EMP roster
for ***READ LIST OF EMPLOYERS***.
| and ODDNAME}
Did [fill HESHE] work at [fill JOBFIL]
|
in order to receive cash assistance?
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
WHICHEXP2
Which job?
|LN JOB NAME
(Which job did [fill HESHE] work
|Display E_NO and EMPNAME
in order to receive cash assistance?) |If ODDNAME ne <> and ODDNAME onpath,
|display (JOBCNT+<1>) and ODDNAME
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@
|
Wednesday, August 27, 2003
Page 91 of 340
Survey:
Section: Section: General Income 1
Mark One Only
Items Booklet
WORKEXP3
Did [fill TEMPNAME] participate in a work experience program because
the state or county welfare office required it, or because [fill HESHE]
chose to do it, or for BOTH reasons?
(1) Required to do work experience program
(2) Chose to do work experience program
(3) Both required and chose
@
Page 92 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
Mark One Only
ASSETIRA
Next are a couple of questions about retirement accounts.
At any time since [fill MONTH1] 1st, [fill HAVHAS]
[fill TEMPNAME] owned an Individual Retirement Account (IRA)
or a Keogh account?
H
(1) Yes
(2) No
@
Mark One Only
ASSET401
Did [fill TEMPNAME] [fill ALSOFIL] participate in a 401k, 403b,
or thrift plan?
H
(1) Yes
(2) No
@
Mark One Only
ASETDRAW
Since [fill MONTH1] 1st, [fill HAVHAS] [fill TEMPNAME] received
any lump sum or regular distribution payments from [fill ANYOFFIL]
[fill HISHER] [fill IRA401FIL]?
(1)
(2)
(3)
(4)
Yes, lump sum
Yes, regular distribution
Yes, both
No, no payments received
@
Multiple Entry
ASSET1
SHOW FLASHCARD F
The next few questions are about assets and other investments,
either individually or jointly owned [fill INCLCHILDFIL].
Since [fill MONTH1] 1st, did [fill TEMPNAME]
own, either individually or jointly...
H
(1) Yes (2) No
...any U.S. Government savings bonds?
@1
...an interest-earning checking account?
@2
...a savings account?
@3
[fill <
Aside from any assets held as part of [fill HISHER]
retirement accounts, did [fill HESHE] own, either
individually or jointly.../<>]
...a money market (MM) deposit account or MM fund? @4
...any CD's (that is, certificates of deposit)? @5
...mutual funds?
@6
...stocks?
@7
{pop-up}
...or any other assets that produced income,
such as rental property, mortgages from
which [fill HESHE] received payments, or
any other financial investments?
@8
Wednesday, August 27, 2003
Page 93 of 340
Survey:
Section: Section: Assets 1
Items Booklet
Multiple Entry
ASSET2
[fill /
]
H
READ (OR VERIFY) ALL RESPONSE OPTIONS
(1) Yes
(2) No
...any municipal or corporate bonds? @1 pop-up box:@A (see post temp)
...U.S. Government securities?
@2
...mortgages from which [fill HESHE]
received payments?
@3
...rental property?
@4
...royalties?
@5
...or any other financial investments? @6
pop-up
SPECIFY: @6sp
Mark One Only
NOINC
Let me make sure that the information I have is correct.
So far, I have not recorded any sources of income
[fill OTHBONDFIL] for [fill TEMPNAME] since
[fill MONTH1] 1st. Did [fill HESHE] receive any income at all -- any
financial help from someone outside the household, any
cash or other assistance from a welfare-type program, any part-time or
odd jobs, or anything else?
(1) Yes
(2) No
@
Page 94 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
Mark One Only
INCLIST
Let me make sure that the information I have about [fill PTEMPNAME]
income sources since [fill MONTH1] 1st is correct. I have recorded:
[fill table9(<1>)]
[fill table9(<2>)]
[fill table9(<3>)]
[fill table9(<4>)]
[fill table9(<5>)]
[fill table9(<6>)]
[fill table9(<7>)]
[fill table9(<8>)]
[fill table9(<9>)]
[fill table9(<10>)]
[fill table9(<11>)]
[fill table9(<12>)]
[fill table9(<13>)]
[fill table9(<14>)]
[fill table9(<15>)]
[fill table9(<16>)]
[fill table9(<17>)]
[fill table9(<18>)]
[fill table9(<19>)]
[fill table9(<20>)]
[fill table9(<21>)]
[fill table9(<22>)]
[fill table9(<23>)]
[fill table9(<24>)]
[fill table9(<25>)]
[fill table9(<26>)]
[fill table9(<27>)]
[fill table9(<28>)]
[fill table9(<29>)]
[fill table9(<30>)]
[fill table9(<31>)]
[fill table9(<32>)]
[fill table9(<33>)]
[fill table9(<34>)]
[fill table9(<35>)]
[fill table9(<36>)]
[fill table9(<37>)]
[fill table9(<38>)]
[fill table9(<39>)]
[fill table9(<40>)]
[fill table9(<41>)]
[fill table9(<42>)]
[fill table9(<43>)]
[fill table9(<44>)]
[fill table9(<45>)]
[fill table9(<46>)]
[fill table9(<47>)]
[fill table9(<48>)]
[fill table9(<49>)]
[fill table9(<50>)]
[fill table9(<51>)]
[fill table9(<52>)]
[fill table9(<53>)]
[fill table9(<54>)]
[fill table9(<55>)]
[fill table9(<56>)]
[fill table9(<57>)]
[fill table9(<58>)]
[fill table9(<59>)]
[fill table9(<60>)]
Wednesday, August 27, 2003
Page 95 of 340
Survey:
Section: Section: Assets 1
Items Booklet
[fill table9(<61>)]
[fill table9(<62>)]
[fill table9(<63>)]
[fill table9(<64>)]
[fill table9(<65>)]
[fill table9(<66>)]
[fill table9(<67>)]
[fill table9(<68>)]
[fill table9(<69>)]
[fill table9(<70>)]
[fill table9(<71>)]
[fill table9(<72>)]
[fill table9(<73>)]
[fill table9(<74>)]
[fill table9(<75>)]
[fill table9(<76>)]
[fill table9(<77>)]
[fill table9(<78>)]
[fill table9(<79>)]
[fill table9(<80>)]
[fill table9(<81>)]
[fill BUS]
[fill EMP]
[fill SENAME]
[fill ODDNAME]
Is this correct?
(1) Yes
(2) No
@
Page 96 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
Mark All That Apply
ERRSRC
Which ones should NOT be on the list? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
[fill table9(<1>)]
[fill table9(<2>)]
[fill table9(<3>)]
[fill table9(<4>)]
[fill table9(<5>)]
[fill table9(<6>)]
[fill table9(<7>)]
[fill table9(<8>)]
[fill table9(<9>)]
[fill table9(<10>)]
[fill table9(<11>)]
[fill table9(<12>)]
[fill table9(<13>)]
[fill table9(<14>)]
[fill table9(<15>)]
[fill table9(<16>)]
[fill table9(<17>)]
[fill table9(<18>)]
[fill table9(<19>)]
[fill table9(<20>)]
[fill table9(<21>)]
[fill table9(<22>)]
[fill table9(<23>)]
[fill table9(<24>)]
[fill table9(<25>)]
[fill table9(<26>)]
[fill table9(<27>)]
[fill table9(<28>)]
[fill table9(<29>)]
[fill table9(<30>)]
[fill table9(<31>)]
[fill table9(<32>)]
[fill table9(<33>)]
[fill table9(<34>)]
[fill table9(<35>)]
[fill table9(<36>)]
[fill table9(<37>)]
[fill table9(<38>)]
[fill table9(<39>)]
[fill table9(<40>)]
[fill table9(<41>)]
[fill table9(<42>)]
[fill table9(<43>)]
[fill table9(<44>)]
[fill table9(<45>)]
[fill table9(<46>)]
[fill table9(<47>)]
[fill table9(<48>)]
[fill table9(<49>)]
[fill table9(<50>)]
[fill table9(<51>)]
[fill table9(<52>)]
[fill table9(<53>)]
[fill table9(<54>)]
[fill table9(<55>)]
[fill table9(<56>)]
Wednesday, August 27, 2003
Page 97 of 340
Survey:
Section: Section: Assets 1
Items Booklet
[fill table9(<57>)]
[fill table9(<58>)]
[fill table9(<59>)]
[fill table9(<60>)]
[fill table9(<61>)]
[fill table9(<62>)]
[fill table9(<63>)]
[fill table9(<64>)]
[fill table9(<65>)]
[fill table9(<66>)]
[fill table9(<67>)]
[fill table9(<68>)]
[fill table9(<69>)]
[fill table9(<70>)]
[fill table9(<71>)]
[fill table9(<72>)]
[fill table9(<73>)]
[fill table9(<74>)]
[fill table9(<75>)]
[fill table9(<76>)]
[fill table9(<77>)]
[fill table9(<78>)]
[fill table9(<79>)]
[fill table9(<80>)]
[fill table9(<81>)]
@KEY
Mark One Only
ANYOTH
Is anything missing? Did [fill TEMPNAME] [fill PERSONALLYFIL]
have any other income sources, such as help from someone outside
the household, from the government or military, from any [fill OTHERFIL]
kind of work, or from any other source outside this household?
IT IS EXTREMELY IMPORTANT TO GET A COPMPLETE LISTING OF
ALL INCOME SOURCES.
(1) Yes
(2) No
@
Page 98 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
OTHSRCE2
Mark All That Apply
SHOW FLASHCARD F2 IF NECESSARY
What kind of income? Anything else?
H
ENTER ALL THAT APPLY
ENTER (N) NO MORE
RE-ENTER PRECODE TO DELETE
(1) Income from Job/Business/Other Work
(2) Unemployment or Workers Compensation, and Disability
Payments
(3) Social Security, Pensions, Retirement, and Survivor Income
(4) Military or Veterans Benefits/Pay
(5) Public Assistance and Other Welfare Programs
(6) Lump Sum Payments
(7) Support from Others Outside the Household
(8) Miscellaneous Cash Income
(9) Assets
@KEY
Multiple Entry
ADJOBUS
PROBE IF NECESSARY
Provide a brief label or description of work, job or business:
@1
{pop-up}
When we talk about this later, I'm going to refer to this as
[fill HISHER] [fill ADJOBUS@1] work.
Is this OK?
(1) Yes, description OK
(2) No, change description
@2
Mark All That Apply
OTHUNEMP
PROBE IF NECESSARY:
What form of Unemployment or Workers Compensation, and
Disability Payments?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(5) State Unemployment Compensation
(6) Supplemental Unemployment Benefits
(7) Other Unemployment Compensation
(9) Black Lung Payments
(10) Workers Compensation
(11) State Temporary Sickness or Disability Benefits
(12) Employer or Union Temporary Sickness Benefits
(13) Payments from a Sickness, Accident, or Disability
Insurance Policy Purchased on your own
(14) Employer Disability Payments
@KEY
Wednesday, August 27, 2003
Page 99 of 340
Survey:
Section: Section: Assets 1
Items Booklet
Mark All That Apply
OTHSS
PROBE IF NECESSARY:
What form of Social Security, Pensions, Retirement, and Survivor Income?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(8)
Social Security
(34) State Government Pension
Railroad Retirement
(35) Local Government Pension
Federal SSI
(36) Income from a Paid-up Life
State SSI
Insurance Policy or Annuity
Veterans Compensation
(37) Income from Estates or Trusts
or Pension
(38) Payments for Retirement,
(30) Pension from a Company
Disability or as a
or Union
Survivor Benefit
(31) Federal Civil Service or
(39) Pension/Retirement Lump Sums
other Fed. Civilian
(42) Draw from IRA/Keogh/401k, 403B
Employee Pension
or Thrift Plan
(32) U.S. Military Retirement Pay (52) Lump Sum Payments
(33) National Guard or Reserve
Forces Retirement
@KEY
Mark All That Apply
OTHMIL
PROBE IF NECESSARY:
What form of Military or Veterans Benefits or Pay?
ENTER ALL THAT APPLY
RE-ENTER PRECODE TO DELETE
ENTER (N) FOR NO MORE
(8) Veterans Compensation or Pension
(32) U.S. Military Retirement Pay
(33) National Guard or Reserve Forces Retirement
(40) The G.I. Bill
(41) Department of Veterans Affairs Educational Assistance
(54) National Guard or Reserve Pay
@KEY
Multiple Entry
OTHPUB
PROBE IF NECESSARY:
What form of Public Assistance and Other Welfare Programs?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE /RE-ENTER PRECODE TO DELETE
(3) Federal Supplemental Security Income
(4) State Supplemental Security Income
(19) Energy Assistance
(20) Cash Assistance (TANF or AFDC)
(21) General Assistance or General Relief
(24) Other Welfare
(25) WIC, or Women, Infants and Children Nutrition Program
(26) Pass Through Child Support payments
(27) Food Stamps
(60) Transportation Assistance
(61) Food Assistance (grocery money, vouchers, certificates)
(62) Clothing Assistance
(63) Housing Assistance
(64) Short-Term Cash Assistance
@KEY
{pop-up} SPECIFY: @SP1
Page 100 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
Mark All That Apply
OTHLUMP
PROBE IF NECESSARY:
What form of Lump Sum Payments?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(15)
(36)
(39)
(52)
(56)
Severance Pay
Income from a Paid-up Life Insurance Policy or Annuity
Pension/Retirement Lump Sums
Lump Sum Payments
Miscellaneous Cash Income
@KEY
Mark All That Apply
OTHOUT
PROBE IF NECESSARY:
What form of Support from Others Outside the Household?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(26)
(28)
(29)
(50)
(51)
Pass Through Child Support payments
Child Support Payments
Alimony Payments
Income Assistance from a Charitable Group
Money from Relatives or Friends
@KEY
Mark All That Apply
OTHMISC
PROBE IF NECESSARY:
What form of Miscellaneous Cash Income?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(23)
(50)
(53)
(56)
Foster Child Care Payments
Income Assistance from a Charitable Group
Income from Roomers or Boarders
Miscellaneous Cash Income
@KEY
Wednesday, August 27, 2003
Page 101 of 340
Survey:
Section: Section: Assets 1
Items Booklet
Multiple Entry
OTHASST
PROBE IF NECESSARY: What form of Assets?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) IRA (Individual Retirement account) or a Keogh account
(2) 401K, 403b, or thrift plan
(3) Interest-earning checking account
(4) Savings account
(5) Money market deposit account
(6) Certificates of deposit
(7) Mutual funds
(8) Stocks
(9) Municipal or corporate bonds
(10) U.S. Government securities
(11) Mortgages from which he/she received payments
(12) Rental property
(13) Royalties
(14) U.S. Government savings bonds
(15) Other financial investments
@KEY
{pop-up)SPECIFY @SP
Mark One Only
JT
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] owned [fill ASNAME].
Subsequent times asked:
Earlier you told me that, since [fill MONTH1] 1st,
[fill TEMPNAME] owned [fill ASNAME].
Did [fill HESHE] own any [fill ASNAME] jointly
with someone else [fill OTHSPOUSE]
(1) Yes
(2) No
@
Mark All That Apply
JTWHO
[fill /] [fill DODOES]
|(0) Non-Household Member(s)
[fill TEMPNAME] own
|
[fill ASNAME] jointly with?
|
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NONE OR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
[fill ERRORFIL]
Page 102 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
Mark One Only
OAST
Asset Type: [fill C_ASNAME]
[fill INADDITIONFIL]
[fill INADDITIONFIL2] [fill HESHE] [fill ALSOFIL] own any in
[fill HISHER] name only?
(1) Yes
(2) No
@
Mark One Only
ANYJNT
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] [fill FNDSTCK1FIL].
Subsequent times asked:
(Earlier you told me that,) since [fill MONTH1] 1st,
[fill TEMPNAME] [fill FNDSTCK1FIL].
Did [fill TEMPNAME] [fill FNDSTCK2FIL]
jointly with someone else [fill OTHSPOUSE]
(1) Yes
(2) No
@
Mark All That Apply
JTWHO2
[fill /] [fill DODOES]
|(0) Non-Household Member(s)
[fill TEMPNAME] own
|
[fill ASNAME2] jointly with?
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
[fill ERRORFIL]
Mark One Only
OAST2
ASSET TYPE: [fill C_ASNAME3]
[fill INADDITIONFIL] [fill MONTH1] 1st, did [fill TEMPNAME] have any in
just [fill HISHER] own name?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 103 of 340
Survey:
Section: Section: Assets 1
Items Booklet
Mark One Only
ANYJTRNT
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] owned some rental property.
Subsequent times asked:
(Earlier you told me that,) since [fill MONTH1] 1st,
[fill TEMPNAME] owned some rental property.
Did [fill TEMPNAME] own any rental property jointly
with someone else [fill OTHSPOUSE]
H
(1) Yes
(2) No
@
JTWHO3
Mark All That Apply
[fill /] [fill DODOES]
older plus}
[fill TEMPNAME] own
|(0) Non-Household Member(s)
rental property jointly with?
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
[fill ERRORFIL]
Mark One Only
|18 and
OWNRNT
ASSET TYPE: RENTAL PROPERTY
[fill INADDITIONFIL] [fill MONTH1] 1st, did [fill TEMPNAME] have any in
just [fill HISHER] own name?
(1) Yes
(2) No
@
Page 104 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 1
MRTJNT
Mark One Only
First time asked:
You said that, since [fill MONTH1] 1st,
[fill TEMPNAME] held a mortgage from which [fill HESHE]
received payments.
Subsequent times asked:
(Earlier you told me that,) since [fill MONTH1] 1st,
[fill TEMPNAME] held a mortgage from which [fill HESHE]
received payments.
Did [fill HESHE] own this jointly with someone
else[fill OTHSPOUSE]
H
(1) Yes
(2) No
@
Mark All That Apply
JTWHO4
[fill /] [fill DODOES]
|members 18 and older
[fill TEMPNAME] own
|(0) Non-Household Member(s)
mortgages (from which [fill HESHE]
|
received interest) jointly with?
|
|
ENTER ALL THAT APPLY
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
[fill ERRORFIL]
Mark One Only
MRTOWN
ASSET TYPE: MORTGAGES (FROM WHICH HE/SHE RECEIVED INTEREST)
[fill INADDITIONFIL] [fill MONTH1] 1st, did [fill TEMPNAME] have any in
just [fill HISHER] own name?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 105 of 340
Survey:
Section: Section: Assets 1
Items Booklet
Mark One Only
ADINCSRCE2
The next part of the interview is
about [fill PTEMPNAME] income since [fill MONTH1] 1st.
We want to be both as accurate and as efficient as we can,
so it would be very helpful if you could refer to any
records you might have.
(Also -- we know that people aren't used to talking about
their income, but we ask these questions to get an overall
picture of your community and the nation, and NOT to find
out about [fill YOUANYONEFIL] personally.)
AT APPROPRIATE MOMENTS, ENCOURAGE RESPONDENT TO GET RECORDS.
PRESS "ENTER" TO CONTINUE
@
Page 106 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
PAYHR
The next questions are about income [fill TEMPNAME] received from
[fill HISHER] [fill JOBWORKFIL] [fill EMPNAM].
If I_PAYHR eq <1> display:
Last time I recorded [fill TEMPNAME] had a set annual salary.
[fill ISWASFIL] that still the case, or [fill ISWASFIL] [fill HESHE]
paid by the hour, or [fill ISWASFIL] [fill HESHE] paid some other way?
Else if I_PAYHR eq <2> display:
Last time I recorded [fill TEMPNAME] were paid by the hour.
[fill ISWASFIL] that still the case, or [fill DOESDIDFIL] [fill HESHE]
have a set annual salary, or [fill ISWASFIL] [fill HESHE] paid some
other way?
Else display:
[fill DOESDIDFIL] [fill HESHE] have a set annual salary, [fill ISWASFIL]
[fill HESHE] paid by the hour, or [fill ISWASFIL] [fill HESHE]
paid some other way?
(1) Set annual salary
(2) Paid by the hour
(3) Paid some other way
@
Enter Number
PYRAT
[fill THENEXTQFIL]
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill ATJOBFIL]?
READ IF NECESSARY: Do not include your overtime rate here. Income earned
at overtime rates will be collected later.
[fill ENTERNFIL]
[fill ENTERLFIL]
$@ per hour
Mark One Only
HRAPRX
[fill SORRYFIL}
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
BIGHOUR
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill PYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 107 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
PYPER
[fill THENEXTQFIL]
How often [fill ISWASFIL] [fill HESHE] paid by [fill EMPNAM]?
READ IF NECESSARY
(1) Once a week
(2) Once every 2 weeks
(3) Once a month
(4) Twice a month
(5) On commission
(6) Some other way
@
Mark One Only
OTHPY
[fill THENEXTQFIL]
How often [fill ISWASFIL] [fill HESHE] paid by [fill EMPNAM]?
READ IF NECESSARY
(1) Once a week
(2) Once every 2 weeks
(3) Once a month
(4) Twice a month
(5) On commission
(6) Some other way
6
SPECIFY THE OTHER PAY PERIOD:
@
Multiple Entry
LSTPY
[fill THENEXTQFIL]
SHOW CALENDAR ON FLASHCARD E
Please look at the calendar. On what date [fill WASWERE]
[fill TEMPNAME] last paid (by [fill EMPNAM])?
ENTER (N) IF NOT PAID DURING REFERENCE PERIOD
MONTH: @MON
DAY: @DAY
Mark One Only
NUDAY: [fill NUDAY]
INCR: [fill INCR]
PM1: [fill PM1]
PM2: [fill PM2]
PM3: [fill PM3]
PM4: [fill PM4]
PM5: [fill PM5]
@
Page 108 of 340
LF14
dates1: [fill DATES(<1>)]
dates2: [fill DATES(<2>)]
dates3: [fill DATES(<3>)]
dates4: [fill DATES(<4>)]
dates5: [fill DATES(<5>)]
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
EASYWAY
[fill THENEXTQFIL]
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL][fill HOURFIL]annual income amounts, if that would be
easier. What would be easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
Monthly totals
Weekly/Biweekly/Bimonthly>]
Hourly pay rates>/<>]
Annual amount
None of the above
@
Multiple Entry
MONTHLY
[fill THENEXTQFIL]
How much [fill RECEIVFIL] BEFORE deductions from
[fill JOBBIZFIL] [fill MONTHXFIL]?
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
{pop-up: MONTHLY5_ERR or MONTHLY4_ERR or MONTHLY3_ERR or MONTHLY2_ERR or
MONTHLY1_ERR}
Mark One Only
MONTHLY5_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MONTHLY4_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MONTHLY3_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 109 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
MONTHLY2_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MONTHLY1_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGMONTH5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MONTHLY@5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGMONTH4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MONTHLY@4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGMONTH3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MONTHLY@3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGMONTH2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MONTHLY@2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 110 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGMONTH1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MONTHLY@1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
VARY
Since [fill MONTHXFIL], [fill PAYCKVARYFIL]?
(1) The same
(2) Varied
@
Enter Number
SAME
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
[fill ENTERVFIL]
[fill ENTERLFIL]
$@
Enter Number
PAYAPRX
Can you give me an approximate amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
BIGSAME
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill SAME], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
CALCPYVR
That comes out to about $[fill PAYMONTHFIL] per month. Does that
sound about right?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 111 of 340
Survey:
Section: Section: Labor Force 2
Enter Number
Items Booklet
SAMECHK
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount
before all taxes and deductions?
$@
Multiple Entry
P1M
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL] from [fill EMPNAM]
[fill MONTHFIL].
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
RECORD EACH PAYCHECK SEPARATELY, IF POSSIBLE.
[fill PAYDAYFIL5]
@51 @52 @53 @54 @55
[fill MONTH4FIL] [fill PAYDAYFIL4]
@41 @42 @43 @44 @45
[fill MONTH3FIL] [fill PAYDAYFIL3]
@31 @32 @33 @34 @35
[fill MONTH2FIL] [fill PAYDAYFIL2]
@21 @22 @23 @24 @25
[fill MONTH1FIL] [fill PAYDAYFIL1]
@11 @12 @13 @14 @15
[fill ERRORFIL]
{pop-up P1M5_ERR or P1M4_ERR or P1M3_ERR or P1M2_ERR or P1M1_ERR}
Mark One Only
P1M1_ERR
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
Mark One Only
P1M2_ERR
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
Mark One Only
P1M3_ERR
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
Mark One Only
P1M4_ERR
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
Mark One Only
P1M5_ERR
PROBE: Can you give me an approximate amount?
IF YES, F1 BACK AND CORRECT
PRESS ENTER TO PROCEED @
Page 112 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
MTOT5VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MTOTAL5], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MTOT4VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MTOTAL4], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MTOT3VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MTOTAL3], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MTOT2VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MTOTAL2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MTOT1VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MTOTAL1], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 113 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
EXTRA1
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when you received additional checks?
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Mark One Only
RATECHG
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill HISHER] job with [fill EMPNAM] [fill ISWASFIL]
$[fill PYRAT].
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same pay rate throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Multiple Entry
STRTPAY
When did that $[fill PYRAT] an hour pay rate first show up in
[fill PTEMPNAME] paycheck?
MONTH: @MTH
DAY: @DAY
Enter Number
PYRAT2
What was [fill PTEMPNAME] hourly pay rate before that?
[ENTERLFIL}
$@ per hour
Enter Number
HRAPRX2
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
BIGHOUR2
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill PYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 114 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
CALCHRVR
Earlier you stated that [fill TEMPNAME] usually worked [fill JOBHRS] hours
per week. At $[fill PYRAT], that works out to
about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right for [fill PTEMPNAME] gross income?
(1) Yes
(2) No
@
Enter Number
ESTHR1
What is your best estimate of [fill PTEMPNAME] income BEFORE deductions
from [fill EMPNAM] [fill WEEKFIL] at that $[fill PYRAT] pay rate?
$@
Mark One Only
CALCHRV2
$[fill PYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
ESTHR2
What is your best estimate of [fill PTEMPNAME] income BEFORE deductions
from [fill EMPNAM] [fill WEEKFIL] at that $[fill PYRAT2]
pay rate?
$@
Enter Number
AMOUNT1
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
with [fill EMPNAM] [fill JOBENDFIL]
[ENTERLFIL]
$@
Enter Number
APXAMT1
Can you give me an approximate annual salary amount - within a couple of
thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Wednesday, August 27, 2003
Page 115 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BIGAMOUNT1
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill AMOUNT1], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
SAMEAMT1
[fill HASWASFIL] [fill HISHER] annual salary for the whole time
[fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same annual salary throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Multiple Entry
STRTANN1
When did that $[fill AMOUNT1] annual salary first show up in
[PTEMPNAME] paycheck?
MONTH: @MTH
YEAR: @DAY
Enter Number
AMOUNT2
What was [fill PTEMPNAME] annual salary before that?
$@
Enter Number
APXAMT2
Can you give me an approximate annual salary amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Enter Number
PWAMT2FIX
Job With: [fill EMPNAM]
What is the correct annual amount?
$@
Mark One Only
BIGPWAMT2
DO NOT READ TO RESPONDENT
THE MONTHLY AMOUNT, $[fill PWAMT2FIX], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 116 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGAMOUNT2
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill AMOUNT2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
CALCANN1
That $[fill AMOUNT1] annual salary, divided by 12 months, works out
to be about $[fill TOTALFIL]. Does that sound about right for a gross
monthly amount?
(1) Yes
(2) No
@
Enter Number
ESTANN1
What is your best estimate of [fill PTEMPNAME] average gross monthly income
from [fill EMPNAM] at that annual salary rate?
$@
Mark One Only
CALCANN2
And for [fill HISHER] salary before that...
$[fill AMOUNT2] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
(1) Yes
(2) No
@
Enter Number
ESTANN2
What is your best estimate of [fill PTEMPNAME] average gross monthly income
from [fill EMPNAM] at that annual salary rate?
$@
Wednesday, August 27, 2003
Page 117 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
TRYMNTH
Let's try [fill ANOTHERFIL].
How much [fill RECEIVFIL] BEFORE deductions from
[fill EMPNAM] [fill MONTHXFIL]?
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
{pop-up TRYMTH5_ERR to TRYMTH1_ERR}
Mark One Only
BIGPWTRYMNTH
DO NOT READ TO RESPONDENT
THE MONTHLY AMOUNT, $[fill PWTRYMNTHFIX], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
TRYMTH4_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
TRYMTH3_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
TRYMTH2_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
TRYMTH1_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 118 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGTRYMTH5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill TRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTRYMTH4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill TRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTRYMTH3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill TRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTRYMTH2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill TRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTRYMTH1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill TRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 119 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
ANYTIPS
Since [fill MONTH1STFIL], did [fill TEMPNAME] receive
any tips, bonuses, cash or monetary awards, overtime pay,
or commissions from [fill JOBBIZFIL]?
(1) Yes
(2) No
@
Mark One Only
TIPS
Did the income amounts we just talked about include all of
[fill PTEMPNAME] (tips, bonuses, cash awards, overtime pay,
or commissions) from [fill JOBBIZFIL]?
(1) Yes
(2) No
@
Multiple Entry
TIPSAMT
How much [fill RECEIVFIL] in (tips, bonuses, cash awards, overtime
pay, or commissions) [fill FROMEMPFIL] [fill MONTHXFIL]?
READ IF NECESSARY: Your best estimate here is fine.
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
BIGTIP5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill TIPTOTAL5],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 120 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGTIP4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill TIPTOTAL4],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTIP3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill TIPTOTAL3],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTIP2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill TIPTOTAL2],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTIP1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill TIPTOTAL1],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 121 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
CONTING
The next questions are about the income [fill TEMPNAME] received from all
of [fill HISHER] [fill JOBFIL].
What [fill ISWASFIL] the total amount of income, BEFORE taxes and other
deductions, that [fill TEMPNAME] [fill HAVHAS] received from
[fill JOBEMPFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
BIGPWCON
DO NOT READ TO RESPONDENT
THE MONTHLY AMOUNT, $[fill PWCONTINGFIX], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCON5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill CONTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCON4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill CONTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 122 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGCON3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill CONTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCON2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill CONTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCON1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill CONTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
TAKEHOME
[fill REGPAYFIL] the amounts you gave me
[fill HISHER] take-home pay, or were they [fill HISHER] gross pay
BEFORE any taxes and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Mark One Only
GETGROSS
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available, such
as pay stubs, that would show the gross amount?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 123 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
GROSSPAYM5
What were the gross pay amounts in [fill MONTH5]?
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill PAYMONTHFIL]
$@1
$[fill PAYMONTHFIL]
$@2
$[fill PAYMONTHFIL]
$@3
$[fill PAYMONTHFIL]
$@4
$[fill PAYMONTHFIL]
$@5
Mark One Only
GROSSM5VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH5], $[fill GTOTAL5], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
ALLGROSSM5
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
GROSSPAYM4
What were the gross pay amounts in [fill MONTH4]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill PAYMONTHFIL]
$@1
$[fill PAYMONTHFIL]
$@2
$[fill PAYMONTHFIL]
$@3
$[fill PAYMONTHFIL]
$@4
$[fill PAYMONTHFIL]
$@5
Mark One Only
GROSSM4VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH4], $[fill GTOTAL4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Page 124 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
ALLGROSSM4
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
GROSSPAYM3
What were the gross pay amounts in [fill MONTH3]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill PAYMONTHFIL]
$@1
$[fill PAYMONTHFIL]
$@2
$[fill PAYMONTHFIL]
$@3
$[fill PAYMONTHFIL]
$@4
$[fill PAYMONTHFIL]
$@5
Mark One Only
GROSSM3VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH3], $[fill GTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
ALLGROSSM3
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
GROSSPAYM2
What were the gross pay amounts in [fill MONTH2]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill PAYMONTHFIL]
$@1
$[fill PAYMONTHFIL]
$@2
$[fill PAYMONTHFIL]
$@3
$[fill PAYMONTHFIL]
$@4
$[fill PAYMONTHFIL]
$@5
Wednesday, August 27, 2003
Page 125 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
GROSSM2VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH2], $[fill GTOTAL2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
ALLGROSSM2
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
GROSSPAYM1
What were the gross pay amounts in [fill MONTH1]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill PAYMONTHFIL]
$@1
$[fill PAYMONTHFIL]
$@2
$[fill PAYMONTHFIL]
$@3
$[fill PAYMONTHFIL]
$@4
$[fill PAYMONTHFIL]
$@5
Mark One Only
GROSSM1VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH1], $[fill GTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
ALLGROSSM1
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
GROSSPAYANN
What was the gross annual amount?
$@1
Page 126 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
ALLGROSSANN
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MLMOREJ
{Display employers that are not the top two jobs}
Earlier you told me that since [fill MONTH1] 1st, you also
worked for the following employer(s):
**READ LIST OF EMPLOYERS ABOVE**
What was the total amount of income you received from
[fill EMPLOYERFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51 @52 @53 @54 @55
How about in [fill MONTH4]?
@41 @42 @43 @44 @45
And [fill MONTH3]?
@31 @32 @33 @34 @35
And [fill MONTH2]?
@21 @22 @23 @24 @25
And [fill MONTH1]?
@11 @12 @13 @14 @15
Mark One Only
SLRYB
The next few questions are about the income [fill TEMPNAME]
received from [fill ALLBUS] since [fill BUSSTRTFIL].
[fill DOESDIDFIL] [fill HESHE] draw a regular salary from this business?
(That is, take a regular paycheck, as opposed to just treating the profits
as [fill HISHER] income.)
(1) Yes, [fill DRAWFIL] a regular salary
(2) No, [fill DIDFIL] NOT draw a regular salary
@
Mark One Only
BPAYHR
[fill THENEXTQFIL1]
[fill THENEXTQFIL2]
How [fill ISWASFIL] [fill TEMPNAME] paid? [fill C_DOESDIDFIL] [fill HESHE]
have a set annual
salary, [fill DOESDIDFIL] the business pay [fill HIMHER] by the hour, or
[fill ISWASFIL] [fill HESHE] paid some other way?
[fill NOTEFIL]
(1) Set annual salary
(2) Pay by the hour
(3) Paid some other way
@
Wednesday, August 27, 2003
Page 127 of 340
Survey:
Section: Section: Labor Force 2
Enter Number
Items Booklet
BPYRAT
[fill THENEXTQFIL]
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill FROMBIZFIL]?
READ IF NECESSARY: Do not include your overtime rate here. Income earned
at overtime rates will be collected later.
[fill ENTERNFIL]
$@ per hour
Mark One Only
BHRAPRX
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
BBIGHOUR
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill BPYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BPYPER
[fill THENEXTQFIL]
How often [fill ISWASFIL] [fill HESHE] paid by [fill ALLBUS]?
READ IF NECESSARY
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Once a week
Once every 2 weeks
Once a month
Twice a month
Quarterly
On commission
Some other way
@
Page 128 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BOTHPY
[fill THENEXTQFIL]
How often [fill ISWASFIL] [fill HESHE] paid by [fill ALLBUS]?
READ IF NECESSARY
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Once a week
Once every 2 weeks
Once a month
Twice a month
Quarterly
On commission
Some other way
7
SPECIFY THE OTHER PAY PERIOD:
@
Multiple Entry
BLSTPY
[fill THENEXTQFIL]
SHOW CALENDAR ON FLASHCARD E
Please look at the calendar. On what date [fill WASWERE]
[fill TEMPNAME] last paid (by [fill ALLBUS])?
ENTER (N) IF NOT PAID DURING REFERENCE PERIOD
Month: @MTH
Day: @DAY
Mark One Only
BNUDAY: [fill BNUDAY]
BINCR: [fill BINCR]
BPM1: [fill BPM1]
BPM2: [fill BPM2]
BPM3: [fill BPM3]
BPM4: [fill BPM4]
BPM5: [fill BPM5]
@
BLF14
dates1: [fill BDATES(<1>)]
dates2: [fill BDATES(<2>)]
dates3: [fill BDATES(<3>)]
dates4: [fill BDATES(<4>)]
dates5: [fill BDATES(<5>)]
Mark One Only
BEASYWAY
[fill THENEXTQFIL]
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL] [fill HOURFIL]quarterly, or annual income amounts,
if that would be easier. What's easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
(6)
Monthly totals
Weekly/Biweekly/Bimonthly>]
Hourly pay rates>/<>]
Quarterly amount
Annual amount
Some other way
@
Wednesday, August 27, 2003
Page 129 of 340
Survey:
Section: Section: Labor Force 2
Items Booklet
BMONTHLY
Multiple Entry
[fill THENEXTQFIL]
How much income [fill RECEIVFIL] from this business BEFORE taxes and
other deductions [fill MONTHFIL]?
[fill NOTEFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
{popup: BMONTHLY5_ERR or BMONTHLY4_ERR or BMONTHLY3_ERR or BMONTHLY2_ERR or
BMONTHLY1_ERR}
Mark One Only
BIGPWBMONTH
DO NOT READ TO RESPONDENT
THE MONTHLY AMOUNT, $[fill PWBMONTHFIX], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMONTHLY5_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMONTHLY4_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMONTHLY3_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMONTHLY2_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 130 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BMONTHLY1_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGMONTH5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BMONTHLY@5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
BBIGMONTH4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BMONTHLY@4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
BBIGMONTH3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BMONTHLY@3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
BBIGMONTH2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BMONTHLY@2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 27, 2003
Page 131 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BBIGMONTH1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BMONTHLY@1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
BVARY
Since [fill MONTHFIL], [fill PAYCKVARYFIL]?
(1) The same
(2) Varied
@
Enter Number
BSAME
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
[fill ENTERVFIL]
$@
Enter Number
BPAYAPRX
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
BBIGSAME
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill BSAME], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BCALCPYVR
That comes out to about $[fill BPAYMONFIL] per month. Does that sound
about right?
(1) Yes
(2) No
@
Page 132 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Enter Number
BSAMECHK
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount before all
taxes and deductions?
$@
Multiple Entry
BP1M
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL].
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
[fill PAYDAYFIL5]
@51 @52 @53 @54 @55
[fill MONTH4FIL] [fill PAYDAYFIL4]
@41 @42 @43 @44 @45
[fill MONTH3FIL] [fill PAYDAYFIL3]
@31 @32 @33 @34 @35
[fill MONTH2FIL] [fill PAYDAYFIL2]
@21 @22 @23 @24 @25
[fill MONTH1FIL] [fill PAYDAYFIL1]
@11 @12 @13 @14 @15
{pop-up: BP1M5_ERR to BP1M1_ERR}
Mark One Only
BP1M5_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BP1M4_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BP1M3_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BP1M2_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BP1M1_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 133 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BMTOT5VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BMTOTAL5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMTOT4VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BMTOTAL4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMTOT3VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BMTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMTOT2VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BMTOTAL2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BMTOT1VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BMTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 134 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BEXTRA1
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when you received additional checks?
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Mark One Only
BRATECHG
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill ALLBUS] [fill ISWASFIL]
$[fill BPYRAT].
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill BIZSTRTFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same pay rate throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Multiple Entry
BSTRTPAY
When did that $[fill BPYRAT] an hour pay rate first show up
in [fill PTEMPNAME] paycheck?
MONTH: @MTH
DAY: @DAY
Enter Number
BPYRAT2
What was [fill PTEMPNAME] hourly pay rate before that?
$@ per hour
Enter Number
BHRAPRX2
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
BBIGHOUR2
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill BPYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 135 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BCALCHRVR
Earlier you stated that [fill TEMPNAME] usually worked
[fill HRSBS] hours per week. At $[fill BPYRAT], that works out to
about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
BESTHR1
What is your best estimate of [fill PTEMPNAME] income BEFORE deductions
from [fill ALLBUS] [fill WEEKFIL] at that $[fill BPYRAT] pay rate?
$@
Mark One Only
BCALCHRV2
$[fill BPYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
BESTHR2
What is your best estimate of [fill PTEMPNAME] income
BEFORE deductions from [fill ALLBUS] [fill WEEKFIL]
at $[fill BPYRAT2] pay rate?
$@
Enter Number
BQTRAMT
What was [fill PTEMPNAME] income before taxes
and personal deductions from [fill ALLBUS]
for the most recent quarter (or the most recent quarter
that you can tell me about)?
$@
Enter Number
BAPXQTR
Can you give me an approximate quarterly salary amount -within a couple thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Page 136 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BBIGQTR
DO NOT READ TO RESPONDENT
THE QUARTERLY RATE ENTERED, $[fill BQTRAMT], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Multiple Entry
BQTRMNTH
And when did that quarter close?
(What was the last month and year of
the quarter that the [fill QTRAMTFIL] dollars applies to?)
MONTH: @MTH
YEAR: @YEAR
Enter Number
BAMOUNT1
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
with [fill ALLBUS] [fill BIZENDFIL]
$@
Enter Number
BAPXAMT1
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a couple
of thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
BBIGAMT1
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill BAMOUNT1], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BSAMEAMT1
[fill HASWASFIL] [fill HISHER] [fill CURRENTFIL] for the whole time
[fill BIZSTRTFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same [fill CURRENTFIL] throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Wednesday, August 27, 2003
Page 137 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
BSTRTANN1
When did that $[fill BAMOUNT1] annual salary first show up in
[PTEMPNAME] paycheck?
MONTH: @MTH
YEAR: @DAY
Enter Number
BAMOUNT2
What was [fill PTEMPNAME] annual salary before that?
$@
Enter Number
BAPXAMT2
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
BBIGAMT2
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill BAMOUNT2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BCALCANN1
That $[fill BAMOUNT1] annual income, divided by 12 months, works out
to be about $[fill PAYANN1FIL]a month. Does that sound about right for
a gross monthly amount?
(1) Yes
(2) No
@
Enter Number
BESTANN1
What is your best estimate of [fill PTEMPNAME] average gross monthly
income from [fill ALLBUS] at that annual salary rate?
$@
Mark One Only
BCALCANN2
And for [fill HISHER] salary before that...
$[fill BAMOUNT2] divided by 12 is about $[fill BPAYANN2FIL].
Is that about right for a gross monthly amount?
(1) Yes
(2) No
@
Page 138 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
BESTANN2
Enter Number
What is your best estimate of [fill PTEMPNAME] average gross monthly
income from [fill ALLBUS] at that annual salary rate?
$@
BTRYMNTH
Multiple Entry
Let's try [fill ANOTHERFIL].
How much [fill RECEIVFIL] BEFORE deductions from
[fill ALLBUS] [fill MONTHFIL]?
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
{popup: BTRYMNTH5_ERR or BTRYMNTH4_ERR or BTRYMNTH3_ERR or BTRYMNTH2_ERR or
BTRYMNTH1_ERR}
Mark One Only
BTRYMTH5_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BTRYMTH4_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BTRYMTH3_ERR
PROBE: Can yougive me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BTRYMTH2_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BTRYMTH1_ERR
PROBE: Can you give me an approximate amount?
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 139 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BBIGTRY5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BTRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTRY4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BTRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTRY3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BTRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTRY2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BTRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTRY1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BTRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 140 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BANYTIPS
Other than [fill HISHER] regular income, since [fill MONTH1] 1st,
did [fill TEMPNAME] receive any tips, bonuses, overtime pay,
or commissions from [fill HISHER] work with [fill ALLBUS]?
(1) Yes
(2) No
@
Mark One Only
BTIPS
Did the income amounts we just talked about include all of
[fill PTEMPNAME] tips, bonuses, overtime pay, or commissions
from [fill ALLBUS]?
(1) Yes
(2) No
@
Multiple Entry
BTIPSAMT
How much [fill RECEIVFIL] in tips, bonuses, overtime pay, or commissions
[fill FROMBIZFIL] [fill MONTHFIL]?
READ IF NECESSARY: Your best estimate here is fine.
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Mark One Only
BBIGTIP5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BTIPTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 141 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BBIGTIP4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BTIPTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTIP3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BTIPTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTIP2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BTIPTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BBIGTIP1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BTIPTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BTAKEHOME
Just to be sure -- were the amounts you gave me [fill HISHER]
take-home pay, or were they [fill HISHER] gross pay BEFORE any taxes
and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Page 142 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BGETGROSS
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available,
such as pay stubs, that would show the gross amount?
(1) Yes
(2) No
@
Multiple Entry
BGROSSPAYM5
What were the gross pay amounts in [fill MONTH5]?
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M5@1]
$[fill BP1M5@2]
$[fill BP1M5@3]
$[fill BP1M5@4]
$[fill BP1M5@5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
BGROSSM5VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH5], $[fill BGTOTAL], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BALLGROSSM5
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
BGROSSPAYM4
What were the gross pay amounts in [fill MONTH4]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M4@1]
$[fill BP1M4@2]
$[fill BP1M4@3]
$[fill BP1M4@4]
$[fill BP1M4@5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Wednesday, August 27, 2003
Page 143 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BGROSSM4VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH4], $[fill BGTOTAL4], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BALLGROSSM4
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
BGROSSPAYM3
What were the gross pay amounts in [fill MONTH3]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M3@1]
$[fill BP1M3@2]
$[fill BP1M3@3]
$[fill BP1M3@4]
$[fill BP1M3@5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
BGROSSM3VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH3], $[fill BGTOTAL3], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BALLGROSSM3
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Page 144 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Multiple Entry
BGROSSPAYM2
What were the gross pay amounts in [fill MONTH2]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M2@1]
$[fill BP1M2@2]
$[fill BP1M2@3]
$[fill BP1M2@4]
$[fill BP1M2@5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
BGROSSM2VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH2], $[fill BGTOTAL2], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
BALLGROSSM2
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
BGROSSPAYM1
What were the gross pay amounts in [fill MONTH1]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M1@1]
$[fill BP1M1@2]
$[fill BP1M1@3]
$[fill BP1M1@4]
$[fill BP1M1@5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
BGROSSM1VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH1], $[fill BGTOTAL1], IS
UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 145 of 340
Survey:
Section: Section: Labor Force 2
Mark One Only
Items Booklet
BALLGROSSM1
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
BGROSSPAYANN
What was the gross annual amount?
$@
Mark One Only
BALLGROSSANN
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Mark One Only
OINCB
[fill ASIDEFRMFIL] [fill MONTH1] 1st) did [fill TEMPNAME] receive any
[fill OTHERFIL] income for [fill SELF] out of the money
that [fill BUSNAME] brought in, or from the profits of the business?
(1) Yes
(2) No
@
Multiple Entry
OINCAMT
What was the total amount of other income [fill HESHE] received from
[fill ALLBUS] [fill MONTHXFIL]
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4]?
@41 @42 @43 @44 @45
[fill MONTH3]
@31 @32 @33 @34 @35
[fill MONTH2]
@21 @22 @23 @24 @25
[fill MONTH1]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Page 146 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
LSTB
HAVE YOU ASKED ANOTHER PERSON IN THIS HOUSEHOLD ABOUT
THE NET PROFIT OR LOSS FROM [FILL ALLBUS]?
(1) YES
(2) NO
@
Multiple Entry
PRFTB
For [fill ALLBUS], what was [fill YOURSHAREFIL]
the net profit or loss [fill BIZDATESFIL] Net profit or loss is the
difference between gross receipts and expenses.
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount: $@1
OR
Net loss amount:
$@2
Multiple Entry
ANNPRFT
Can you give me an annual figure?
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount: $@1
OR
Net loss amount:
$@2
Mark One Only
PRFTBCHK
Does that [fill PRFTLOSSFIL] include [fill PTEMPNAME] own income
from this business (that we talked about earlier), or do we need to
add [fill HISHER] income to the [fill PRFTLOSSFIL] to get a total net
profit or loss?
(1) Salary/draw is included in the net profit/loss amount
(2) Add salary/draw to net profit/loss amount
to get total net profit/loss
Wednesday, August 27, 2003
Page 147 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
MLMOREB
Display businesses that are not the top two businesses
Earlier you told me that since [fill MONTH1] 1st, you also
had the following businesses:
**READ LIST OF BUSINESSES ABOVE**
What was the total amount of income you received from
[fill BUSINESSFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51 @52 @53 @54 @55
How about [fill MONTH4]?
@41 @42 @43 @44 @45
And [fill MONTH3]?
@31 @32 @33 @34 @35
And [fill MONTH2]?
@21 @22 @23 @24 @25
And [fill MONTH1]?
@11 @12 @13 @14 @15
Mark One Only
MOONLITE
People sometimes earn extra money doing work outside of their regular
jobs, such as freelancing, consulting, or moonlighting.
Other than what we've already talked about, did [fill TEMPNAME] do
any of that kind of work since [fill MONTH1] 1st?
H
(1) Yes
(2) No
@
Multiple Entry
MLM4
What was the total amount of income [fill TEMPNAME] received
from this work so far this month?
ENTER (N) FOR NONE OR NO MORE.
ENTER (S) FOR SAME AS PREVIOUS AMOUNT.
[fill ERRORFIL]
@51 @52 @53 @54 @55
How about in [fill MONTH4]?
@41 @42 @43 @44 @45
And [fill MONTH3]?
@31 @32 @33 @34 @35
And [fill MONTH2]?
@21 @22 @23 @24 @25
And [fill MONTH1]?
@11 @12 @13 @14 @15
Page 148 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
ROLLOVR1
Earlier you said that [fill TEMPNAME] received a lump sum payment
from [fill LUMPFIL].
Did [fill HESHE] re-invest or "roll over" any of the money into an IRA or
some other kind of retirement plan?
(1) Yes
(2) No
@
Mark One Only
ROLLOVR2
[fill C_DODOES] [fill HESHE] plan to re-invest or "roll over"
any of the money?
(1) Yes
(2) No
@
Enter Number
ROLLAMT
How much [fill PLANFIL] "roll over" into
another RETIREMENT account?
$@
Mark One Only
DEFER
At any time since [fill MONTH1] 1st, did [fill TEMPNAME]
receive any kind of deferred payment or final paycheck
from a job or business that ended before [fill MONTH1] 1st?
(1) Yes
(2) No
@
Mark One Only
DEFERAMT
What was the total amount of income [fill TEMPNAME] received
since [fill MONTH1] 1st?
$@
Wednesday, August 27, 2003
Page 149 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
LUMP1YN
[fill C_HAVHAS] [fill TEMPNAME] received any Pension or
Retirement Lump Sums yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] -- did [fill HESHE] also
receive Pension or Retirement Lump Sums?
ENTER (A) FOR "ALL REMAINING MONTHS"
ENTER (N) FOR "NONE OR NO MORE"
(1) Yes
(2) No
[fill MONTH1] @1
[fill MONTH2] @2
[fill MONTH3] @3
[fill MONTH4] @4
Multiple Entry
LUMP1AMT
How much [fill RECEIVFIL]
in Pension or Retirement Lump Sum
income [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) for SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
BIGLUMP15
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 150 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGLUMP14
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX2]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGLUMP13
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX3]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGLUMP12
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX4]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGLUMP11
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX5]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 151 of 340
Survey:
Section: Section: Labor Force 2
Multiple Entry
Items Booklet
LUMP2YN
[fill C_HAVHAS] [fill TEMPNAME] received any Severence Pay
yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] -- did [fill HESHE] also
receive Severence Pay?
ENTER (A) FOR "ALL REMAINING MONTHS"
ENTER (N) FOR "NONE OR NO MORE"
(1) Yes (2) No
[fill MONTH1] @1
[fill MONTH2] @2
[fill MONTH3] @3
[fill MONTH4] @4
Multiple Entry
LUMP2AMT
How much [fill RECEIVFIL]
in Severance Pay income [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) for SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
BIGLUMP25
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGLUMP24
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX2]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 152 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Labor Force 2
Mark One Only
BIGLUMP23
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX3]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGLUMP22
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX4]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGLUMP21
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED - $[fill INDEX5]
IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
LFREC
DO NOT READ TO RESPONDENT
Did the respondent use any records to answer any
labor force earnings questions?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 153 of 340
Survey:
Section: Section: General Income 2
Page 154 of 340
Items Booklet
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
CSHMTHB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2] in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
(2) No
[MONTH2] @1
[MONTH3] @2
[MONTH4] @3
[MONTH5] @4
Multiple Entry
CSHMTH
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2].
[fill C_HAVHAS] [fill HESHE] received any of those
payments yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] -- did
[fill HESHE] [fill ALSOFIL] receive those payments?
ENTER (A) FOR REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
[fill MONTH3]? @3
[fill MONTH4]? @4
Wednesday, August 27, 2003
Page 155 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
YBEG20
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need [fill INCTYP1]
[fill INCTYP2] in [fill MONTH5]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
YSTOP21
Why did [fill TEMPNAME] stop receiving
[fill INCTYP1] [fill INCTYP2]
after [fill MONTH3]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Got a job or earning increased
Family situation changed
Others in the household earned enough money
Penalized or sanctioned for non-cooperation
Time limit expired
Didn't want to use up time limit
Chose not to participate
Other [if @1 eq <7>]SPECIFY:
@SP1
@SP2
@1
Multiple Entry
YBEG21
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need [fill INCTYP1]
[fill INCTYP2]
in [fill MONTH4]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY
Page 156 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
YSTOP22
Why did [fill TEMPNAME] stop receiving
[fill INCTYP1] [fill INCTYP2]
after [fill MONTH2]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Got a job or earning increased
Family situation changed
Others in the household earned enough money
Penalized or sanctioned for non-cooperation
Time limit expired
Didn't want to use up time limit
Chose not to participate
Other [if @1 eq <7>]SPECIFY:
@SP1
@SP2
@1
Multiple Entry
YBEG22
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH3]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
YSTOP23
Why did [fill TEMPNAME] stop receiving
[fill INCTYP1] [fill INCTYP2]
after [fill MONTH1]?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Got a job or earning increased
Family situation changed
Others in the household earned enough money
Penalized or sanctioned for non-cooperation
Time limit expired
Didn't want to use up time limit
Chose not to participate
Other [if @1 eq <7>]SPECIFY:
@SP1
@SP2
@1
Wednesday, August 27, 2003
Page 157 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
YBEG23
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need
[fill INCTYP1][fill INCTYP2]
in [fill MONTH2]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
BEG120
When did [fill TEMPNAME] start receiving [fill INCTYP1]
[fill INCTYP2]?
MONTH: @MON
YEAR: @YEAR
Multiple Entry
BEG120A
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]?
MONTH: [fill BEG120@MON]
YEAR: [fill BEG120@YEAR]
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]
on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
BEG120B
Multiple Entry
BEG120C
[fill RECEIVFIL]?
(1) Yes
(2) No
@
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]
CONTINUOUSLY, every month [fill THROUGHFIL]?
MONTH: @MTH
YEAR: @YR
Page 158 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
YBEG220
What changed in [fill PTEMPNAME] life
that caused [fill HIMHER] to need
[fill INCTYP1][fill INCTYP2]?
[fill MONTH1FIL] Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
CSHAMT15
[fill NOTINCFSFIL] much [fill RECEIVFIL]
from [fill INCTYP1] [fill INCTYP2] [fill MONTHXFIL]
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@51 @52 @53 @54 @55
[fill ERRORFIL]
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
CHCK5
THE AMOUNT ENTERED - [fill INDEX:,]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
CHCK4
THE AMOUNT ENTERED - [fill INDEX2:,]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 159 of 340
Survey:
Section: Section: General Income 2
Mark One Only
Items Booklet
CHCK3
THE AMOUNT ENTERED - [fill INDEX3:,]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
CHCK2
THE AMOUNT ENTERED - [fill INDEX4:,]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
CHCK1
THE AMOUNT ENTERED - [fill INDEX5:,]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
INCPASS
Earlier I recorded that [TEMPNAME] received pass through
child support payments from a state or county welfare
program.
Were these payments INCLUDED in the amount(s) you gave me?
PASS THROUGH CHILD SUPPORT MAY ALSO BE KNOWN AS "BONUS"
CHILD SUPPORT OR "DISREGARD PAYMENTS".
(1) Yes, bonus/pass through amounts are included
(2) No, amounts do NOT include bonus/pass through
(3) (did not receive any bonus/pass through income)
@
Page 160 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
PASSAMT5
How much pass through child support did
[fill TEMPNAME] receive [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill ERRORFIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
Mark One Only
BIGPASS5
THE AMOUNT ENTERED - [fill INDEX6]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGPASS4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGPASS3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 161 of 340
Survey:
Section: Section: General Income 2
Mark One Only
Items Booklet
BIGPASS2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGPASS1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
KIDONLY
Were [fill PTEMPNAME]
[fill INCTYP1] [fill INCTYP2]
payments for both adults AND children in the household,
or JUST the children?
(1) Both adults and children
(2) Children only
@
Mark All That Apply
CASHCOV
Who [fill ISWASFIL] [fill PTEMPNAME]
| LN NAME
[fill MONTHFIL]
| {display HH roster}
[fill INCTYP1] [fill INCTYP2]
|
payment for?
|
|
ENTER LINE NUMBER OF PERSON COVERED
|
ENTER (A) FOR ALL PERSONS COVERED
|
ENTER (N) FOR NONE/NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
@KEY [fill ERRORFIL]
|
Page 162 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
WICMNTHB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
WIC, or the Women, Infants and Children Nutrition Program
in [fill MONTH1].
Did [fill HESHE] also receive those benefits
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[MONTH2] @1
[MONTH3] @2
[MONTH4] @3
[MONTH5] @4
Multiple Entry
WICMNTH
Earlier I recorded that [fill TEMPNAME] received WIC, or the Women,
Infants and Children Nutrtion Program. [fill C_HAVHAS][fill TEMPNAME]
received any benefits from the WIC program yet this month?
(1) Yes
(2) No
@WIC5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] - did [fill HESHE] [/ <>] receive
WIC benefits?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1] @WIC1
[fill MONTH2] @WIC2
[fill MONTH3] @WIC3
[fill MONTH4] @WIC4
Wednesday, August 27, 2003
Page 163 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
WYBEG20
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need WIC in [fill MONTH5]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
WYSTOP21
Why did [fill TEMPNAME] stop receiving WIC after [fill MONTH3]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@1
Multiple Entry
WYBEG21
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC in [fill MONTH4]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 164 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
WYSTOP22
Why did [fill TEMPNAME] stop receiving WIC after [fill MONTH2]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@
Multiple Entry
WYBEG22
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC in [fill MONTH3]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERROFFIL]
Multiple Entry
WYSTOP23
Why did [fill TEMPNAME] stop recveiving WIC after [fill MONTH1]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@
Wednesday, August 27, 2003
Page 165 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
WYBEG23
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC in [fill MONTH2]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
WBEG120
When did [fill TEMPNAME] start receiving WIC?
MONTH: @MON
YEAR: @YEAR
Multiple Entry
WBEG120A
When did [fill TEMPNAME] start receiving WIC?
MONTH: [fill WBEG120@MON]
YEAR: [fill WBEG120@YEAR]
When did [fill TEMPNAME] start receiving
WIC on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
WBEG120B
Multiple Entry
WBEG120C
[fill RECEIVFIL]?
(1) Yes
(2) No
@
When did [fill TEMPNAME] start receiving WIC CONTINUOUSLY, every month
[fill THROUGHFIL]?
MONTH: @MTH
YEAR: @YR
Page 166 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
WYBEG220
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to need
WIC [fill MONTH1FIL]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Mark All That Apply
WICPER
Who [fill DODIDFIL] [fill PTEMPNAME]
| LN NAME
[fill MTHFIL] WIC benefits cover?
| {display all women ages 16-65,
| children le 5, single fathers with
ENTER LINE NUMBER OF PERSON COVERED
| children le 5}
ENTER (A) FOR ALL PERSONS COVERED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
@KEY [fill ERRORFIL]
Multiple Entry
FSMTHYNB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
Food Stamps in [fill MONTH1].
Did [fill HESHE] also receive Food Stamps
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
(2) No
[MONTH2] @1
[MONTH3] @2
[MONTH4] @3
[MONTH5] @4
Wednesday, August 27, 2003
Page 167 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
FSMTHYN
Earlier I recorded that [fill TEMPNAME] [fill WASWEREFIL] authorized
to receive Food Stamps. [fill C_HAVHAS] [fill TEMPNAME] received any
Food Stamp benefits yet this month?
(1) Yes
(2) No
@2
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] - did
[fill HESHE] [fill ALSOFIL] receive Food Stamps?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) YES
[MONTH1] @
[MONTH2] @
(2) No
[MONTH3] @
[MONTH4] @
Multiple Entry
FYBEG20
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need Food Stamps in [fill MONTH5]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 168 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
FYSTOP21
Why did [fill TEMPNAME] stop receiving Food Stamps
after [fill MONTH3]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend schoo, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@1
Multiple Entry
FYBEG21
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need Food Stamps in [fill MONTH4]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY[fill ERRORFIL]
Multiple Entry
FYSTOP22
Why did [fill TEMPNAME] stop receiving Food Stamps
after [fill MONTH2]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@1
Wednesday, August 27, 2003
Page 169 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
FYBEG22
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need Food Stamps in [fill MONTH3]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
FYSTOP23
Why did [fill TEMPNAME] stop receiving Food Stamps
after [fill MONTH1]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@1
Multiple Entry
FYBEG23
What changed in [fill PTEMPNAME] life that caused [fill HIMHER]
to need Food Stamps in [fill MONTH2]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 170 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
FBEG120A
When did [fill TEMPNAME] start receiving Food Stamps?
MONTH: [fill FBEG120@MON]
YEAR: [fill FBEG120@YEAR]
When did [fill TEMPNAME] start receiving
Food Stamps on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
FBEG120B
Multiple Entry
FBEG120C
[fill RECEIVFIL]?
(1) Yes
(2) No
@
When did [fill TEMPNAME] start receiving Food Stamps CONTINUOUSLY,
every month [fill THROUGHFIL]?
MONTH: @MTH
YEAR: @YR
Multiple Entry
FYBEG220
What changed in [fill PTEMPNAME] life that caused [fill HIMHER]
to need Food Stamps[fill MONTH1FIL]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation, divorce or widowed
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 27, 2003
Page 171 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
FSAMT15
How much [fill RECEIVFIL] in
Food Stamps [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill ERRORFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
BIGFS5
THE AMOUNT ENTERED - [fill INDEX6]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGFS4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGFS3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGFS2
THE AMOUNT ENTERED -[fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 172 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Mark One Only
BIGFS1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark All That Apply
FSPER
Who [fill ISWASFIL] covered by
| LN NAME
[fill PTEMPNAME] [fill MTHFIL]
| {display HH roster}
Food Stamp benefits?
|
|
ENTER LINE NUMBER OF PERSON COVERED
|
ENTER (A) FOR ALL PERSONS COVERED
|
ENTER (N) FOR NO MORE
|
|
@KEY
|
Multiple Entry
CSMTHB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
child support payments in [fill MONTH1].
[fill DIDFIL]
[fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
(2) No
[MONTH2] @1
[MONTH3] @2
[MONTH4] @3
[MONTH5] @4
Wednesday, August 27, 2003
Page 173 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
CSMTH
Earlier I recorded that [fill TEMPNAME] received child support
payments. [fill PASSTHRUFIL] [fill TEMPNAME]
received any child support payments yet this month?
(1) Yes
(2) No
@
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] - did [fill HESHE] [/ <>]
receive child support payments?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
[MONTH1] @
[MONTH2] @
(2) No
[MONTH3] @
[MONTH4] @
Multiple Entry
CSAMT15
[fill HOWFIL]
much [fill RECEIVFIL] in child support
payments [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Mark One Only
BIGCS5
THE AMOUNT ENTERED - [fill INDEX6]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 174 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Mark One Only
BIGCS4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCS3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCS2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGCS1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
KCOVBEG
Earlier I recorded that [fill TEMPNAME] |NAMES
received [fill INCTYP1][fillINCTYP2]
|(display children's names
on behalf of
|under the age of 18
**READ NAME(S)OF CHILD(REN)**
|for whom R is a mom, dad
|or guardian)
When did [fill TEMPNAME] begin to receive |
[fill INCTYP3]for
|
**READ NAME(S)OF CHILD(REN)**?
|
|
MONTH: @STRTMTH
|
YEAR: @STRTYR
@
Wednesday, August 27, 2003
Page 175 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
KDMTHYNB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2]
for [fill HISHER] [fill GICHILD] in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
(2) No
[MONTH2] @1
[MONTH3] @2
[MONTH4] @3
[MONTH5] @4
Multiple Entry
KDMTHYN
Have [fill TEMPNAME] received any
|NAMES
[fill INCTYP1] [fill INCTYP2] for
|{display children's names
**READ NAME(S) OF CHILD(REN)**
|under the age of 18
yet this month?
|for whom R is a mom, dad,
(1) Yes (2) No
|or guardian}
@5
|
|
SHOW CALENDAR ON FLASHCARD E
|
|
In which of the last four months |
[fill MONTH1], [fill MONTH2],
|
[fill MONTH3],or [fill MONTH4] |
did [fill HESHE] [fill ALSOFIL]receive |
[fill INCTYP3] for
|
**READ NAME(S) OF CHILD(REN)**?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[MONTH1] @1 [MONTH3] @3
[MONTH2] @2 [MONTH4] @4
Page 176 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
KIDAMT15
How much [fill RECIEVFIL] in [fill INCTYP1] [fill INCTYP2]
on behalf of the [fill GICHILD] [fill MONTHXFIL]?
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
[fill ERRORFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
Mark One Only
BIGKAMT5
THE AMOUNT ENTERED - [fill INDEX:]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGKAMT4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGKAMT3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGKAMT2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 177 of 340
Survey:
Section: Section: General Income 2
Mark One Only
Items Booklet
BIGKAMT1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark All That Apply
SSKIDCOV
Who did these [fill INCTYP3]
| LN NAME
cover?
| {display >GDLST< template}
|
ENTER LINE NUMBER OF PERSON COVERED
|
ENTER (A) FOR ALL PERSONS COVERED
|
ENTER (N) FOR NONE OR NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
@KEY [fill ERRORFIL]
|
Multiple Entry
RESNSS
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2] [fill FORSELFFIL].
What is the reason [fill HESHE] [fill AREIS] getting
[fill INCTYP1] [fill INCTYP2]?
Any other reason?
ENTER (N) IF NO SECOND REASON
(1) Retired
(2) Disabled
(3) Widowed or surviving child
(4) Spouse or dependent child
(5) Other reason {pop up: SPECIFY: @SP}
@1
@2 [fill ERRORFIL]
Mark One Only
AGESS
[fill EARLIERFIL]
At what age did [fill TEMPNAME] begin receiving
[fill INCTYP1] [fill INCTYP2] because of
[fill HISHER] disability?
(REPORT AGE IN YEARS)
AGE: @
Page 178 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
JNTSSYN
Mark One Only
[fill EARLIERFIL]
(Since [fill MONTH1] 1st,)
Did [fill TEMPNAME] receive [fill INCTYP1] [fill INCTYP2]
jointly with [fill HISHER] spouse?
(1) Yes
(2) No
@
WHENSS
Mark One Only
[fill EARLIERFIL]
On what day of the month are [fill HISHER] payments
usually deposited?
(1)
(2)
(3)
(4)
First day of the month
Third day of the month
2nd, 3rd, or 4th Wednesday
Other
@
TRANTYP
Multiple Entry
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received transportation assistance. Did [fill HESHE] receive...
(1) Yes
(2) No
...gas vouchers?
@1
...bus or subway tokens or passes?
@2
...help registering, repairing, or insuring a car?
@3
...rides to a doctor's office or medical appointment?
@4
...some other kind of transportation assistance?
{pop up: What was that?}
@5
@SP
Multiple Entry
GASVSCE
Did [fill HESHE] receive the gas vouchers through a government social
service agency or through someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Wednesday, August 27, 2003
Page 179 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
GASMTH
[fill C_HAVHAS] [fill TEMPNAME] received any gas vouchers
yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months -- [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] -- did
[fill HESHE] [fill ALSOFIL] receive gas vouchers?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
[fill MONTH3]? @3
[fill MONTH4]? @4
Multiple Entry
GASMTHB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
gas vouchers in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE
(1) Yes
(2) No
[fill MONTH2]
[fill MONTH3]
[fill MONTH4]
[fill MONTH5]
@2
@3
@4
@5
Multiple Entry
GASAMT
How much [fill RECEIVFIL]
in gas vouchers [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Page 180 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Mark One Only
BIGGAS5
THE AMOUNT ENTERED - [fill INDEX6]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGGAS4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGGAS3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGGAS2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGGAS1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 181 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
TOKENSCE
Did [fill HESHE] receive the bus or subway tokens or passes
through a government social service agency or through
someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Multiple Entry
TOKMTH
[fill C_HAVHAS] [fill TEMPNAME] received any bus or subway tokens
or passes yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR
In which of the last four months -- [fill MONTH1],
[fill MONTH2], [fill MONTH3], or [fill MONTH4] -- did
[fill HESHE] [fill ALSOFIL] receive bus or subway tokens or passes?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
[fill MONTH3]? @3
[fill MONTH4]? @4
Multiple Entry
TOKMTHB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
bus or subway tokens or passes in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[MONTH2] @2
[MONTH3] @3
[MONTH4] @4
[MONTH5] @5
Page 182 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
TOKAMT
How much [fill RECEIVFIL]
in bus or subway tokens or passes [fill MONTHXFIL]
ENTER (N) FOR NONE/NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Mark One Only
BIGTOK5
THE AMOUNT ENTERED - [fill INDEX6]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTOK4
THE AMOUNT ENTERED - [fill INDEX2]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTOK3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGTOK2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 183 of 340
Survey:
Section: Section: General Income 2
Items Booklet
BIGTOK1
Mark One Only
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
FOODTYP
Multiple Entry
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received some food assistance. [fill FOODFIL] [fill HESHE] receive...
(1) Yes (2) No
... Money, vouchers, or certificates to buy groceries or
food?
@1
... Bags of groceris or packaged foods?
@2
... Any meals from a shelter, soup kitchen, Meals-on-Wheels,
or other charity?
@3
... Any other food assistance? {pop up: What was that?}
@4
@SP
Multiple Entry
FOODSCE
Did [fill HESHE] get the grocery money, vouchers,
or certificates through a government social service agency, through
a community or religious charitable organization, through family or
friends, or through someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Community or religious charity
(3) Family or friends
(4) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Mark One Only
CLOTHTYP
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received clothing assistance or clothes. Did [fill HESHE]
receive clothes or money or vouchers to buy clothes?
(1) Clothes
(2) Money or vouchers
(3) Both clothes and money or vouchers
@
Page 184 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
CLOTHSCE
Did [fill HESHE] get that through a government social service
agency, through a community or religious charitable organization,
through family or friends, through an employer, or through
someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Community or religious charity
(3) Family or friends
(4) Employer
(5) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Mark One Only
PUBHSTYP
Earlier you said that [fill TEMPNAME] received assistance
to help pay for housing since [fill MONTH1] 1st. Was that
through Section 8, some other rental assistance program,
some other kind of housing program, or are you not sure?
(1) Section 8
(2) Other rental assistance
(3) Other housing program
(4) Not sure; don't know
@
Multiple Entry
PUBHSSCE
Did [fill HESHE] get that through a government social service agency,
through a local housing authority, through a community or religious
charitable organization, or through someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Housing authority
(3) Community or religious charity
(4) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Wednesday, August 27, 2003
Page 185 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
CASHSCE
Earlier you said that since [fill MONTH1] 1st, [fill TEMPNAME]
received [fill INCTYP1]. Did [fill HESHE] get that through a
government social service agency, through a community or religious
charitable organization, through family or friends, or
through someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Community or religious charity
(3) Family or friends
(4) Someplace else {pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Mark One Only
CASHGVT
Was that through the federal, state, or local government?
(1) Federal
(2) State
(3) Local
@
Multiple Entry
OTHSCE
Earlier you said that since [fill MONTH1] 1st,
[fill TEMPNAME] received [fill INCTYP1]. Did [fill HESHE] get that
through a government social service agency, through a community or
religious charitable organization, through family or friends, or through
someplace else?
ENTER ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
(1) Government agency
(2) Community or religious charity
(3) Family or friends
(4) Someplace else
{pop up: What was that?}
@SP
@KEY [fill ERRORFIL]
Page 186 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
MNTHYNB
SHOW CALENDAR ON FLASHCARD E
Earlier I recorded that [fill TEMPNAME] received
[fill INCTYP1] [fill INCTYP2] in [fill MONTH1].
Did [fill HESHE] also receive those payments
in [fill MONTH2], [fill MONTH3], [fill MONTH4],
or [fill MONTH5]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[MONTH2] @2
[MONTH3] @3
[MONTH4] @4
[MONTH5] @5
Multiple Entry
MNTHYN
[fill EARLIERFIL]
[fill INCOMEFIL]
[fill C_HAVHAS] [fill TEMPNAME] received any [fill INCTYP3] yet this month?
(1) Yes
(2) No
@5
SHOW CALENDAR ON FLASHCARD E
In which of the last four months - [fill MONTH1], [fill MONTH2],
[fill MONTH3], or [fill MONTH4] - did [fill HESHE] [fill ALSOFIL]
receive [fill INCTYP1] [fill INCTYP2]?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes
(2) No
[MONTH1] @1
[MONTH2] @2
[MONTH3] @3
[MONTH4] @4
Multiple Entry
MYBEG20S
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH5]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other,{pop up: SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 27, 2003
Page 187 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
MYBEG20L
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH5]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation or divorce
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
MYSTOP21
Why did [fill TEMPNAME] stop receiving [fill INCTYP1]
[fill INCTYP2] after [fill MONTH3]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend schoo, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@
Multiple Entry
MYBEG21L
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH4]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation or divorce
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 188 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
MYBEG21S
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH4]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other {pop up: SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
MYSTOP22
Why did [fill TEMPNAME] stop receiving [fill INCTYP1]
[fill INCTYP2] after [fill MONTH2]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend schoo, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@1
Multiple Entry
MYBEG22L
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH3]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation or divorce
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Wednesday, August 27, 2003
Page 189 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
MYBEG22S
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2]
in [fill MONTH3]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other {pop up: SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
MYSTOP23
Why did [fill TEMPNAME] stop receiving [fill INCTYP1]
[fill INCTYP2] after [fill MONTH1]?
(1) Became ineligible because of increased income
(2) Became ineligible because of family changes
(Family member left, over age limit, etc.)
(3) Still eligible but could not/chose not to collect
(4) Became ineligible because program requirements were
not met (did not attend school, job training, etc.)
(5) Eligibility ran out because of time limits
(6) The money is not worth it
(7) Other {pop up: SPECIFY:}
@SP1
@SP2
@1
Multiple Entry
MYBEG23L
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1] [fill INCTYP2] in [fill MONTH2]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) New child (or other dependent) or pregnancy
(2) Separation or divorce
(3) Job loss or wages reduced
(4) Loss or reduction of other income
(5) Became disabled or otherwise unable to work
(6) No change - just decided it was time
(7) No change - just heard about the program
(8) Needed to re-certify
(9) Other {pop up: SPECIFY}
@SP1
@SP2
@KEY [fill ERRORFIL]
Page 190 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Multiple Entry
MYBEG23S
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2] in [fill MONTH2]? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other,{pop up: SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
MBEG120
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]?
MONTH: @MON
YEAR: @YEAR
Multiple Entry
MBEG120A
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]?
MONTH: [fill MBEG120@MON]
YEAR: [fill MBEG120@YEAR]
When did [fill TEMPNAME] start receiving
[fill INCTYP1] [fill INCTYP2]
on [fill HISHER] own, or in [fill HISHER] own name?
MONTH: @MO
YEAR: @YR
Mark One Only
MBEG120B
Multiple Entry
MBEG120C
[fill RECEIVFIL]
[fill RECEIVFIL2]?
(1) Yes
(2) No
@
When did [fill TEMPNAME] start receiving [fill INCTYP1] [fill INCTYP2]
CONTINUOUSLY, every month [fill THROUGHFIL]?
MONTH: @MTH
YEAR: @YR
Wednesday, August 27, 2003
Page 191 of 340
Survey:
Section: Section: General Income 2
Multiple Entry
Items Booklet
MYBEG220L
What changed in [fill PTEMPNAME] life that caused [fill HIMHER] to
need [fill INCTYP1][if INCTYP2 ne <>] [fill INCTYP2][endif][fill
MONTH1FIL] Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
New child (or other dependent) or pregnancy
Separation or divorce
Job loss or wages reduced
Loss or reduction of other income
Became disabled or otherwise unable to work
No change - just decided it was time
No change - just heard about the program
Needed to re-certify
Other [if @9 eq <9>]SPECIFY:
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
MYBEG220S
What set of circumstances led [fill TEMPNAME] to need
[fill INCTYP1] [fill INCTYP2][fill MONTH1FIL] Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1)
(2)
(3)
(4)
Needed the money
Became disabled/blind
Over 65
Other, {pop up: SPECIFY:}
@SP1
@SP2
@KEY [fill ERRORFIL]
Multiple Entry
MNTHAMT15
[fill EXCLUDEFIL] [fill CHILDPAYFIL]
how much [fill RECEIVFIL]
in [fill INCTYP1] [fill INCTYP2]
[fill MONTHXFIL]?
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@51 @52 @53 @54 @55
[fill MONTH1FIL]?
@41 @42 @43 @44 @45
[fill MONTH2FIL]?
@31 @32 @33 @34 @35
[fill MONTH3FIL]?
@21 @22 @23 @24 @25
[fill MONTH4FIL]?
@11 @12 @13 @14 @15
Page 192 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: General Income 2
Mark One Only
BIGAMT5
THE AMOUNT ENTERED - [fill INDEX6]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGAMT4
THE AMOUNT ENTERED - [fill INDEX2:,]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGAMT3
THE AMOUNT ENTERED - [fill INDEX3]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGAMT2
THE AMOUNT ENTERED - [fill INDEX4]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
BIGAMT1
THE AMOUNT ENTERED - [fill INDEX5]
IS [fill LGSMFIL].
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark All That Apply
TMCOV
Who [fill DOESDIDFIL] [fill PTEMPNAME]
| LN NAME
[fill MONTHFIL] [fill INCTYP1]
| {display HH roster}
[fill INCTYP2] cover?
|
|
ENTER LINE NUMBER OF PERSON COVERED
|
ENTER (A) FOR ALL PERSONS COVERED
|
ENTER (N) FOR NONE/NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
@KEY
|
Wednesday, August 27, 2003
Page 193 of 340
Survey:
Section: Section: General Income 2
Mark One Only
Items Booklet
GINCRECUSE
DO NOT READ TO RESPONDENT
Did the respondent use any records to answer any
general income earnings questions?
(1) Yes
(2) No
@
Page 194 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JINTSP_PD
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME] jointly with
|{display names marked in JTWHO}
[fill SPOUSEFIL].)
|{star small children's names}
|
What is the easiest way
|
for you to tell me about [fill SHAREFIL] |
the interest or dividend income
|
[fill ANDSPKIDFIL] received from those |
jointly held [fill ASNAME]?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Multiple Entry
JTINTSP
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO}
[fill HOWMUCHFIL]
|{star small children's names}
by these joint [fill ASNAME]?
|
|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL1]
|
Multiple Entry
JTINTSP2
[fill HOWMUCHFIL] interest or dividend |JOINT WITH:
income [fill WASFIL] produced by these |{display names marked in JTWHO}
joint [fill ASNAME]...
|{star children's names}
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
|
4-Month Total: $[fill JNTINTSP]
|
Wednesday, August 27, 2003
Page 195 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
BIGAST1
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JCATSP1Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 10 dollars, |
between 10 and 25 dollars,
|
between 25 and 50 dollars,
|
or more than 50 dollars?
|
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Mark One Only
JCATSP1Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
25 dollars, between 25 and 75 dollars, |
between 75 and 150 dollars, or more
|
than 150 dollars?
|
|
(1) Less than $25
|
(2) $25 to $74.99
|
(3) $75 to $149.99
|
(4) $150 or more
|
|
@
|
Mark One Only
JCATSP2Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
50 dollars, between 50 and 150 dollars, |
between 150 and 500 dollars, or more
|
than 500 dollars?
|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
Page 196 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JCATSP2Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
JCATSP3Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
150 dollars, between 150 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
JCATSP3Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than 500
|
dollars, between 500 and 1,500 dollars, |
between 1,500 and 5,000 dollars, or more |
than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 197 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JINTCH_PD
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME] jointly with
|{display names marked in JTWHO
**READ NAMES**.)
|{star children's names}
|
What is the easiest way for you to tell |
me about the interest or dividend income |
from those joint [fill ASNAME]?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Multiple Entry
JTINTCH
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO}
[fill HOWMUCHFIL]
|{star children's names}
by these joint [fill ASNAME]?
|
|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL2]
|
Multiple Entry
JTINTCH2
How much interest or dividend income was |JOINT WITH:
produced by these joint [fill ASNAME]? |{display names marked in JTWHO}
H |{star children's names}
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
|
4-Month Total: $[fill JNTINTCH]
|
Page 198 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
BIGAST2
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JCATCH1Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
10 dollars, between 10 and 25 dollars, |
between 25 and 50 dollars, or more
|
than 50 dollars?
|
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Mark One Only
JCATCH1Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
25 dollars, between 25 and 75 dollars, |
between 75 and 150 dollars, or more
|
than 150 dollars?
|
|
(1) Less than $25
|
(2) $25 to $74.99
|
(3) $75 to $149.99
|
(4) $150 or more
|
|
@
|
Mark One Only
JCATCH2Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
50 dollars, between 50 and 150 dollars, |
between 150 and 500 dollars, or more
|
than 500 dollars?
|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
Wednesday, August 27, 2003
Page 199 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JCATCH2Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
JCATCH3Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
150 dollars, between 150 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
JCATCH3Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Page 200 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
JTOTHINT_PD
Mark One Only
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME] jointly with
|{display names marked in JTWHO}
**READ NAME(S)**.)
|{star childrens' names}
|
What is the easiest way for you to tell |
me about the share of the interest or |
dividend income [fill TEMPNAME]
|
[fill ANDSPKIDFIL] received from these |
jointly held [fill ASNAME]?
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
@
|
JTOTHINT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
by these joint
[fill ASNAME]?
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL3]
|
|
|
Multiple Entry
JTOTHINT2
What was [fill PTEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL] share of the interest |{display names marked in JTWHO}
or dividend income produced by these
|{star children's names}
joint [fill ASNAME]?
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JNTOTINT]
|
Wednesday, August 27, 2003
Page 201 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
BIGAST3
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JCATOT1Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 10 dollars, |
between 10 and 25 dollars,
|
between 25 and 50 dollars,
|
or more than 50 dollars?
|
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Mark One Only
JCATOT1Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
25 dollars, between 25 and 75 dollars, |
between 75 and 150 dollars, or more
|
than 150 dollars?
|
|
(1) Less than $25
|
(2) $25 to $74.99
|
(3) $75 to $149.99
|
(4) $150 or more
|
|
@
Mark One Only
JCATOT2Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 50 dollars, |
between 50 and 150 dollars, between 150 |
and 500 dollars, or more than 500 dollars?|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
Page 202 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JCATOT2Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
JCATOT3Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 150 dollars, |
between 150 and 500 dollars, between 500 |
and 1,500 dollars, or more than 1,500 |
dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
JCATOT3Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 203 of 340
Survey:
Section: Section: Assets 2
Items Booklet
EXCL_CD
Mark One Only
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill ASNAME] [fill OWNNAMEFIL].
Are these CDs included in [fill PTEMPNAME] [fill IRA401FIL] account,
or [fill DODOES] [fill HESHE] own them separately from any retirement
account -- or both?
H
(1) All CDs are included in IRA/Keogh/401k/403b/thrift accounts
(2) All CDs are owned separately from retirement accounts
(3) Both -- some are included in retirement accounts
and some are owned separately
@
OINT_PD
Mark One Only
[fill INCOMENOWFIL]
[fill EARLIERFIL] What is the easiest way for you to tell me about
[fill PTEMPNAME] interest or dividend income from those [fill ASNAME]?
READ ANSWER CATEGORIES IF NECESSARY
H
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) DO NOT READ -- None of these
@
OINT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL] by these [fill ASNAME]?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL4]
Page 204 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
OINT2
What was the total amount of interest or dividend income
[fill TEMPNAME] earned from these [fill ASNAME]...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill OWNINT]
Mark One Only
BIGAST4
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
OCAT1Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL]
less than 10 dollars, between 10 and 25 dollars,
between 25 and 50 dollars, or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
OCAT1Y
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 25 dollars,
between 25 and 75 dollars, between 75 and
150 dollars, or more than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Wednesday, August 27, 2003
Page 205 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
OCAT2Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIl] amount [fill SINCEFIL] less
than 50 dollars, between 50 and 150 dollars, between 150
and 500 dollars, or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
OCAT2Y
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between
100 and 500 dollars, between 500 and 1,500 dollars,
or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $1,499.99
$1,500 or more
@
Mark One Only
OCAT3Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less
than 150 dollars, between 150 and 500 dollars, between 500
and 1,500 dollars, or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Mark One Only
OCAT3Y
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 500 dollars, between
500 and 1,500 dollars, between 1,500 and 5,000 dollars,
or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $1,499.99
$1,500 to $4,999.99
$5,000 or more
@
Page 206 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Enter Number
DKINT
[fill ASIDEFRMFIL]
is the total amount of interest or dividend income
[fill TEMPNAME] [fill HAVHAS] earned since [fill MONTH1] 1st on all
[fill OTHERFIL] [fill ASNAME] [fill HESHE] owned?
[fill ENTERLFIL]
$@
Mark One Only
DKCAT1Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 10 dollars,
between 10 and 25 dollars, between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Mark One Only
DKCAT2Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 50 dollars,
between 50 and 150 dollars, between 150 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
DKCAT3Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 150 dollars,
between 150 and 500 dollars, between 500 and 1,500 dollars,
or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Wednesday, August 27, 2003
Page 207 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JTANYWSP
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME2] jointly with
|{display names marked in JTWHO2}
**READ NAMES**.
|{star small children's names}
|
What kind of dividends do [fill YOUTHEYFIL]|
[fill BOTHALLFIL] get from these joint |
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends |
credited against a margin account or
|
automatically reinvested?
|
H|
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
NODIVSP
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
[fill TEMPNAME] and [fill SPOUSEFIL]
|{display names marked in JTWHO2}
have received no dividends of any kind |{star small children's names}
from these joint [fill ASNAME2] since
|
[fill MONTH1] 1st -- is that correct?
|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
|
Mark One Only
JTDIVSP_PD
What is the easiest way for you to tell |JOINT WITH:
me about [fill SHAREFIL] the dividend |{display names marked in JTWHO2}
income [fill ANDSPKIDFIL] received from |{star small children's names}
those jointly held [fill ASNAME2]?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
@
|
Page 208 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
JTDIVSP
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
[fill INCLUDEFIL] [fill HOWWHATFIL]
|{star small children's names}
[fill ISWASFIL][fill YOURTHEIRFIL]
|
[fill SHARE2FIL] [fill CREDITEDFIL]
|
dividend income [fill WASFIL]
|
[fill PRODUCEDFIL]
|
by all these joint [fill ASNAME2]?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1 $@2
|
$@3 $@4
|
$@5 $@6
|
|
Total: $[TOTALFIL5]
|
Multiple Entry
JTDIVSP2
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display name marked in JTWHO2
|{star small children's names}
[fill INCLUDEFIL] was [fill YOURTHEIRFIL] |
share of the [fill CREDITEDFIL] dividend |
income produced by all these joint
|
[fill ASNAME2]...
|
ENTER (N) FOR NONE OR NO MORE
H|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
And [fill MONTH2]?
|
@21 @22 @23
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JNTDIVSP]
|
Mark One Only
BIGAST5
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 209 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JDIVSP1Q
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 100 dollars, |
between 100 and 400 dollars,
|
between 400 and 1,000 dollars,
|
or more than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $399.99
|
(3) $400 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
JDIVSP1Y
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Is the annual amount less than 250
|
dollars, between 250 and 1,000 dollars, |
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Mark One Only
JDIVSP2Q
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Was the [fill 4MONQTRFIL] amount
|
[fill SINCEFIL] less than 25 dollars, |
between 25 and 100 dollars,
|
between 100 and 500 dollars,
|
or more than 500 dollars?
|
|
(1) Less than $25
|
(2) $25 to $99.99
|
(3) $100 to $499.99
|
(4) $500 or more
|
|
@
|
Page 210 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JDIVSP2Y
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Was the annual amount less than 100
|
dollars, between 100 and 500 dollars, |
between 500 and 1,000 dollars, or more |
than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
JTANYWCH
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME2] jointly with
|{display names marked in JTWHO2}
**READ NAME(S)**.
|{star small children's names}
|
What kind of dividends do [fill YOUTHEYFIL]|
[fill BOTHALLFIL] get from these joint |
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends |
credited against a margin account or
|
automatically reinvested?
|
H|
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
NODIVCH
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
[fill TEMPNAME] and **READ NAME(S)**
|{display names marked in JTWHO2}
have received no dividends of any kind |{star small children's names}
from these joint [fill ASNAME2] since
|
[fill MONTH1] 1st -- is that correct?
|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
|
Wednesday, August 27, 2003
Page 211 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JTDIVCH_PD
What is the easiest way for you to tell |JOINT WITH:
me about the dividend income received |{display names marked in JTWHO2}
from those jointly held [fill ASNAME2]? |{star small children's names}
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
@
|
Multiple Entry
JTDIVCH
[fill INCLUDEFIL] [fill CREDITEDFIL]
|JOINT WITH:
dividend income [fill ISWASFIL]
|(display names marked in JTWHO2)
[fill PRODUCEDFIL]
|{star small children's names}
by all these joint [fill ASNAME2]?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL7]
|
Multiple Entry
JTDIVCH2
[fill INCLUDEFIL] [fill CREDITEDFIL]
|JOINT WITH:
dividend income was produced by all
|(display names marked in JTWHO2)
these joint [fill ASNAME2]...
|{star small children's names}
|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JNTDIVCH]
|
Page 212 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
BIGAST6
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JDIVCH1Q
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 100 dollars, |
between 100 and 400 dollars,
|
between 400 and 1,000 dollars,
|
or more than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $399.99
|
(3) $400 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
JDIVCH1Y
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Is the annual amount less than 250
|
dollars, between 250 and 1,000 dollars, |
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Mark One Only
JDIVCH2Q
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Was the [fill 4MONQTRFIL] amount
|
[fill SINCEFIL] less than 25 dollars, |
between 25 and 100 dollars,
|
between 100 and 500 dollars,
|
or more than 500 dollars?
|
|
(1) Less than $25
|
(2) $25 to $99.99
|
(3) $100 to $499.99
|
(4) $500 or more
|
|
@
|
Wednesday, August 27, 2003
Page 213 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JDIVCH2Y
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star small children's names}
Is the annual amount less than 100
|
dollars, between 100 and 500 dollars, |
between 500 and 1,000 dollars, or more |
than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
JTOTHANY
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME2] jointly with
|{display names marked in JTWHO2}
**READ NAME(S)**.
|{star small children's names}
|
What kind of dividends do these joint |
[fill ASNAME2] produce? Do they produce |
dividend checks, or are the dividends |
credited against a margin account or
|
automatically reinvested?
|
H|
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
NODIVOTH
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
these joint [fill ASNAME2] produced no |{display names marked in JTWHO2}
dividends of any kind since
|{star small children's names}
[fill MONTH1] 1st -- is that correct?
|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
|
Page 214 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JTOTHDIV_PD
What is the easiest way for you to tell |JOINT WITH:
me about the share of the dividend
|{display names marked in JTWHO2
income [fill TEMPNAME]
|{star small children's names}
[fill ANDSPKIDFIL] received from
|
those jointly held [fill ASNAME2]?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
@
|
Multiple Entry
JTOTHDIV
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
[fill INCLUDEFIL] [fill ISWASFIL]
|
[fill YOURTHEIRFIL] share of the
|
[fill CREDITEDFIL]
|
dividend income
|
[fill PRODUCEDFIL]
|
by all these joint [fill ASNAME2]?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1 $@2
|
$@3 $@4
|
$@5 $@6
|
|
Total: $[TOTALFIL9]
|
Multiple Entry
JTOTHDIV2
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star small children's names}
[fill INCLUDEFIL] was
|
[fill YOURTHEIRFIL] share of the
|
[fill CREDITEDFIL]
|
dividend income produced
|
by all these joint [fill ASNAME2]...
|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
in [fill MONTH4]?
|
@41 @42 @43
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
And [fill MONTH2]?
|
@21 @22 @23
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JAMTDVOT]
|
Wednesday, August 27, 2003
Page 215 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
BIGAST7
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JDIVOT1Q
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star small children's names}
Asset Type: MUTUAL FUNDS
|
|
[fill SORRYFIL]
|
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 100 dollars, |
between 100 and 400 dollars,
|
between 400 and 1,000 dollars,
|
or more than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $399.99
|
(3) $400 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
JDIVOT1Y
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star small children's names}
Asset Type: MUTUAL FUNDS
|
|
[fill SORRYFIL]
|
Is the annual amount less than 250
|
dollars, between 250 and 1,000 dollars, |
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Page 216 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JDIVOT2Q
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star small children's names}
Asset Type: STOCKS
|
|
[fill SORRYFIL]
|
Was the [fill 4MONQTRFIL] amount
|
[fill SINCEFIL] less than 25 dollars, |
between 25 and 100 dollars,
|
between 100 and 500 dollars,
|
or more than 500 dollars?
|
|
(1) Less than $25
|
(2) $25 to $99.99
|
(3) $100 to $499.99
|
(4) $500 or more
|
|
@
|
Mark One Only
JDIVOT2Y
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star small children's names}
Asset Type: STOCKS
|
|
[fill SORRYFIL]
|
Is the annual amount less than 100
|
dollars, between 100 and 500 dollars, |
between 500 and 1,000 dollars, or more |
than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
EXCLUDE
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill SOMEFIL] [fill FNDSTKFIL2][fill INNAMEFIL]
Are these [fill FNDSTKFIL2] included in
[fill IRA401FIL]
or [fill DODOES] [fill HESHE] own them separately from any
retirement account -- or both?
H
(1) All shares are included in IRA/Keogh/401k/403b/
thrift accounts
(2) All shares are owned separately from retirement accounts
(3) Both -- some are included in retirement accounts
and some are owned separately
@
Wednesday, August 27, 2003
Page 217 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
OWNTYPE
[fill EARLIERFIL]
What kind of dividends [fill DODOES] [fill TEMPNAME] get from these
[fill FNDSTK1FIL]? [fill C_DODOES] [fill HESHE] get dividend checks,
or are the dividends credited against a margin account or
automatically reinvested?
(1)
(2)
(3)
(4)
Dividend CHECKS
CREDITED or AUTOMATICALLY REINVESTED dividends
Both
Neither; no dividends received
@
Mark One Only
NODIVOWN
ASK IF NECESSARY:
Just to be sure, these [fill ASNAME2] produced no dividends
of any kind since [fill MONTH1] 1st -- is that correct?
(1) Yes; correct; no dividends received
(2) No; incorrect; DID RECEIVE dividends
@
Mark One Only
OWNDIV_PD
[fill EARLIERFIL]
[fill INCOMENOWFIL]
What is the easiest way for you to tell me about
[fill YOURNAMEFIL] dividend income from
[fill ASNAME2] [fill OWNNAMEFIL]
READ ANSWER CATEGORIES IF NECESSARY
(1)
(2)
(3)
(4)
4-month total
Monthly amounts
Quarterly amount
Annual amount
(5) DO NOT READ -- None of these
@
Page 218 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
OWNDIV
[fill ANOTHERFIL]
[fill INCLUDEFIL]
[if CREDITEDFIL ne <>][fill CREDITEDFIL] [endif]dividend income [fill ISWASFIL]
[fill PRODUCEDFIL]
by the [fill ASNAME2] [fill HESHE] owned in
[fill HISHER] own name?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL11]
Multiple Entry
OWNDIV2
[fill INCLUDEFIL] [fill CREDITEDFIL] dividend income did
[fill TEMPNAME] receive from the [fill NONRETFIL] [fill ASNAME2]
[fill HESHE] owned in [fill HISHER] own name...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill OWNADV]
Mark One Only
BIGAST8
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 219 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
ODIV1Q
Asset Type: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount [fill SINCEFIL] less than 100 dollars,
between 100 and 400 dollars, between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
ODIV1Y
Asset Type: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250 dollars, between 250 and
1,000 dollars, between 1,000 and 2,500 dollars, or more than
2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2,499.99
$2,500 or more
@
Mark One Only
ODIV2Q
Asset Type: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount [fill SINCEFIL] less than
25 dollars, between 25 and 100 dollars, between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Mark One Only
ODIV2Y
Asset Type: STOCKS
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between 100 and 500 dollars,
between 500 and 1,000 dollars, or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Page 220 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Enter Number
DKDIV
[fill ASIDEFRMFIL]
is the total amount of dividend income [fill TEMPNAME]
[fill HAVHAS] earned since [fill MONTH1] 1st on all [fill OTHERFIL]
[fill ASNAME2] [fill HESHE] owned?
[fill ENTERLFIL]
$@
Mark One Only
DKDIV1M
Asset Type: MUTUAL FUNDS
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 100 dollars,
between 100 and 400 dollars, between 400 and 1,000 dollars,
or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
DKDIV2M
Asset Type: STOCKS
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 25 dollars,
between 25 and 100 dollars, between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Wednesday, August 27, 2003
Page 221 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JTRENT_PD
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned rental property jointly with
|{display names marked in JTWHO3}
[fill SPOUSEFIL].)
|
|
What is the easiest way for you to tell |
me about [fill SHAREFIL] the income
|
[fill ANDSPKIDFIL] received from those |
jointly held properties?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
@
|
Multiple Entry
JTRENT
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO3}
[fill HOWMUCHFIL]
|
in GROSS RENT from all property
|
[fill THEYFIL] owned jointly?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL13]
|
Mark One Only
BIGAST9
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 222 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
JTRENT2
[fill HOWMUCHFIL] GROSS RENT from the |JOINT WITH:
property [fill YOUTHEYFIL] owned jointly |{display names marked in JTWHO3}
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43 @44 @45
|
|
How about in [fill MONTH3]?
|
@31 @32 @33 @34 @35
|
|
And [fill MONTH2]?
|
@21 @22 @23 @24 @25
|
|
And [fill MONTH1]?
|
@11 @12 @13 @14 @15
|
4-Month Total: $[fill JARNT_TOT]
|
Mark One Only
BIGAST10
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
JTCLEAR
[fill PERIODFIL]
|JOINT WITH:
[fill HOWMUCHFIL]
|{display names marked in JTWHO3}
NET INCOME or net loss after expenses? |
H|
READ NAMES IF NECESSARY
|
ENTER A NET LOSS AS A NEGATIVE AMOUNT |
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL14]
|
Wednesday, August 27, 2003
Page 223 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Multiple Entry
JTCLEAR2
[fill WHATWASFIL] NET INCOME
|JOINT WITH:
or net loss after expenses...
|{display names marked in JTWHO3}
ENTER A NET LOSS AS A NEGATIVE AMOUNT |
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43 @44 @45
|
|
How about in [fill MONTH3]?
|
@31 @32 @33 @34 @35
|
|
And [fill MONTH2]?
|
@21 @22 @23 @24 @25
|
|
And [fill MONTH1]?
|
@11 @12 @13 @14 @15
|
4-Month Total: $[fill JACLR_TOT]
|
Mark One Only
BIGAST11
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JTCLR1Q
Asset Type: RENTAL PROPERTY
|JOINT WITH:
|{display names marked in JTWHO3}
[fill SORRYFIL]
|
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 250 dollars, |
between 250 and 1,000 dollars,
|
between 1,000 and 2,000 dollars,
|
or more than 2,000 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $1,999.99
|
(4) $2,000 or more
|
|
@
|
Page 224 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
JTCLR1Y
Asset Type: RENTAL PROPERTY
|JOINT WITH:
|{display names marked in JTWHO3}
[fill SORRYFIL]
|
Is the annual amount less than
|
500 dollars, between 500 and 2,500
|
dollars, between 2,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
JTOTHRNT_PD
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned rental property jointly with
|{display names marked in JTWHO3}
**READ NAME(S)**.)
|
|
What is the easiest way for you to tell |
me about the share of the
|
income [fill TEMPNAME]
|
[fill ANDSPFIL] received from
|
this property?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
@
|
Multiple Entry
JTOTHRNT
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO3}
[fill HOWMUCHFIL] [fill HOWMUCHFIL2]
|
GROSS RENT from all [fill OTHERFIL]
|
jointly-owned rental property?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL15]
|
Wednesday, August 27, 2003
Page 225 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
BIGAST12
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
JTOTHRNT2
What was [fill PTEMPNAME]
|JOINT WITH:
share of the GROSS RENT from all
|{display names marked in JTWHO3}
jointly-owned rental property?
|
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JARNTOTH]
|
Mark One Only
BIGAST13
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
JTOTHCLR
[fill PERIODFIL]
|JOINT WITH:
[fill HOWMUCHFIL] [fill HOWMUCHFIL2]
|{display names marked in JTWHO3}
NET INCOME or loss after expenses?
|
|
READ NAMES IF NECESSARY
|
ENTER A NET LOSS AS A NEGATIVE AMOUNT |
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL16]
|
Page 226 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
JTOTHCLR2
What was [fill PTEMPNAME]
|JOINT WITH:
share of the NET INCOME or net loss after |{display names marked in JTWHO3}
expenses...
|
ENTER A NET LOSS AS A NEGATIVE AMOUNT H |
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JACLR2_TOT]
|
Mark One Only
BIGAST14
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
JCLROT1Q
Asset Type: RENTAL PROPERTY
|JOINT WITH:
|{display names marked in JTWHO3}
[fill SORRYFIL]
|
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 250 dollars, |
between 250 and 1,000 dollars,
|
between 1,000 and 2,000 dollars,
|
or more than 2,000 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $1,999.99
|
(4) $2,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 227 of 340
Survey:
Section: Section: Assets 2
Items Booklet
JCLROT1Y
Mark One Only
Asset Type: RENTAL PROPERTY
|JOINT WITH:
|{display names marked in JTWHO3}
[fill SORRYFIL]
|
Is the annual amount less than
|
500 dollars, between 500 and 2,500
|
dollars, between 2,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
OWNRENT_PD
Mark One Only
(Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned some
rental property[fill OWNNAMEFIL].)
What is the easiest way for you to tell me about the income
from this rental property?
READ ANSWER CATEGORIES IF NECESSARY
H
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) DO NOT READ -- None of these
@
OWNRENT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
from this rental property?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL17]
Mark One Only
BIGAST15
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 228 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
OWNRENT2
How much GROSS RENT did [fill TEMPNAME] receive
from this rental property...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill OARNT_TOT]
Mark One Only
BIGAST16
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Multiple Entry
OWNCLEAR
[fill PERIODFIL]
[fill HOWMUCHFIL]
NET INCOME or net loss after expenses?
H
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL18]
Wednesday, August 27, 2003
Page 229 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Multiple Entry
OWNCLEAR2
What was [fill PTEMPNAME] NET INCOME
or net loss after expenses...
H
ENTER (N) FOR NONE OR NO MORE
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill OACLR_TOT]
Mark One Only
BIGAST17
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
OCLR1Q
Asset Type: RENTAL PROPERTY
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than
250 dollars, between 250 and 1,000 dollars, between 1,000
and 2,000 dollars, or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Mark One Only
OCLR1Y
Asset Type: RENTAL PROPERTY
[fill SORRYFIL]
Is the annual amount less than 500 dollars, between 500 and 2,500
dollars, between 2,500 and 5,000 dollars, or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $2,499.99
$2,500 to $4,999.99
$5,000 or more
@
Page 230 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Enter Number
DKRNT
[fill ASIDEFRMFIL]
is the total amount of income
[fill TEMPNAME] received in GROSS RENT since [fill MONTH1] 1st
from all [fill OTHERFIL] rental property [fill HESHE] owned?
H
[fill ENTERLFIL]
$@
Mark One Only
BIGAST18
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Enter Number
DKCLEAR
[fill INSTEADFIL]
Since [fill MONTH1] 1st, what has been [fill PTEMPNAME]
NET INCOME or net loss after expenses from this rental property?
H
ENTER A NET LOSS AS A NEGATIVE AMOUNT
ENTER (N) FOR NONE
[fill ENTERLFIL]
$@
Mark One Only
BIGAST19
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
DKRNT1Q
Asset Type: RENTAL PROPERTY
[fill SORRYFIL]
Was it less than 250 dollars, 250 to 1,000 dollars,
1,000 to 2,000 dollars, or more than 2,000 dollars?
(1)
(2)
(3)
(4)
less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Wednesday, August 27, 2003
Page 231 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
JTMRTINT_PD
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
held a mortgage from which [fill HESHE] |{display names marked in JTWHO4}
received payments jointly with
|
[fill SPOUSEFIL].)
|
|
What is the easiest way for you to tell |
me about [fill SHAREFIL] the interest |
income [fill ANDSPKIDFIL] received from |
the joint mortgages?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
@
|
Multiple Entry
JTMRTINT
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO4}
[fill HOWMUCHFIL]
|
from all mortgages (from which [fill HESHE]
received interest)the two of
|
[fill THEMYOUFIL] held jointly?
|
H|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: [FILL TOTALFIL19]
|
Page 232 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
JTMRTINT2
How much interest did [fill TEMPNAME] |JOINT WITH:
and [fill HISHER] [fill SPOUSE] receive |{display names marked in JTWHO4}
from all mortgages (from which [fill HESHE]
received interest) the two of
|
[fill THEMYOUFIL] held jointly...
|
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
|
in [fill MONTH4]?
|
@41 @42 @43
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
And [fill MONTH2]?
|
@21 @22 @23
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill MIJNT_TOT]
|
Mark One Only
BIGAST20
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
MRTRG1Q
Asset Type: MORTGAGES
|JOINT WITH:
|{display names marked in JTWHO4}}
[fill SORRYFIL]
|
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 250 dollars, |
between 250 and 1,000 dollars,
|
between 1,000 and 2,000 dollars,
|
or more than 2,000 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $1,999.99
|
(4) $2,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 233 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
MRTRG1Y
Asset Types: MORTGAGES
|JOINT WITH:
|{display names marked in JTWHO4}
[fill SORRYFIL]
|
Was the annual amount less than 500
|
dollars, between 500 and 2,500 dollars, |
between 2,500 and 5,000 dollars,
|
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
JTOTHMRT_PD
(Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
held mortgages (from which [fill HESHE] |{display names marked in JTWHO4}
received interest) with **READ NAME(S)**.)|
|
What is the easiest way for you to tell |
me about the share of the interest
|
income [fill TEMPNAME] received from
|
those jointly-owned mortgages?
|
|
READ ANSWER CATEGORIES IF NECESSARY
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
|
(5) DO NOT READ -- None of these |
|
|
@
|
Multiple Entry
JTOTHMRT
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO4}
[fill HOWMUCHFIL]
|
from all mortgages (from which [fill HESHE]
received interest) held jointly by
|
[fill HIMHER] and [fill HISHER]
|
investment partner?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
Total: $[FILL TOTALFIL20]
|
Page 234 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
JTOTHMRT2
What was [fill PTEMPNAME] share of the |JOINT WITH:
interest received from all mortgages
|{display names marked in JTWHO4}
(from which [fill HESHE] received
|
interest) held jontly by [fill HIMHER] and|
[fill HISHER] investment partner...
|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERLFIL]
|
in [fill MONTH4]?
H|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill MIJNTOTH]
|
Mark One Only
BIGAST21
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
OMRTRG1Q
Asset Type: MORTGAGES
|JOINT WITH:
|{display names marked in JTWHO4}
[fill SORRYFIL]
|
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 250 dollars, |
between 250 and 1,000 dollars,
|
between 1,000 and 2,000 dollars,
|
or more than 2,000 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $1,999.99
|
(4) $2,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 235 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
OMRTRG1Y
Asset Type: MORTGAGES
|JOINT WITH:
|{display names marked in JTWHO4}
[fill SORRYFIL]
|
Is the annual amount less than
|
500 dollars, between 500 and 2,500
|
dollars, between 2,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $2,499.99
|
(3) $2,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
OWNMTINT_PD
(Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] held
mortgages (from which [fill HESHE] received interest) [fill OWNAMEFIL])
What is the easiest way for you to tell me about [fill HISHER]
interest income from those mortgages?
READ ANSWER CATEGORIES IF NECESSARY
H
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) DO NOT READ -- None of these
@
Multiple Entry
OWNMTINT
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
from all mortgages (from which [fill HESHE] received interest)
held in [fill HISHER] own name?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL21]
Page 236 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
OWNMTINT2
How much interest did [fill TEMPNAME] receive from
all mortgages (from which HESHE received interest)
held in [fill HISHER] own name...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill MIOWN_TOT]
Mark One Only
BIGAST22
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
OWNMTR1Q
Asset Type: MORTGAGES
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than
250 dollars, between 250 and 1,000 dollars, between 1,000 and
2,000 dollars, or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Mark One Only
OWNMTR1Y
Asset Type: MORTGAGES
[fill SORRYFIL]
Was the annual amount less than 500 dollars, between 500 and
2,500 dollars, between 2,500 and 5,000 dollars, or more than
5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $2,499.99
$2,500 to $4,999.99
$5,000 or more
@
Wednesday, August 27, 2003
Page 237 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Enter Number
DKMRT
[fill ASIDEFRMFIL] is the total amount of interest
income [fill TEMPNAME] received since [fill MONTH1] 1st
from all [fill OTHERFIL] mortgages [fill HESHE] owned?
H
[fill ENTERLFIL]
$@
Mark One Only
BIGAST23
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
DKMRT1MQ
Asset Type: MORTGAGES
[fill SORRYFIL]
Was the amount since [fill MONTH1] 1st less than 250 dollars,
between 250 and 1,000 dollars, between 1,000 and 2,000 dollars,
or more than 2,000 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $1,999.99
$2,000 or more
@
Mark One Only
ROYALTY_PD
[fill ASFIL1]
(Earlier you said [fill TEMPNAME] had income from
royalties.)
What is the easiest way for you to tell me about
[fill HISHER] royalty income?
READ ANSWER CATEGORIES IF NECESSARY
H
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) DO NOT READ -- None of these
@
Page 238 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Multiple Entry
ROYALTY
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
(If royalty income is shared, count only [fill HISHER] share.)
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL22]
Multiple Entry
ROYALTY2
How much royalty income did [fill HESHE] receive ...
(If royalty income is shared, count only [fill HISHER]
share.)
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill RNDUP1_TOT]
Mark One Only
BIGAST24
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 239 of 340
Survey:
Section: Section: Assets 2
Items Booklet
Mark One Only
ROYAL1Q
Asset Type: ROYALTIES
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than
25 dollars, between 25 and 100 dollars,
between 100 and 500 dollars, or more
than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Mark One Only
ROYAL1Y
Asset Type: ROYALTIES
Was the annual amount less than
25 dollars, between 25 and 250 dollars,
between 250 and 1,000 dollars, or more
than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $249.99
$250 to $999.99
$1,000 or more
@
Mark One Only
RNDUP2_TOT
Earlier you told me that [fill TEMPNAME] |{Display list of investments}
had [fill INVESTMENTFIL]. Since
|
[fill MONTH1] 1st, how much income did |
[fill HESHE] receive from this investment? |
(If this income is shared, count only
|
[fill HISHER] [fill CHILDFIL]
|
H|
ENTER (N) FOR NONE
|
ENTER A NET LOSS AS A NEGATIVE AMOUNT
|
|
$@
|
Mark One Only
BIGAST25
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Page 240 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Assets 2
Mark One Only
RNDP2RNG
Asset Type: [fill INVESTMNTFIL]
|{Display list of investments}
|
Was it less than 25 dollars, 25 to 100 |
dollars, 100 to 500 dollars, or more than |
500 dollars?
|
|
(1) $0 to $25
|
(2) $25 to $99
|
(3) $100 to $499
|
(4) $500 or more
|
|
@
|
Mark One Only
ASTRECUSE
DO NOT READ TO RESPONDENT
Did the respondent use any records to answer any assets questions?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 241 of 340
Survey:
Section: Section: Health Insurance
Mark One Only
Items Booklet
TEENCHIP
At any time between [fill MONTH1] 1st
and today [fill WASWERE] [fill TEMPNAME] covered by
[fill CHIPFIL][fill COMMAFIL] [fill CHIPORFIL] SCHIP,
the State Children's Health Insurance Program, that helps
families get health insurance?
H
(1) Yes
(2) No
@
Multiple Entry
TCHIPMNTH
[fill HAVHAS] [fill TEMPNAME] been covered at any time in this month?
(1) Yes
(2) No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS/ENTER (N) FOR NO MORE
(1) Yes
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
(2) No
@1
@2
@3
@4
Mark One Only
CAIDANY
At any time between [fill MONTH1] 1st and today
[fill WASWERE] [fill TEMPNAME][if ALSOFIL ne <>] [fill ALSOFIL][endif]
covered by Medicaid,[if CAIDPROG1 ne <>][fill CAIDPROG1], [endif]Medical
Assistance, or any other kind of government assistance program that helps
pay for health care?
H
READ IF NECESSARY: Do not include Medicare or government military health
insurance here; that will be covered later in another question.
PRESS (M) TO VIEW MORE NAMES OF GOVERNMENT
HEALTH PROGRAMS OFFERED IN THIS STATE
(1) Yes
(2) No
@
Page 242 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Multiple Entry
CAIDNAME
What program [fill WASWERE] [fill TEMPNAME] covered by?
IF MORE THAN ONE NAME GIVEN ASK FOR THE ONE NAME USED MOST FREQUENTLY
(1) Medicaid
(2) Medical Assistance
(3) [fill CAIDPROG1]
(4) [fill CAIDPROG2]
(5) [fill CAIDPROG3]
(6) [fill CAIDPROG4]
(7) [fill CAIDPROG5]
(8) [fill NONMED1]
(9) [fill NONMED2]
(10) [fill NONMED3]
(11) [fill NONMED4]
(12) [fill CHIPFIL]
(13) [fill CHIPFIL]
(14) [fill CHIPFIL]
(15) Other {SPECIFY: @SP}
@KEY [fill ERRORFIL]
Multiple Entry
CDMNTH
[fill HAVHAS] [fill TEMPNAME] been covered by
[fill MEDICAIDFIL] at any time in this month?
(1) Yes
(2) No
@CDMTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
@CDMTH1
@CDMTH2
@CDMTH3
@CDMTH4
Mark One Only
CAIDBEGYR
In what year did [fill PTEMPNAME] coverage start?
ENTER (A) FOR ALWAYS COVERED
YEAR: @
Mark One Only
CAIDBEGPB
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT COVERAGE
STARTED IS BEFORE [FILL TEMPNAME] WAS BORN, OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
Wednesday, August 27, 2003
Page 243 of 340
Survey:
Section: Section: Health Insurance
Mark One Only
Items Booklet
CAIDBEGMTH
In what month did that coverage start?
MONTH: @
Mark One Only
CAIDALL
And [fill HAVEHAS] [fill TEMPNAME] been covered every month since then,
up to [fill MONTHXFI]?
(1) Yes
(2) No
@
Multiple Entry
CAIDBEGST
When did [fill TEMPNAME] start receiving CONTINUOUS coverage,
every month up to today?
MONTH:@MTH
YEAR: @YR
Mark One Only
CAIDBEGPB2
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT
COVERAGE STARTED IS MORE THAN 3 YEARS AGO,
OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
Mark One Only
MCARE
At any time between [fill MONTH1] 1st and today
[fill WASWERE] [fill TEMPNAME] [fill ALSOFIL]
covered by Medicare?
H
READ IF NECESSARY: Medicare is the government health insurance program for
people 65 years old and older or people with certain disabilities.
(1) Yes
(2) No
@
Page 244 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Multiple Entry
CARETHEN
[fill MEDIFIL] [fill WASWERE] [fill HESHE] covered by Medicare at any time in this
month?
(1) Yes
(2) No
@CRMTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
@CRMTH1
@CRMTH2
@CRMTH3
@CRMTH4
Mark One Only
HIOWN
Earlier I recorded that [fill TEMPNAME] [fill WASWERE] covered under
[fill NAMEFIL] At any time between [fill MONTH1] 1st and today,
did [fill TEMPNAME] also have health insurance in [fill HISHER] own name?
(1) Yes
(2) No
@
Mark One Only
POLVER
Earlier I recorded that [fill TEMPNAME] had health insurance
in [fill HISHER] own name. Is that correct?
(1) Yes
(2) No
Mark One Only
HIDEP
[fill OTHERFIL]
At any time between [fill MONTH1] 1st and today, (fill WASWERE] [fill
TEMPNAME] [fill ALSOFIL] covered as a family member on
someone else's plan?
(1) Yes
(2) No
Wednesday, August 27, 2003
Page 245 of 340
Survey:
Section: Section: Health Insurance
Mark One Only
Items Booklet
PRICOV
[fill OTHERFIL] [fill MEDICAREFIL][fill ANDFIL] [fill CAIDFIL]
[fill ATFIL] any time between [fill MONTH1] 1st
and today [fill WASWERE] [fill TEMPNAME] [fill ALSOFIL]
covered by [fill KINDFIL] health insurance?
INCLUDE MEDICARE SUPPLEMENT ("MEDIGAP") AND
GOVERNMENT MILITARY HEALTH INSURANCE HERE
(1) Yes
(2) No
@
Mark One Only
HIOWNER
[fill ISWASFIL] that health insurance coverage in [fill HISHER]
own name or [fill WASWERE] [fill HESHE] covered as a family member on
someone else's plan?
(1) Plan(s) in own name
(2) Covered by someone else's plan(s)
(3) Both
@
Mark All That Apply
HIHOLDR
Who is the policy holder?
| LN HOUSEHOLD MEMBER'S NAME
|{display ge <15>} plus
ENTER THE LINE NUMBER OF THE POLICY HOLDER(S)|(0 Non- Household Members
ENTER ALL THAT APPLY
|
ENTER (N) FOR NONE OR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@
|
Multiple Entry
PRIMNTH
[C_HAVHAS] [fill TEMPNAME] been covered
[fill EITHERFIL]
at any time in this month?
INCLUDE ALL PRIVATE PLANS THAT COVERED [fill TEMPNAME] EITHER AS A
POLICY HOLDER OR AS A DEPENDENT ON SOMEONE ELSE'S PLAN.
H
(1) Yes
(2) No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
Page 246 of 340
[fill MONTH3]? @3
[fill MONTH4]? @4
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
HIPERS
Mark All That Apply
And did [fill PTEMPNAME] health
|LINE NO HOUSEHOLD MEMBER'S NAME
insurance also cover [fill POLICYFIL] |Display HH members 15+
at any time since [fill MONTH1] 1st? |
|
(1) Yes
|
(2) No
|
|
@KEY
|
WHOHIPERS
Mark All That Apply
And did [fill PTEMPNAME] plan(s) also |LINE NO HOUSEHOLD MEMBER'S NAME
cover [fill POLICYFIL] at any time
|[Display HH members 15+]
since [fill MONTH1] 1st?
|
|
(1) Yes
|
(2) No
|
|
1
|
|
Who was covered?
|
|
@KEY
|
|
ENTER LINE NUMBERS OF PERSONS COVERED |
ENTER (A) FOR ALL PERSONS COVERED
|
ENTER (N) FOR NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
MNTHDEP
Mark One Only
[fill WASWEREFIL] **READ NAME(S)**
|List names as reported in HIPERS
[fill ALSOFIL] covered during the same |
months [fill TEMPNAME] [fil WASWEREFIL] |
covered…?
|
[fill MONTH1FIL]
|
[fill MONTH2FIL]
|
[fill MONTH3FIL]
|
[fill MONTH4FIL]
|
[fill MONTHXFIL]
|
|
(1) Yes
|
(2) No
|
|
@
|
MNTHERR1
Mark All That Apply
Who was not covered in [fill MONTH1]?
|
MARK ALL THAT APPLY
ENTER (N) FOR NONE OR NO MORE
RE-ENTER PRECODE TO DELETE
|
@KEY
|
Wednesday, August 27, 2003
|List names as reported in HIPERS
|
|
|
Page 247 of 340
Survey:
Section: Section: Health Insurance
Items Booklet
MNTHERR1B
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH1]?
(1) Yes
(2) No
@
Mark All That Apply
Who was not covered in [fill MONTH2]?
|
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
|
@KEY
|
MNTHERR2
|List names as reported in HIPERS
|
|
|
MNTHERR2B
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH2]?
(1) Yes
(2) No
Mark All That Apply
Who was not covered in [fill MONTH3]?
|
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
|
@KEY
|
MNTHERR3
|List names as reported in HIPERS
|
|
|
MNTHERR3B
Mark One Only
Was [fill NAME(HX)] covered in [fill MONTH3]?
(1) Yes
(2) No
Mark All That Apply
Who was not covered in [fill MONTH4]?
|
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
|
@KEY
|
MNTHERR4
|List names as reported in HIPERS
|
|
|
Mark One Only
MNTHERR4B
Was [fill NAME(HX)] covered in [fill MONTH4]?
(1) Yes
(2) No
Page 248 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Mark All That Apply
Who was not covered in [fill MONTH5]?
|
MARK ALL THAT APPLY
ENTER (N) FOR NO MORE
RE-ENTER PRECODE TO DELETE
|
@KEY
|
MNTHERR5
|List names as reported in HIPERS
|
|
|
Mark One Only
MNTHERR5B
Was [fill NAME(HX)] covered in [fill MONTH5]?
(1) Yes
(2) No
@
Mark One Only
HIOTHR
During the period from [fill MONTH1] 1st through today,
did [fill HISHER] health insurance cover anyone who did NOT
live in this household?
(1) Yes
(2) No
@
Multiple Entry
HIWHO
Who was that?
(Who, OUTSIDE this household, did the health insurance cover?)
(1) Yes
(2) No
...Spouse/Partner
@HISPSE
...Children 18 years of age or older @HIOLDKID
...Children under 18 years old
...Others
@HIYNGKID
@HIOTHR
Multiple Entry
HEMPLY
Was the health insurance obtained through-H
READ ANSWER CATEGORIES
THIS QUESTION REFERS TO THE RESPONDENT'S CURRENT PRIMARY SOURCE OF
COVERAGE. IF THEY ARE NOT COVERED NOW, REFER TO THEIR MOST RECENT PRIMARY
PLAN.
(1) A Current employer, work or business
(2) A Former employer or business
(3) A Union
(4) TRICARE / CHAMPUS
(5) CHAMPVA
(6) The Military/VA health care
(7) Private purchased
(8) Or in some other way {pop up: SPECIFY: @SP}
@HE
Wednesday, August 27, 2003
Page 249 of 340
Survey:
Section: Section: Health Insurance
Items Booklet
MULTEMP
Multiple Entry
Which employer [if R currently works for both | JOBS
an employer and a business fill: or business] |
provides that coverage?
|
|
THIS QUESTION REFERS TO THE RESPONDENT'S
|
CURRENT PRIMARY SOURCE OF COVERAGE. IF THEY ARE | BUSINESSES
NOT COVERED NOW, REFER TO THEIR MOST RECENT |
PRIMARY COVERAGE.
|
|
ENTER (1) TO SELECT A JOB
|
ENTER (2) TO SELECT A BUSINESS
|
|
@1
|
|
ENTER THE NUMBER OF THE [fill JOB/BUSINESS] |
@2
|
HICOST
Mark One Only
[fill DOESDIDFIL] [fill HISHER] [fill EMPLOYERFIL] pay
all, part, or none of the premium of the coverage?
THIS QUESTION REFERS TO THE RESPONDENT'S CURRENT PRIMAEY SOURCE OF
COVERAGE. IF THEY ARE NOT COVERED NOW, REFER TO THEIR MOST RECENT PRIMARY
COVERAGE.
(1) All
(2) Part
(3) None
@
Mark One Only
CHIP
[fill TEENFIL]
|NAMES OF CHILDREN UNDER 20
|Display (L_NO)'s children under 20
At any time between [fill MONTH1] 1st
|
and today, [fill WASWEREFIL]
|
**READ LIST OF CHILD(REN)** covered
|
by [fill CHIPFIL] [fill CHIPORFIL]
|
SCHIP, the State Children's Health
|
Insurance Program that helps families
|
get health insurance for children?
|
H|
(1) Yes
|
(2) No
|
|
@
|
Page 250 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Mark All That Apply
PARENT IS
CHIPKIDS
|
|
Which of [fill HISHER] children were
|LINE NO CHILD'S NAME
covered?
|Display (L_NO)'s children
|under <20>
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
|
@KEY
|
Mark One Only
MORCHIP
ASK OR VERIFY
How about [NAME OF NEXT CHILD SELECTED IN CHIPKIDS]? Was [fill HESHEFIL]
also covered during **READ MONTHS**?
(1) Yes, covered same exact months
(2) No, covered different months
Multiple Entry
CHIPMNTH
Has [fill KIDNAME1] been covered at any time this month?
(1) Yes
(2) No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], [fill MONTH4] -- was [fill HESHEFIL] [fill ALSOFIL]
covered?
ENTER (A) FOR ALL REMAINING MONTHS/ENTER (N) FOR NO MORE
(1) Yes
(2) No
[fill MONTH1]? @1
[fill MONTH2]? @2
[fill MONTH3]? @3
[fill MONTH4]? @4
[fill ERRORFIL]
Wednesday, August 27, 2003
Page 251 of 340
Survey:
Section: Section: Health Insurance
Mark One Only
Items Booklet
KIDANY
At any time between [fill MONTH1] 1st
|LINE NO CHILD'S NAME
and today, [fill WASWEREFIL]
|Display (L_NO)'s children
**READ NAME(S) OF CHILD(REN)**
|under <20>
[fill ALSOFIL] covered by Medicaid,
|
[if CAIDPROG1 ne <>][fill CAIDPROG1],
|
Medical Assistance, or any other kind of |
government assistance program that helps pay |
for health care?
|
|
READ IF NECESSARY:
|
Do not include Medicare or government
|
military health insurance here; that will be |
covered later in another question.
|
|
PRESS (M) TO VIEW MORE NAMES OF
|
GOVERNMENT HEALTH PROGRAMS OFFERED IN
|
THIS STATE
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
CAIDKIDS
PARENT IS [fill TEMPNAME]
|LINE NO CHILD'S NAME
|Display (L_NO)'s children under 20
Which of [fill HISHER] children
|
were covered?
|
|
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER LINE NUMBER TO DELETE
|
|
@KEY
|
[fill ERRORFIL]
|
Mark One Only
MORCAID
ASK OR VERIFY
How about [fill KIDNAME2]? Was [fill TEMP]
also covered during **READ MONTHS**?
(1) Yes, covered same exact months
(2) No, covered different months
@
Page 252 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Multiple Entry
KCDMNTH
Has [fill KIDNAME2] been covered
[fill CMEDICAIDFIL] at any time in this month?
(1) Yes
(2) No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], [fill MONTH4] -- was [fill HESHEFIL] [fill ALSOFIL]
covered?
ENTER (A) FOR ALL REMAINING MONTHS/ENTER (N) FOR NO MORE
(1) Yes
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
(2) No
@1
@2
@3
@4
Multiple Entry
KCAIDNAME
First time asked:
What program was [fill KIDNAME2] covered by?
Subsequent times asked:
How about [fill KIDNAME2]?
(What program was [fill KIDNAME2] covered by?)
IF MORE THAN ONE NAME GIVEN ASK FOR THE ONE NAME USED MOST FREQUENTLY
(1) Medicaid
(2) Medical Assistance
(3) [fill CAIDPROG1]
(4) [fill CAIDPROG2]
(5) [fill CAIDPROG3]
(6) [fill CAIDPROG4]
(7) [fill CAIDPROG5]
(8) [fill NONMED1]
(9) [fill NONMED2]
(10) [fill NONMED3]
(11) [fill NONMED4]
(12) [fill CHIPFIL]
(13) [fill CHIPFIL]
(14) [fill CHIPFIL]
(15) Other {SPECIFY: @SP}
@KEY [fill ERRORFIL]
Mark One Only
KDCAIDBEGYR
In what year did [fill TEMPNAME] [fill CHIPNAME] coverage start?
ENTER (A) FOR ALWAYS COVERED
YEAR: @
Mark One Only
KDCAIDBEGPB
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THAT COVERAGE STARTED IS BEFORE
[fill KIDNAME1] WAS BORN, OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
Wednesday, August 27, 2003
Page 253 of 340
Survey:
Section: Section: Health Insurance
Items Booklet
KDCAIDBEGMTH
Mark One Only
In what month did that coverage start?
MONTH: @
KDCAIDALL
Mark One Only
And has [fill KIDNAME1] been covered
every month since then up to today?
(1) Yes
(2) No
@
KDCAIDBEGST
Multiple Entry
When did [fill TEMPNAME] start receiving CONTINUOUS coverage,
every month, up through today?
MONTH: @MTH
YEAR: @YR
KDCAIDBEGPB2
Mark One Only
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THE COVERAGE STARTED IS BEFORE
[fill KIDNAME1] WAS BORN, OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to proceed
KDCAIDBEGYR2
Mark One Only
In what year did [fill KIDNAME2]'s coverage start?
ENTER (A) FOR ALWAYS COVERED
YEAR: @
KDBEGPB2
Mark One Only
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THAT COVERAGE STARTED IS BEFORE
[fill KIDMNAME2] WAS BORN, OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to proceed
Mark One Only
KDCAIDBEGMTH2
In what month did that coverage start?
MONTH: @
Mark One Only
KDCAIDALL2
And [fill HAVHAS] [fill TEMPNAME] been covered
every month since then up to today?
(1) Yes
(2) No
@
Page 254 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
KDCAIDBEGST2
Multiple Entry
When did [fill KIDNAME2] start receiving CONTINUOUS coverage,
every month, up through today?
MONTH: @MTH
YEAR: @YR
Mark One Only
KDCAIDBEGPB2_2
PLEASE CHECK FOR POSSIBLE ERROR. THE YEAR THAT COVERAGE STARTED IS BEFORE
[fill TEMPNAME] WAS BORN, OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
Mark One Only
KDCOV
[fill OTHERTHANFIL]
|LN NAME(S)
[fill ATFILL] any time since [fill MONTH1] 1st,|[any kid that was not covered all
[fill WASWEREFIL] **READ NAME(S)**
|months by private insurance
covered by any [fill OTHERFIL] type
|in current wave.]
of health insurance?
|
|
(1) Yes
|
(2) No
|
|
@
Mark All That Apply
PRIKIDS
PARENT IS: [fill NAME(L_NO)]
|LINE NO CHILD'S NAME
|Display (L_NO)'s children under 20
Which of [fill HISHER] children
|
were covered?
|
|
**READ NAME(S)**
|
|
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@KEY
|
Mark One Only
MORPRI
ASK OR VERIFY
How about [fill KIDNAME3]? Was [fill HESHE] also
covered during **READ MONTHS**?
(1) Yes, covered exact same months
(2) No, covered different months
Wednesday, August 27, 2003
Page 255 of 340
Survey:
Section: Section: Health Insurance
Multiple Entry
Items Booklet
KDMNTH
Has [fill KIDNAME3] been covered [fill TEMP]
at any time in this month?
(1) Yes
(2) No
@MONTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2], [fill
MONTH3], and [fill MONTH4] was [fill HESHEFIL] [fill /<>] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NONE OR NO MORE
(1) Yes (2) No
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
@1
@2
@3
@4
Mark All That Apply
KDPOL
ASK OR VERIFY
| Display HH members 15+
|(0) Someone Living Outside the HH
[if FIRST_TIME eq <0>]Who is the policy |
holder for [fill KIDNAME3]'s plan?
|
[else]How about [fill KIDNAME3]?
|
(Who is the policy holder for
|
[fill KIDNAME3]'s plan?)[endif]
|
|
ENTER THE LINE NUMBER(S)
|
OF THE POLICY HOLDER(S)
|
|
ENTER (N) FOR NO MORE
|
|
@KEY
|
Mark One Only
VERIFY
[fill JUSTFIL] I have recorded that [fill TEMPNAME] [fill WASWERE] not
covered by a health insurance plan at any time since [fill MONTH1] 1st.
Is that correct?
(1) Yes (not covered/none covered)
(2) No
@
Page 256 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Mark One Only
VERPLAN
What type of insurance [fill WASWERE] [fill TEMPNAME] covered by?
PRESS (M) TO VIEW MORE NAMES OF GOV'T HEALTH PROGRAMS OFFERED IN THIS STATE
(1)
(2)
(3)
(4)
(5)
Medicare
Medicaid/[fill CAIDPROG1]
State Children's Health Insurance Program (CHIP)
TRICARE or CHAMPUS
CHAMPVA ("CHAMPVA" is the civilian health and medical program
of the Department of Veteran's Affairs)
(6) VA healthcare
(7) Military healthcare
(8) Indian Health Service
(9) Other government health care[if NONMED1 ne <>]/
[fill NONMED1][endif]
(10) Employer/union provided (policyholder)
(11) Employer/union provided (as dependent)
(12) Privately purchased (policyholder)
(13) Privately purchased (as dependent)
(14) Plan of someone outside the household
(15) Other
@
Multiple Entry
VERMNTH
[fill HAVHAS] [fill TEMPNAME] covered at any time in this month?
(1) Yes
(2) No
@MONTH5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2) No
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
@MONTH1
@MONTH2
@MONTH3
@MONTH4
Author Note: Repeat VERIFY thru VERMNTH for each person identified as not covered (in HINS12) then goto HINS13A.
Wednesday, August 27, 2003
Page 257 of 340
Survey:
Section: Section: Health Insurance
Multiple Entry
Items Booklet
HINONE
SHOW FLASHCARD H
Which ONE OR MORE of these reasons describe why [fill HESHE] [fill WASWERE]
not covered?
ENTER ALL THAT APPLY / ENTER (N) FOR NO MORE / RE-ENTER PRECODE TO DELETE
(1) Too expensive, can't afford health insurance
(2) No health insurance offered by (employer of self, spouse, or parent)
(3) Not working at a job long enough to qualify
(4) Job layoff, job loss, or any reason related to unemployment
(5) Not eligible because working part time or temporary job
(6) Can't obtain insurance because of poor health, illness, age, or a
pre-existing condition
(7) Dissatisfied with previous insurance OR don't believe in insurance
(8) Have been healthy, not much sickness in the family, haven't needed
health insurance
(9) Able to go to VA or military hospital for medical care
(10) Covered by some other health plan, such as Medicaid or CAID
(11) No longer covered by parents policy
(12) Other @SPEC @KEY
Mark One Only
HIHOWLNG
(Earlier I recorded that [fill TEMPNAME] [fill HAVHAS] been
covered by private health insurance for the past several months.)
As far as you know, was there ever a time in [fill HISHER]
life when [fill TEMPNAME] [fill WASWERE] not covered by
private insurance?
(1) Yes
(2) No
@
Mark One Only
HIHOWLNGYR
[if HIHOWLNG offpath](Earlier I recorded that you were covered by private
health insurance in [fill COVERAGEFIL].) Before [fill MONTHFIL],
when was the last time [fill TEMPNAME] [fill WASWERE] WITHOUT
private health insurance coverage?
[else]When was the last time [fill TEMPNAME] [fill WASWERE]
WITHOUT private health insurance coverage?[endif]
ENTER (A) FOR ALWAYS COVERED
YEAR: @
Mark One Only
PRICOVPB
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT THE
UNINSURANCE SPELL STARTED IS BEFORE [fill NAME(L_NO)] WAS BORN,
OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
Mark One Only
HIHOWLNGMTH
In what month was that?
MONTH: @
Page 258 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Health Insurance
Mark One Only
HINOLNG
[fill VERIFYFILL]
[fill TEMPNAME] EVER covered by private health insurance?
(1) Yes
(2) No
@
Mark One Only
HINOLNGYR
([fill EARLIERFILL][fill COVEREDFIL].) Before [fill STARTFILL], when was
the last time you were covered by private health insurance?
In what year was that?
YEAR: @
Mark One Only
UNINSPB
PLEASE CHECK FOR A POSSIBLE ERROR. THE YEAR THAT THE
UNINSURANCE SPELL STARTED IS BEFORE [fill TEMPNAME] WAS BORN,
OR IN A FUTURE YEAR.
F1 to back up and correct
Press (P) to Proceed
Mark One Only
HINOLNGMTH
In what month in [fill HINOLNGYR] was that?
MONTH: @
Wednesday, August 27, 2003
Page 259 of 340
Survey:
Section: Section: Education
Items Booklet
Mark One Only
ENROLL
[fill C_WASWERE] [fill TEMPNAME] enrolled in school, either full-time or
part-time, at any time between [fill MONTH1] 1st and today?
READ IF NECESSARY:
Include any regular school, such as elementary,
high school, or college, or any vocational, technical,
or business school beyond high school.
(1) Yes
(2) No
@
Mark One Only
FULLPART
[fill ISAREFIL] [fill HESHE] enrolled full-time or part-time?
H
(1) Full-time
(2) Part-time
@
Multiple Entry
MNTHENRL
[fill C_HAVHAS] [fill HESHE] been enrolled in school this month?
(1) Yes
(2) No
@ENRLM5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] enrolled in school?
ENTER (A) FOR "ALL REMAINING MONTHS."
ENTER (N) FOR "NONE OR NO MORE."
(1) Yes (2) No
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
Page 260 of 340
@ENRLM1
@ENRLM2
@ENRLM3
@ENRLM4
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Education
Mark One Only
ENLEVEL
At what level or grade [fill WASWERE] [fill HESHE] enrolled?
(PROBE IF NECESSARY: Or was it something that doesn't really have a grade,
like a vocational, technical, or business school?)
"COLLEGE YEAR" INDICATES THE LEVEL ACCORDING TO ACADEMIC STANDING, NOT THE
NUMBER OF YEARS ENROLLED IN COLLEGE.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
Elementary grades 1-8
High School grades 9-12
College year 1 (Freshman)
College year 2 (Sophomore)
College year 3 (Junior)
College year 4 (Senior)
First year graduate or professional school
Second year or higher in graduate or professional school
(9) Vocational, technical, or business school beyond
high school level
(10) Enrolled in college, but not working towards degree
@
Mark One Only
EDCHCK1
You said that [fill TEMPNAME] [fill WASWERE] ENROLLED in
[fill EDFIL1]
[fill EDFIL2]
Earlier I recorded that the highest grade or level [fill HESHE]
COMPLETED was
[fill EDFIL3]
Are both of these statements correct?
(1) Yes, both statements are correct
(2) Only COMPLETED statement is correct, ENROLLED statement should be
changed
(3) Only ENROLLED statement is correct, COMPLETED statement should be
changed
(4) Both the COMPLETED statement and the ENROLLED statement should be
changed
@
Mark One Only
FXENRL
At what level or grade [fill WASWERE] [fill HESHE] enrolled?
"COLLEGE YEAR" INDICATES THE LEVEL ACCORDING TO ACADEMIC STANDING,
NOT THE NUMBER OF YEARS ENROLLED IN COLLEGE.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Elementary grades 1-8
High School grades 9-12
College year 1 (Freshman)
College year 2 (Sophomore)
College year 3 (Junior)
College year 4 (Senior)
College year 5 (First year graduate or
professional school)
(8) College year 6+ (Second year or higher in graduate or
professional school)
(9) Vocational, technical, or business school beyond
high school level
(10) Enrolled in college, but not working towards degree
@
Wednesday, August 27, 2003
Page 261 of 340
Survey:
Section: Section: Education
Items Booklet
Mark One Only
FXEDUC
What is the highest level of school [fill TEMPNAME] [fill HAVHAS]
completed or the highest degree [fill HESHE] [fill HAVHAS] received?
REPORT ONLY "REGULAR" EDUCATIONAL ATTAINMENT HERE. DO NOT INCLUDE ANY
VOCATIONAL, TECHNICAL, TRADE, OR BUSINESS TRAINING.
(31)
(32)
(33)
(34)
(39)
(40)
(41)
(43)
(44)
(45)
(46)
(47)
Less than 1st grade
(35) 9th grade
1st, 2nd, 3rd or 4th grade
(36) 10th grade
5th or 6th grade
(37) 11th grade
7th or 8th grade
(38) 12th grade, no diploma
HIGH SCHOOL GRADUATE (diploma or GED or equivalent)
Some college credit, but less than 1 year
1 or more years of college, no degree (regular Jr. coll./coll./univ.)
Associate (2-yr) college degree
Bachelor's degree (for example: BA, AB, BS)
Master's degree (for example: MA, MS, MENG, Med, MSW, MBA)
Professional School degree (for example: MD, DDS, JD)
Doctorate degree (for example: Ph.D., Ed.D.)
@
Mark One Only
EDCHCK2
[fill C_WASWERE] [fill HESHE] enrolled in a program working
towards a degree?
(1) Yes
(2) No
@
Mark One Only
EDFUND
Since [fill MONTH1] 1st, were any of [fill TEMPNAME] educational expenses
paid for by any type of educational assistance or financial aid?
READ IF NECESSARY: Include financial assistance such as loans, grants,
scholarships, employer assistance, veterans benefits, or any other type of
financial aid.
(1) Yes
(2) No
@
Mark One Only
EDELSE
(During [fill HISHER] enrollment since [fill MONTH1] 1st,)
did [fill TEMPNAME] receive any other types of aid?
(1) Yes
(2) No
@
Page 262 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Education
Mark All That Apply
EDASST
SHOW FLASHCARD I
What kind of educational assistance did [fill TEMPNAME] receive? Anything else?
ENTER ALL THAT APPLY / ENTER (N) FOR NONE/NO MORE / RE-ENTER PRECODE TO DELETE
(1) Federal PELL Grant
(2) Assistance from the Department of Veteran's Affairs (VA) such as GI or
Montgomery Bill, Survivors and Dependents, other Veterans'
Administration Educational Assistance Programs
(3) College (or Federal) Work Study Program
(4) Any Other Federal grant or program; for example, SEOG, Health or
Nursing Grant, ROTC, NSF Grant
(5) A loan that has to be repaid, for example, Stafford, Perkins, or SLS
(6) A grant, scholarship, or tuition remission from the school attended
(7) A teaching or research assistantship from the school attended
(8) A grant/scholarship from the state, such as SSIGP, Douglas Scholarships
(9) A grant or scholarship from some other source, such as a foundation,
corporation, or community group, National Merit Scholarship, etc.
(10) Assistance provided by [fill HISHER] employer
(11) Aid from some other source (EXCLUDE all direct aid from parents
including trusts or college savings funds)
(12) Assistance from a state or local welfare office
@KEY
Wednesday, August 27, 2003
Page 263 of 340
Survey:
Section: Section: Programs
Items Booklet
HOTLUNYN2
Mark One Only
[fill /<>]
|marked in I_WHOHOTLN or I_WHOHOTLN2}
|
Since [fill MONTH1] 1st, did
|
[fill DIDCLDFIL] usually get the
|
lunch that [fill THEIRFIL]
|
school provides?
|
|
ENTER (1) IF [fill NUMFIL] CHILD
|
USUALLY BOUGHT THE SCHOOL LUNCH
|
OR RECEIVED FREE LUNCH
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
WHOHOTLN2
Which children usually got the school lunch? | CHILDREN BETWEEN AGES 5 AND 18
H| LN NAME
ENTER ALL THAT APPLY
| {Display >KIDS< template}
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@KEY
FREELNYN2
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
H
(1) Yes
(2) No
@
FREREDLN2
Mark One Only
Were any of the lunches free or reduced-price because
[fill CHILDFIL] qualified for the
National School Lunch Program?
(1) Yes
(2) No
1
ASK OR VERIFY:
Were they free or reduced-price?
H
(1) Free lunch
(2) Reduced-price lunch
@
Page 264 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Programs
Mark One Only
BRKFSTYN2
[fill /<>]
|marked in I_WHOBRK or I_WHOBRK2}
|
Since [fill MONTH1] 1st, did
|
[fill DIDCLDFIL] usually get the
|
breakfast that [fill THEIRFIL]
|
school provides?
|
H |
ENTER (1) IF [fill NUMFIL] CHILD
|
USUALLY BOUGHT THE SCHOOL BREAKFAST
|
OR RECEIVED FREE BREAKFAST
|
|
(1) Yes
|
(2) No
|
|
@
|
Mark All That Apply
WHOBRK2
Which children usually got
the school breakfast?
| CHILDREN BETWEEN AGES 5 AND 18
| LN NAME
H | display >KIDS< template
ENTER ALL THAT APPLY
|
ENTER (A) FOR ALL CHILDREN LISTED
|
ENTER (N) FOR NO MORE
|
RE-ENTER PRECODE TO DELETE
|
|
@KEY
Mark One Only
CALLBCK
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND ENTERED THE
INFORMATION WE NEED. DO NOT READ THIS QUESTION. ENTER "NO" AND CONTINUE.
We are missing some information that is very important to this survey.
If I were to call back later would you be able to tell me…?
[fill A_CALLBACK(1)]
[fill A_CALLBACK(2)]
[fill A_CALLBACK(3)]
[fill A_CALLBACK(4)]
[fill A_CALLBACK(5)]
[fill A_CALLBACK(6)]
[fill A_CALLBACK(7)]
[fill A_CALLBACK(8)]
[fill A_CALLBACK(9)]
[fill A_CALLBACK(10)]
[fill A_CALLBACK(11)]
[fill A_CALLBACK(12)]
[fill A_CALLBACK(13)]
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 265 of 340
Survey:
Section: Section: Skip
Page 266 of 340
Items Booklet
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Skip
Mark One Only
PRSNSKIP
DO NOT READ TO RESPONDENT
[fill TEMP2] has been skipped.
HIT ENTER TO CONTINUE
@
Wednesday, August 27, 2003
Page 267 of 340
Survey:
Section: Section: Wrapup
Items Booklet
Mark One Only
LFSELF
Now I have a number of questions for [fill NAMEFIL].
It would be best if I could talk to
[fill HERHIMFIL] directly.
Is [fill SHEHEFIL] available now?
(1) Yes [fill RIPFIL]
(2) No
@
Mark One Only
LFSELF2
[fill AWAYFIl]
[fill COULDFIL] you or someone else in the household answer
these questions for [fill PERSONFIL]?
(1)
(2)
(3)
(4)
Yes, (take proxy interview)
No
No, skip for now, try again before leaving household
TYPE-Z -- not available during entire interviewing period
@
Mark One Only
WHYTYPZ1
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Mark One Only
WHYSP1
Enter other TYPE-Z reason.
@
Mark One Only
LFPROXY
ASK IF NECESSARY
| HOUSEHOLD ROSTER
Who will be answering for [fill NAMEFIL]? | LINE NAME
| {Display PXYRS template}
|
@
|
Mark One Only
RIP
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1) Yes
(2) No
@
Page 268 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Wrapup
Mark One Only
LF2SELF2
Could you or someone else in the household answer
these questions for [fill NAMEFIL].
(1) Yes, (take proxy interview)
(2) No
(4) TYPE-Z -- not available during entire interviewing period
@
Mark One Only
WHYTYPZ2
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Mark One Only
WHYSP2
Enter other TYPE-Z reason.
@
Mark One Only
LFPROXY2
ASK IF NECESSARY
| HOUSEHOLD ROSTER
Who will be answering for [fill NAMEFIL]? | LINE NAME
| Display PXYRS template
@
Mark One Only
LF3SELF
I need to continue the interview with [fill SHEHEFIL].
Is [fill SHEHEFIL] available now?
(1) Yes [fill RIPFIL]
(2) No
@
Mark One Only
LF3SELF2
Could you or someone else in the household answer
these questions for [fill NAMEFIL]?
(1) Yes, (take proxy interview)
(2) No
(4) TYPE-Z -- not available during entire interviewing period
@
Wednesday, August 27, 2003
Page 269 of 340
Survey:
Section: Section: Wrapup
Items Booklet
Mark One Only
WHYTYPZ3
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Mark One Only
WHYSP3
Enter other TYPE-Z reason.
@
Mark One Only
ASK IF NECESSARY
Who will be answering for
[fill NAMEFIL]?
|
@
|
LFPROXY3
| HOUSEHOLD ROSTER
| LINE NAME
| Display PXYRS template
Mark One Only
TRYAGAIN
Would it be possible for me to complete the interview
for [fill NAMEFIL] now?
(1) Yes
(2) No
(4) TYPE-Z -- not available during entire interviewing period
@
Mark One Only
WHYTYPZ4
Enter the TYPE-Z reason for
[fill NAMEFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Mark One Only
WHYSP4
Enter other TYPE-Z reason.
@
Mark One Only
LFPROXY4
ASK IF NECESSARY
| HOUSEHOLD ROSTER
Who will be answering for [fill NAMEFIL]? | LINE NAME
| Display PXYRS2 template
@
|
Page 270 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Wrapup
Mark One Only
RIP4
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1) Yes
(2) No
@
Mark One Only
RIP5
One last question for you: We will recontact this household
in 4 months to update information.
If we talk to someone else in your household next time, instead of you,
is it OK if we use your answers as a starting point?
(1) Yes
(2) No
@
Mark One Only
MISNEED
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND
ENTERED THE INFORMATION WE NEED. ENTER "NO" AND CONTINUE.
THE INFORMATION BELOW IS MISSING FROM THIS INTERVIEW.
IS THIS INFORMATION AVAILABLE NOW?
(1) Yes - Collect missing items
(2) No - Exit case
{display names and fills, as on MISITCB}
@
Wednesday, August 27, 2003
Page 271 of 340
Survey:
Section: Section: Missing
Page 272 of 340
Items Booklet
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
MISITCB
Mark One Only
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND
ENTERED THE INFORMATION WE NEED. TRANSMIT THE CASE AS IS.
The last time that I spoke with [fill SOMEONEYOUFIL]
I was told I could call back for a few pieces of information.
I would like to follow up now. I notice that we are missing-{Display people with CB eq <1>}
[fill A_CALLBACK(<1>)]
[fill A_CALLBACK(<2>)]
[fill A_CALLBACK(<3>)]
[fill A_CALLBACK(<4>)]
[fill A_CALLBACK(<5>)]
[fill A_CALLBACK(<6>)]
[fill A_CALLBACK(<7>)]
[fill A_CALLBACK(<8>)]
[fill A_CALLBACK(<9>)]
[fill A_CALLBACK(<10>)]
[fill A_CALLBACK(<11>)]
[fill A_CALLBACK(<12>)]
[fill A_CALLBACK(<13>)]
PRESS ENTER TO CONTINUE
@
MISITKNOW
Mark One Only
Is this information available now?
(1) Yes
(2) No
@
MISITRESP
Mark One Only
ASK IF NECESSARY: With whom am I speaking? | Line
| display template HHROS2
ENTER LINE NUMBER
|
|
@
|
First Name
Mark One Only
MEASYWAY
The next questions are about the income [TEMPNAME]
received from [HISHER] job with [EMPNAM].
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL][fill HOURFIL]annual income amounts,
if that would be easier. What would be easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
Monthly totals
Weekly/Biweekly/Bimonthly>]
Hourly pay rates>/<>]
Annual amount
Some other way
@
Wednesday, August 27, 2003
Page 273 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MMONTHLY
[if MEASYWAY offpath]The next questions are about the income [fill
TEMPNAME] received from [fill HISHER] job with [fill EMPNAM].[endif]
How much [fill RECEIVFIL] BEFORE deductions from
[fill JOBBIZFIL] [fill MONTHXFIL]?
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
{popup: MMONTHLY5_ERR or MMONTHLY4_ERR or MMONTHLY3_ERR or MMONTHLY2_ERR or MMONTHLY1_ERR}
Mark One Only
MBIGMONTH5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MMONTHLY@5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGMONTH4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MMONTHLY@4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGMONTH3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MMONTHLY@3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 274 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBIGMONTH2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MMONTHLY@2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGMONTH1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MMONTHLY@1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MVARY
Enter Number
MSAME
Since [fill MONTHXFIL],
[fill PAYCKVARYFIL]?
(1) The same
(2) Varied
@
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
[fill ENTERVFIL]
[fill ENTERLFIL]
$@
Enter Number
MPAYAPRX
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBIGSAME
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill MSAME], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 275 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MCALCPYVR
That comes out to about $[fill PAYHOURFIL] per month.
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
MSAMECHK
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount before all
taxes and deduction?
$@
Multiple Entry
MP1M
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL] from [fill EMPNAM] [fill MONTHXFIL].
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
RECORD EACH PAYCHECK SEPARATELY, IF POSSIBLE.
[fill PAYDAYFIL5]
[fill SORRYFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL] [fill PAYDAYFIL4]
@41 @42 @43 @44 @45
[fill MONTH3FIL] [fill PAYDAYFIL3]
@31 @32 @33 @34 @35
[fill MONTH2FIL] [fill PAYDAYFIL2]
@21 @22 @23 @24 @25
[fill MONTH1FIL] [fill PAYDAYFIL1]
@11 @12 @13 @14 @15
[fill ERRORFIL]
{popup: MP1M5_ERR or MP1M4_ERR or MP1M3_ERR or MP1M2_ERR or MP1M1_ERR}
Mark One Only
MMTOT5VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MTOTAL5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Page 276 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MMTOT4VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MTOTAL4], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MMTOT3VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MMTOT2VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MTOTAL2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MMTOT1VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MEXTRA1
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when you received additional checks?
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Wednesday, August 27, 2003
Page 277 of 340
Survey:
Section: Section: Missing
Items Booklet
Enter Number
MPYRAT
The next questions are about the income [fill TEMPNAME] received
from [fill HISHER] job with [fill EMPNAM]
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill ATJOBFIL]?
READ IF NECESSARY: Do not include your overtime rate here. Income earned
at overtime rates will be collected later.
$@ per hour
Mark One Only
MHRAPRX
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Mark One Only
MBIGHOUR
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill MPYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MRATECHG
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill HISHER] job with [fill EMPNAM] [fill ISWASFIL]
$[fill MPYRAT].
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same pay rate throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Multiple Entry
MSTRTPAY
When did that $[fill MPYRAT] an hour pay rate first show up in
[fill PTEMPNAME] paycheck?
MONTH: @MTH
DAY: @DAY
Enter Number
MPYRAT2
What was [fill PTEMPNAME] hourly pay rate before that?
[fill ENTERLFIL]
$@ per hour
Page 278 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Enter Number
MHRAPRX2
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBIGHOUR2
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill MPYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MCALCHRVR
Earlier you stated that [fill TEMPNAME] usually worked
[fill JOBHRS] hours per week. At [fill PYRAT] per hour, that
works out to about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right for [fill PTEMPNAME] gross income?
(1) Yes
(2) No
@
Enter Number
MESTHR1
What is your best estimate of [fill PTEMPNAME] income BEFORE
deductions from [fill EMPNAM] [fill WEEKFIL] at that
[fill MPYRAT] pay rate?
$@
Mark One Only
MCALCHRV2
$[fill MPYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
MESTHR2
What is your best estimate of [fill PTEMPNAME] income BEFORE
deductions from [fill EMPNAM] [fill WEEKFIL] at that
[fill MPYRAT2] pay rate?
$@
Wednesday, August 27, 2003
Page 279 of 340
Survey:
Section: Section: Missing
Items Booklet
Enter Number
MAMOUNT1
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
with [fill EMPNAM] [fill JOBENDFIL]
[fill ENTERLFIL]
$@
Enter Number
MAPXAMT1
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a
couple thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBIGAMOUNT1
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MSAMEAMT1
[fill HASWASFIL] [fill HISHER] annual salary for the whole
time [fill JOBBEGFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same annual salary throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Multiple Entry
MSTRTANN1
When did that $[fill PAYANNFIL] annual salary first show up
in [fill PTEMPNAME] paycheck?
MONTH: @MTH
DAY: @DAY
Enter Number
MAMOUNT2
What was [fill PTEMPNAME] annual salary before that?
[fill ENTERLFIL]
$@
Page 280 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Enter Number
MAPXAMT2
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBIGAMOUNT2
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MCALCANN1
That $[fill PAYANN2FIL] annual salary, divided by 12 months, works out
to be about $[fill PAYANN1FIL]. Does that sound about right
for a gross monthly amount?
(1) Yes
(2) No
@
Enter Number
MESTANN1
What is your best estimate of [fill PTEMPNAME] average gross
monthly income from [fill EMPNAM] at that annual salary rate?
$@
Mark One Only
MCALCANN2
And for [fill HISHER] salary before that...
$[fill PAYANN1FIL] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
(1) Yes
(2) No
@
Enter Number
MESTANN2
What is your best estimate of [fill PTEMPNAME] average
gross monthly income from [fill EMPNAM] at that
annual salary rate?
$@
Wednesday, August 27, 2003
Page 281 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MTRYMNTH
Let's try [fill ANOTHERFIL).
How much [fill RECEIVFIL] BEFORE deductions from
[fill EMPNAM] [fill MONTHXFIL]?
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
Mark One Only
MBIGTRYMTH5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MTRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGTRYMTH4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MTRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGTRYMTH3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MTRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 282 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBIGTRYMTH2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MTRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGTRYMTH1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MTRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MANYTIPS
Since [fill MONTH1STFIL], did [fill TEMPNAME] receive
any tips, bonuses, cash awards, overtime pay,
or commissions from [fill JOBBIZFIL]?
(1) Yes
(2) No
@
Mark One Only
MTIPS
Did the income amounts we just talked about include all of
[fill PTEMPNAME] (tips, bonuses, cash awards, overtime pay,
or commissions) from [fill JOBBIZFIL]?
(1) Yes
(2) No
@
Wednesday, August 27, 2003
Page 283 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MTIPSAMT
How much [fill RECEIVFIL] in (tips, bonuses, cash awards, overtime
pay, or commissions) [fill JOBBIZFIL] [fill MONTHXFIL]?
READ IF NECESSARY: Your best estimate here is fine.
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Mark One Only
MBIGTIP5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill TIPTOTAL5],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGTIP4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill TIPTOTAL4],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGTIP3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill TIPTOTAL3],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Page 284 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBIGTIP2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill TIPTOTAL2],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGTIP1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill TIPTOTAL1],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Multiple Entry
MCONTING
The next questions are about the income [fill TEMPNAME] received from
all of [fill HISHER] [fill JOBFIL]. What [fill ISWASFIL] the total
amount of income, BEFORE taxes and other deductions, that [fill TEMPNAME]
[fill HAVHAS] received from [fill JOBEMPFIL] so far this month?
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ERRORFIL]
@51 @52 @53 @54 @55
How about [fill MONTH4]?
@41 @42 @43 @44 @45
And [fill MONTH3]?
@31 @32 @33 @34 @35
And [fill MONTH2]?
@21 @22 @23 @24 @25
And [fill MONTH1]?
@11 @12 @13 @14 @15
Mark One Only
MBIGCON5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill CONTOTAL5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 285 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBIGCON4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill CONTOTAL4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGCON3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill CONTOTAL3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGCON2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill CONTOTAL2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBIGCON1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill CONTOTAL1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MTAKEHOME
[fill REGPAYFIL] the amounts you gave
me [fill HISHER] take-home pay, or were they [fill HISHER]
gross pay BEFORE any taxes and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Page 286 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MGETGROSS
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available, such
as pay stubs, that would show the gross amount?
(1) Yes
(2) No
@
Multiple Entry
MGROSSPAYM5
What were the gross pay amounts in [fill MONTH5]?
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill P1M5_1]
$@1
$[fill P1M5_2]
$@2
$[fill P1M5_3]
$@3
$[fill P1M5_4]
$@4
$[fill P1M5_5]
$@5
Mark One Only
MGROSSM5VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH5],
$[fill GTOTAL5], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MALLGROSSM5
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MGROSSPAYM4
What were the gross pay amounts in [fill MONTH4]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill P1M4_1]
$@1
$[fill P1M4_2]
$@2
$[fill P1M4_3]
$@3
$[fill P1M4_4]
$@4
$[fill P1M4_5]
$@5
Wednesday, August 27, 2003
Page 287 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MGROSSM4VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH4],
$[fill GTOTAL4], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MALLGROSSM4
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MGROSSPAYM3
What were the gross pay amounts in [fill MONTH3]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill P1M3_1]
$@1
$[fill P1M3_2]
$@2
$[fill P1M3_3]
$@3
$[fill P1M3_4]
$@4
$[fill P1M3_5]
$@5
Mark One Only
MGROSSM3VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH3],
$[fill GTOTAL3], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MALLGROSSM3
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Page 288 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MGROSSPAYM2
What were the gross pay amounts in [fill MONTH2]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill P1M2_1]
$@1
$[fill P1M2_2]
$@2
$[fill P1M2_3]
$@3
$[fill P1M2_4]
$@4
$[fill P1M2_5]
$@5
Mark One Only
MGROSSM2VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH2],
$[fill GTOTAL2], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MALLGROSSM2
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MGROSSPAYM1
What were the gross pay amounts in [fill MONTH1]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s): New gross amounts:
$[fill P1M1_1]
$@1
$[fill P1M1_2]
$@2
$[fill P1M1_3]
$@3
$[fill P1M1_4]
$@4
$[fill P1M1_5]
$@5
Mark One Only
MGROSSM1VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH1],
$[fill GTOTAL1], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 27, 2003
Page 289 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MALLGROSSM1
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
MGROSSPAYANN
What was the gross annual amount?
$@
Mark One Only
MBEASYWAY
The next questions are about the income
[fill TEMPNAME] received from [fill ALLBUS].
[fill THEGOALFIL]
We can go straight to monthly totals, or we can try to work with
[fill WEEKFIL] [fill HOURFIL]quarterly, or annual income amounts,
if that would be easier. What's easiest for you?
(1)
[fill <(2)
[fill <(3)
(4)
(5)
(6)
Monthly totals
Weekly/Biweekly/Bimonthly paychecks>]
Hourly pay rates>/<>]
Quarterly amount
Annual amount
Some other way
@
Multiple Entry
MBMONTHLY
[fill THENEXTQFIL]
How much income [fill RECEIVFIL] from this business BEFORE taxes and
other deductions [fill MONTHXFIL]?
THIS REFERS TO THE PERSON'S INCOME FROM THE BUSINESS,
NOT WHAT THE BUSINESS BROUGHT IN.
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@5
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill SORRYFIL]
Page 290 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBBIGMONTH5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MBMONTHLY@5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBBIGMONTH4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MBMONTHLY@4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBBIGMONTH3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MBMONTHLY@3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBBIGMONTH2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MBMONTHLY@2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBBIGMONTH1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MBMONTHLY@1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Wednesday, August 27, 2003
Page 291 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBVARY
Enter Number
MBSAME
Since [fill MONTHXFIL],
[fill PAYCKVARYFIL]?
(1) The same
(2) Varied
@
[fill RECORDSAMEFIL]
What [fill ISWASFIL] that gross [fill WEEKMTHFIL]
amount before deductions?
[fill ENTERVFIL]
$@
Enter Number
MBPAYAPRX
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
ENTER (0) FOR NONE
$@
Mark One Only
MBBIGSAME
DO NOT READ TO RESPONDENT
THE AMOUNT ENTERED FOR A [fill WEEKMTHFIL] PAYCHECK,
$[fill MBSAME], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBCALCPYVR
That comes out to about $[fill BPAYMONFIL] per month.
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
MBSAMECHK
What [fill ISWASFIL] the right [fill WEEKMTHFIL] amount before all
taxes and deductions?
$@
Page 292 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MBP1M
Please tell me the GROSS AMOUNT, before deductions, of each paycheck
[fill TEMPNAME] [fill RECEIVFIL]
from [fill ALLBUS] [fill MONTHXFIL].
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill PAYDAYFIL5]
[fill SORRYFIL]
@51 @52 @53 @54 @55
[fill MONTH4FIL] [fill PAYDAYFIL4]
@41 @42 @43 @44 @45
[fill MONTH3FIL] [fill PAYDAYFIL3]
@31 @32 @33 @34 @35
[fill MONTH2FIL] [fill PAYDAYFIL2]
@21 @22 @23 @24 @25
[fill MONTH1FIL] [fill PAYDAYFIL1]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Mark One Only
MBMTOT5VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BMTOTAL5], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBMTOT4VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BMTOTAL4], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBMTOT3VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BMTOTAL3], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(2) PROCEED
@
Wednesday, August 27, 2003
Page 293 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBMTOT2VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BMTOTAL2], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBMTOT1VER
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BMTOTAL1], IS
UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(2) PROCEED
@
Mark One Only
MBEXTRA1
Based on pay frequency, we may have missed one or more paychecks.
Was there a month when you received additional checks?
IF YES, PRESS F1 TO BACK UP AND ADD PAYCHECK(S).
IF NO, PRESS (P) TO PROCEED.
@
Enter Number
MBPYRAT
What [fill ISWASFIL] [fill HISHER] REGULAR hourly pay rate
[fill FROMBIZFIL]?
READ IF NECESSARY: Do not include your overtime rate here.
Income earned at overtime rates will be collected later.
[fill ENTERNFIL]
[fill ENTERLFIL]
$@ per hour
Mark One Only
MBHRAPRX
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
@
Page 294 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBBIGHOUR
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill MBPYRAT] IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBRATECHG
Earlier I recorded that [fill PTEMPNAME] [fill CURRENTFIL] regular
hourly pay rate at [fill ALLBUS] [fill ISWASFIL]
$[fill MBPYRAT].
[fill HASWASFIL] [fill HISHER] regular rate of pay for the whole time
[fill BUSSTRTFIL], or did [fill HISHER] salary change
[fill SINCETHENFIL]?
(1) Same pay rate throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Multiple Entry
MBSTRTPAY
When did that $[fill MBPYRAT] an hour pay rate first show up
in [fill PTEMPNAME] paycheck?
MONTH: @MTH
DAY: @DAY
Enter Number
MBPYRAT2
What was [fill PTEMPNAME] hourly pay rate before that?
[fill ENTERLFIL]
$@ per hour
Enter Number
MBHRAPRX2
[fill SORRYFIL]
Can you give me an approximate amount?
ENTER (N) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBBIGHOUR2
DO NOT READ TO RESPONDENT
THE HOURLY RATE ENTERED, $[fill MBPYRAT2], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 295 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBCALCHRVR
Earlier you stated that [fill TEMPNAME] usually worked
[fill HRSBS] hours per week. At $[fill MBPYRAT], that works out to
about $[fill PAYHOURFIL] [fill WEEKFIL].
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
MBESTHR1
What is your best estimate of [fill PTEMPNAME] income
BEFORE deductions from [fill ALLBUS] [fill WEEKFIL]
at that [fill MBPYRAT] pay rate?
$@
Mark One Only
MBCALCHRV2
$[fill MBPYRAT2] per hour works out to about $[fill PAYHOUR2FIL]
[fill WEEKFIL].
Does that sound about right?
(1) Yes
(2) No
@
Enter Number
MBESTHR2
What is your best estimate of [fill PTEMPNAME] income
BEFORE deductions from [fill ALLBUS] [fill WEEKFIL]
at [fill MBPYRAT2] pay rate?
$@
Enter Number
MBQTRAMT
What was [fill PTEMPNAME] income before taxes
and personal deductions from [fill ALLBUS]
for the most recent quarter (or the most recent quarter
that you can tell me about)?
[fill ENTERLFIL]
$@
Enter Number
MBAPXQTR
[fill SORRYFIL]
Can you give me an approximate quarterly salary amount -within a couple thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Page 296 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBBIGQTR
DO NOT READ TO RESPONDENT
THE QUARTERLY RATE ENTERED, $[fill MBQTRAMT], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Multiple Entry
MBQTRMNTH
And when did that quarter close?
(What was the last month and year of the quarter that
the [fill QTRAMTFIL] dollars applies to?
MONTH: @MTH
YEAR: @YEAR
Enter Number
MBAMOUNT1
What [fill ISWASFIL] [fill PTEMPNAME] [fill CURRENTFIL]
annual salary with [fill ALLBUS] [fill BIZENDFIL]
[fill ENTERLFIL]
$@
Enter Number
MBAPXAMT1
[fill SORRYFIL]
Can you give me an approximate annual salary amount - within a
couple of thousand dollars or so?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBBIGAMT1
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBSAMEAMT1
[fill HASWASFIL] [fill HISHER] [fill CURRENTFIL] for the whole time
[fill BUSSTRTFIL], or did [fill HESHE] get a raise
[fill SINCETHENFIL]?
(1) Same [fill CURRENTFIL] throughout; NO raise/decrease
(2) RAISE/DECREASE
@
Wednesday, August 27, 2003
Page 297 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MBSTRTANN1
When did that $[fill PAYANN1FIL] annual salary first show up in
[fill PTEMPNAME] paycheck?
MONTH: @MTH
DAY: @DAY
Enter Number
MBAMOUNT2
What was [fill PTEMPNAME] annual salary before that?
[fill ENTERLFIL]
$@
Enter Number
MBAPXAMT2
[fill SORRYFIL]
Can you give me an approximate annual salary amount?
ENTER (X) IF RESPONDENT CANNOT GIVE APPROXIMATE AMOUNT
$@
Mark One Only
MBBIGAMT2
DO NOT READ TO RESPONDENT
THE ANNUAL AMOUNT ENTERED, $[fill PAYANN1FIL], IS UNUSUALLY
[fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBCALCANN1
That $[fill PAYANN2FIL] annual salary, divided by 12 months,
works out to about $[fill PAYANN1FIL]. Does that sound
about right for a gross monthly amount?
(1) Yes
(2) No
@
Enter Number
MBESTANN1
What is your best estimate of [fill PTEMPNAME] average gross
monthly income from [fill ALLBUS] at that annual salary rate?
$@
Mark One Only
MBCALCANN2
And for [fill HISHER] salary before that...
$[fill PAYANN1FIL] divided by 12 is about $[fill PAYANN2FIL].
Is that about right for a gross monthly amount?
(1) Yes
(2) No
@
Page 298 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Enter Number
MBESTANN2
What is your best estimate of [fill PTEMPNAME] average
gross monthly income from [fill ALLBUS] at that annual salary rate?
$@
Multiple Entry
MBTRYMNTH
Let's try [fill ANOTHERFIL].
How much [fill RECEIVFIL] BEFORE deductions from
[fill ALLBUS] [fill MONTHXFIL]?
ENTER (N) FOR NONE OR NO MORE / ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
@5 [fill SORRYFIL]
[fill MONTH4FIL]
@4
[fill MONTH3FIL]
@3
[fill MONTH2FIL]
@2
[fill MONTH1FIL]
@1
[fill ERRORFIL]
Mark One Only
MBBIGTRY5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill MBTRYMNTH@5],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBBIGTRY4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill MBTRYMNTH@4],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBBIGTRY3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill MBTRYMNTH@3],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 299 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBBIGTRY2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill MBTRYMNTH@2],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBBIGTRY1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill MBTRYMNTH@1],
IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBANYTIPS
Other than [fill HISHER] regular income, since [fill MONTH1] 1st,
did [fill TEMPNAME] receive any tips, bonuses, overtime pay,
or commissions from [fill HISHER] work with [fill ALLBUS]?
(1) Yes
(2) No
@
Mark One Only
MBTIPS
Did the income amounts we just talked about include all of
[fill PTEMPNAME] tips, bonuses, overtime pay, or commissions
from [fill ALLBUS]?
(1) Yes
(2) No
@
Page 300 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MBTIPSAMT
How much [fill RECEIVFIL] in tips, bonuses, overtime pay,
or commissions [fill FROMBIZFIL] [fill MONTHXFIL]?
READ IF NECESSARY: Your best estimate here is fine.
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
[fill MONTH4FIL]
@41 @42 @43 @44 @45
[fill MONTH3FIL]
@31 @32 @33 @34 @35
[fill MONTH2FIL]
@21 @22 @23 @24 @25
[fill MONTH1FIL]
@11 @12 @13 @14 @15
[fill ERRORFIL]
Mark One Only
MBBIGTIP5
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH5], $[fill BTIPTOTAL5],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBBIGTIP4
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH4], $[fill BTIPTOTAL4],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBBIGTIP3
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH3], $[fill BTIPTOTAL3],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 301 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBBIGTIP2
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH2], $[fill BTIPTOTAL2],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBBIGTIP1
DO NOT READ TO RESPONDENT
THE TOTAL AMOUNT ENTERED FOR [fill MONTH1], $[fill BTIPTOTAL1],
IF UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) Proceed
@
Mark One Only
MBTAKEHOME
Just to be sure -- were the amounts you gave me [fill HISHER]
take-home pay, or were they [fill HISHER] gross pay BEFORE any
taxes and other deductions were taken out?
H
(1) Take-home pay (net, after deductions)
(2) Gross (total) pay (before deductions)
(3) No deductions (gross pay = net pay)
@
Mark One Only
MBGETGROSS
This survey needs to get people's gross income amounts. Do you know
[fill HISHER] gross pay amounts, or do you have records available,
such as pay stubs, that would show the gross amount?
(1) Yes
(2) No
@
Multiple Entry
MBGROSSPAYM5
What were the gross pay amounts in [fill MONTH5]?
ENTER (A) TO ENTER A GROSS ANNUAL AMOUNT
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M5_1]
$[fill BP1M5_2]
$[fill BP1M5_3]
$[fill BP1M5_4]
$[fill BP1M5_5]
Page 302 of 340
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBGROSSM5VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH5],
$[fill BGTOTAL5], IS UNUSUALLY [fill LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBALLGROSSM5
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH5] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MBGROSSPAYM4
What were the gross pay amounts in [fill MONTH4]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M4_1]
$[fill BP1M4_2]
$[fill BP1M4_3]
$[fill BP1M4_4]
$[fill BP1M4_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
MBGROSSM4VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH4],
$[fill BGTOTAL4], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBALLGROSSM4
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH4] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Wednesday, August 27, 2003
Page 303 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MBGROSSPAYM3
What were the gross pay amounts in [fill MONTH3]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M3_1]
$[fill BP1M3_2]
$[fill BP1M3_3]
$[fill BP1M3_4]
$[fill BP1M3_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
MBGROSSM3VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH3],
$[fill BGTOTAL3], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBALLGROSSM3
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH3] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MBGROSSPAYM2
What were the gross pay amounts in [fill MONTH2]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M2_1]
$[fill BP1M2_2]
$[fill BP1M2_3]
$[fill BP1M2_4]
$[fill BP1M2_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
MBGROSSM2VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH2],
$[fill BGTOTAL2], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Page 304 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBALLGROSSM2
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH2] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Multiple Entry
MBGROSSPAYM1
What were the gross pay amounts in [fill MONTH1]?
ENTER (S) FOR SAME AMOUNT AS PREVIOUS NEW GROSS AMOUNT
ENTER (N) FOR NO MORE
Old net amount(s):
$[fill BP1M1_1]
$[fill BP1M1_2]
$[fill BP1M1_3]
$[fill BP1M1_4]
$[fill BP1M1_5]
New gross amounts:
$@1
$@2
$@3
$@4
$@5
Mark One Only
MBGROSSM1VER
DO NOT READ TO RESPONDENT
THE NEW TOTAL GROSS ANOUNTS ENTERED FOR [fill MONTH1],
$[fill BGTOTAL1], IS UNUSUALLY [FILL LGSMFIL].
(1) BACK UP AND CORRECT
(P) PROCEED
@
Mark One Only
MBALLGROSSM1
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS FOR [fill MONTH1] NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Enter Number
MBGROSSPAYANN
What was the gross annual amount?
$@1
Mark One Only
MBALLGROSSANN
DO NOT READ TO RESPONDENT
ARE ALL AMOUNTS NOW GROSS AMOUNTS?
(1) Yes, all amounts are gross
(2) No, some net amounts remain
@
Wednesday, August 27, 2003
Page 305 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MOINCB
Since [fill MONTH1] 1st, did [fill TEMPNAME] receive any [fill OTHERFIL]
income from [fill ALLBUS]?
(1) Yes
(2) No
@
Multiple Entry
MOINCAMT
What was the total amount of other income [fill HESHE] received from
[fill ALLBUS] [fill MONTHXFIL]
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
@51 @52 @53 @54 @55
How much did you receive in [fill MONTH4]?
@41 @42 @43 @44 @45
How about in [fill MONTH3]?
@31 @32 @33 @34 @35
And in [fill MONTH2]?
@21 @22 @23 @24 @25
And in [fill MONTH1]?
@11 @12 @13 @14 @15
[fill ERRORFIL]
Multiple Entry
MPRFTB
For [fill ALLBUS], what was [fill YOURSHAREFIL]
the net profit or loss [fill BIZDATESFIL] Net profit
or loss is the difference between gross receipts
and expenses.
H
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount: $@1
OR
Net loss amount:
$@2
Multiple Entry
MANNPRFT
Can you give me an annual figure?
ENTER NET PROFIT AMOUNT OR NET LOSS AMOUNT
ENTER (0) FOR NET PROFIT AMOUNT IF BROKE EVEN
Net profit amount: $@1
OR
Net loss amount:
Page 306 of 340
$@2
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBPRFTBCHK
Does that [fill PRFTLOSSFIL] include [fill PTEMPNAME] own income
from this business (that we talked about earlier), or do we need to
add [fill HISHER] income to the [fill PRFTLOSSFIL] to get a total
net profit?
(1) Salary/draw is included in the net profit/loss amount
(2) Add salary/draw to net profit/loss amount to get total
net profit/loss
@
Mark One Only
MJINTSP_PD
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME] jointly with
|{display names marked in JTWHO}
[fill SPOUSEFIL].
|{star small children's names}
What is the easiest way for you to tell |
me about [fill SHAREFIL] the interest or |
dividend income [fill ANDSPKIDFIL]
|
received from those jointly held
|
[fill ASNAME]? (Can you give me the
|
total interest or dividends for the last |
4 months, or would it be easier for you |
to report monthly amounts, or a quarterly |
amount, or an annual amount?)
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Multiple Entry
MJTINTSP
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO}
[fill HOWMUCHFIL]
|{star small children's names}
by these joint [fill ASNAME]?
|
|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL1]
|
Wednesday, August 27, 2003
Page 307 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MJTINTSP2
[fill HOWMUCHFIL] interest or dividend |JOINT WITH:
income [fill WASFIL] produced by these |{display names marked in JTWHO}
joint [fill ASNAME]...
|{star children's names}
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[if I_ASSTCODE ne <> and HHSTATRIP ne <3>]|
ENTER (L) FOR SAME AS LAST INTERVIEW[endif|
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43
|
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
|
And [fill MONTH2]?
|
@21 @22 @23
|
|
And [fill MONTH1]?
|
@11 @12 @13
|
|
4-Month Total: $[fill JNTINTSP]
|
Mark One Only
MBIGAST1
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
MJCATSP1Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 10 dollars, |
between 10 and 25 dollars, between 25 |
and 50 dollars, or more than 50 dollars? |
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Page 308 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJCATSP1Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
25 dollars, between 25 and 75 dollars, |
between 75 and 150 dollars, or more
|
than 150 dollars?
|
|
(1) Less than $25
|
(2) $25 to $74.99
|
(3) $75 to $149.99
|
(4) $150 or more
|
|
@
|
Mark One Only
MJCATSP2Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 50 dollars, |
between 50 and 150 dollars, between 150 |
and 500 dollars, or more than 500 dollars?|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
Mark One Only
MJCATSP2Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Wednesday, August 27, 2003
Page 309 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MJCATSP3Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 150 dollars, |
between 150 and 500 dollars, between 500 |
and 1,500 dollars, or more than 1,500 |
dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
MJCATSP3Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
MJINTCH_PD
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME] jointly with
|{display names marked in JTWHO}
**READ NAMES**.
|{star children's names}
What is the easiest way for you to tell |
me about the interest or dividend income |
from those joint [fill ASNAME]?
|
(Can you give me the total interest or |
dividends for the last 4 months, or
|
would it be easier for you to report
|
monthly amounts, or a quarterly amount, |
or an annual amount?)
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Page 310 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MJTINTCH
[fill ANOTHERFIL]
|JOINT WITH:
[fill PERIODFIL]
|{display names marked in JTWHO}
[fill HOWMUCHFIL]
|{star children's names}
by these joint [fill ASNAME]?
|
|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL2]
|
Multiple Entry
MJTINTCH2
How much interest or dividend income was |JOINT WITH:
produced by these joint [fill ASNAME]? |{display names marked in JTWHO}
H |{star children's names}
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43 @44 @45
|
|
How about in [fill MONTH3]?
|
@31 @32 @33 @34 @35
|
|
And [fill MONTH2]?
|
@21 @22 @23 @24 @25
|
|
And [fill MONTH1]?
|
@11 @12 @13 @14 @15
|
|
4-Month Total: $[fill JNTINTCH]
|
Mark One Only
MBIGAST2
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 311 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MJCATCH1Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 10 dollars, |
between 10 and 25 dollars, between 25 and |
50 dollars, or more than 50 dollars?
|
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Mark One Only
MJCATCH1Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
25 dollars, between 25 and 75 dollars, |
between 75 and 150 dollars, or more
|
than 150 dollars?
|
|
(1) Less than $25
|
(2) $25 to $74.99
|
(3) $75 to $149.99
|
(4) $150 or more
|
|
@
|
Mark One Only
MJCATCH2Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 50 dollars, |
between 50 and 150 dollars, between 150 |
and 500 dollars, or more than 500 dollars?|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
Page 312 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJCATCH2Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
MJCATCH3Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 150 dollars, |
between 150 and 500 dollars, between 500 |
and 1,500 dollars, or more than 1,500 |
dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
MJCATCH3Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 313 of 340
Survey:
Section: Section: Missing
Items Booklet
MJTOTHINT_PD
Mark One Only
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME] jointly with
|{display names marked in JTWHO}
***READ NAMES***.
|{star childrens' names}
What is the easiest way for you to tell |
me about the share of the interest or |
dividend income [fill TEMPNAME]
|
[fill ANDSPKIDFIL] received from these |
jointly held [fill ASNAME]?
|
(Can you give me the total interest or |
dividends for the last 4 months, or
|
would it be easier for you to report
|
monthly amounts, or a quarterly amount, |
or an annual amount?)
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
@
|
MJTOTHINT
Multiple Entry
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL]
by these joint
[fill ASNAME]?
|JOINT WITH:
|{display names marked in JTWHO}
|{star children's names}
|
|
|
READ NAMES IF NECESSARY
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL3]
|
Page 314 of 340
|
|
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MJTOTHINT2
What was [fill PTEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL] share of the interest |{display names marked in JTWHO}
or dividend income produced by these
|{star children's names}
joint [fill ASNAME]?
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43 @44 @45
|
|
How about in [fill MONTH3]?
|
@31 @32 @33 @34 @35
|
|
And [fill MONTH2]?
|
@21 @22 @23 @24 @25
|
|
And [fill MONTH1]?
|
@11 @12 @13 @14 @15
|
4-Month Total: $[fill JNTOTINT]
|
Mark One Only
MBIGAST3
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
MJCATOT1Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 10 dollars, |
between 10 and 25 dollars,
|
between 25 and 50 dollars,
|
or more than 50 dollars?
|
|
(1) Less than $10
|
(2) $10 to $24.99
|
(3) $25 to $49.99
|
(4) $50 or more
|
|
@
|
Mark One Only
MJCATOT1Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
25 dollars, between 25 and 75 dollars, |
between 75 and 150 dollars, or more
|
than 150 dollars?
|
|
(1) Less than $25
|
(2) $25 to $74.99
|
(3) $75 to $149.99
|
(4) $150 or more
|
|
Wednesday, August 27, 2003
Page 315 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MJCATOT2Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
50 dollars, between 50 and 150 dollars, |
between 150 and 500 dollars, or more
|
than 500 dollars?
|
|
(1) Less than $50
|
(2) $50 to $149.99
|
(3) $150 to $499.99
|
(4) $500 or more
|
|
@
|
Mark One Only
MJCATOT2Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
100 dollars, between 100 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Mark One Only
MJCATOT3Q
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than
|
150 dollars, between 150 and 500 dollars, |
between 500 and 1,500 dollars, or more |
than 1,500 dollars?
|
|
(1) Less than $150
|
(2) $150 to $499.99
|
(3) $500 to $1,499.99
|
(4) $1,500 or more
|
|
@
|
Page 316 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJCATOT3Y
Asset Type: [fill C_ASNAME]
|JOINT WITH:
|{display names marked in JTWHO}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than
|
500 dollars, between 500 and 1,500
|
dollars, between 1,500 and 5,000 dollars, |
or more than 5,000 dollars?
|
|
(1) Less than $500
|
(2) $500 to $1,499.99
|
(3) $1,500 to $4,999.99
|
(4) $5,000 or more
|
|
@
|
Mark One Only
MEXCL_CD
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill ASNAME] [fill OWNNAMEFIL].
Are these CDs included in [fill PTEMPNAME] [fill IRA401FIL] account,
or [fill DODOES] [fill HESHE] own them separately from any retirement
account -- or both?
H
(1) All CDs are included in IRA/Keogh/401k/403b/thrift accounts
(2) All CDs are owned separately from retirement accounts
(3) Both -- some are included in retirement accounts
and some are owned separately
@
Mark One Only
MOINT_PD
[fill INCOMENOWFIL]
[fill EARLIERFIL] What is the easiest way for you to tell me about
[fill PTEMPNAME] interest or dividend income from those
[fill ASNAME]?
(Can you give me the total interest or dividends for the last
4 months, or would it be easier for you to report an annual amount,
or a quarterly amount, or monthly amounts?)
H
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) None of these
@
Wednesday, August 27, 2003
Page 317 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MOINT
[fill ANOTHERFIL]
[fill PERIODFIL]
[fill HOWMUCHFIL] by these [fill ASNAME]?
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL4]
Multiple Entry
MOINT2
What was the total amount of interest or dividend income
[fill TEMPNAME] earned from these [fill ASNAME]...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill OWNINT]
Mark One Only
MOCAT1Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than 10 dollars,
between 10 and 25 dollars, between 25 and 50 dollars,
or more than 50 dollars?
(1)
(2)
(3)
(4)
Less than $10
$10 to $24.99
$25 to $49.99
$50 or more
@
Page 318 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MOCAT1Y
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 25 dollars, between 25 and 75 dollars,
between 75 and 150 dollars, or more than 150 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $74.99
$75 to $149.99
$150 or more
@
Mark One Only
MOCAT2Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIl] amount [fill SINCEFIL] less than 50 dollars,
between 50 and 150 dollars, between 150 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $50
$50 to $149.99
$150 to $499.99
$500 or more
@
Mark One Only
MOCAT2Y
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between 100 and 500 dollars,
between 500 and 1500 dollars, or more than 1500 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $1499.99
$1500 or more
@
Mark One Only
MOCAT3Q
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Was the [fill 4MONQRTFIL] amount [fill SINCEFIL] less than 150 dollars,
between 150 and 500 dollars, between 500 and 1,500 dollars,
or more than 1,500 dollars?
(1)
(2)
(3)
(4)
Less than $150
$150 to $499.99
$500 to $1,499.99
$1,500 or more
@
Wednesday, August 27, 2003
Page 319 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MOCAT3Y
Asset Type: [fill C_ASNAME]
[fill SORRYFIL]
Is the annual amount less than 500 dollars, between 500 and 1,500 dollars,
between 1,500 and 5,000 dollars, or more than 5,000 dollars?
(1)
(2)
(3)
(4)
Less than $500
$500 to $1,499.99
$1,500 to $4,999.99
$5,000 or more
@
Mark One Only
MJTANYWSP
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME2] jointly with
|{display names marked in JTWHO2}
***READ NAMES***.
|{star children's names}
|
What kind of dividends do [fill YOUTHEYFIL]
[fill BOTHALLFIL] get from these joint |
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends |
credited against a margin account or
|
automatically reinvested?
|
H|
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
MNODIVSP
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
[fill TEMPNAME] and [fill SPOUSEFIL]
|{display names marked in JTWHO2}
have received no dividends of any kind |{star children's names}
from these joint [fill ASNAME2] since
|
[fill MONTH1] 1st -- is that correct?
|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
|
Page 320 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJTDIVSP_PD
What is the easiest way for you to tell |JOINT WITH:
me about [fill SHAREFIL] the dividend |{display names marked in JTWHO2}
income [fill ANDSPKIDFIL] received from |{star children's names}
those jointly held [fill ASNAME2]?
|
(Can you give me the total dividends
|
for the last 4 months, or would it be |
easier for you to report monthly amounts, |
or a quarterly amount, or an
|
annual amount?)
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Multiple Entry
MJTDIVSP
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
[fill INCLUDEFIL] |[fill ISWASFIL]
|
[fill YOURTHEIRFIL] share of the
|
[fill CREDITEDFIL] dividend income
|
fill PRODUCEDFIL]
|
by all these joint [fill ASNAME2]?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1 $@2
|
$@3 $@4
|
$@5 $@6
|
Total: $[TOTALFIL5]
|
Multiple Entry
MJTDIVSP2
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
[fill INCLUDEFIL] was [fill YOURTHEIRFIL] |
share of the [fill CREDITEDFIL] dividend |
income produced by all these joint
|
[fill ASNAME2]...
|
H|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43
|
How about in [fill MONTH3]?
|
@31 @32 @33
|
And [fill MONTH2]?
|
@21 @22 @23
|
And [fill MONTH1]?
|
@11 @12 @13
|
4-Month Total: $[fill JNTDIVSP]
|
Wednesday, August 27, 2003
Page 321 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MBIGAST5
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
MJDIVSP1Q
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 100 dollars, |
between 100 and 400 dollars,
|
between 400 and 1,000 dollars,
|
or more than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $399.99
|
(3) $400 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
MJDIVSP1Y
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Is the annual amount less than 250
|
dollars, between 250 and 1,000 dollars, |
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Mark One Only
MJDIVSP2Q
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQTRFIL] amount
|
[fill SINCEFIL] less than 25 dollars, |
between 25 and 100 dollars,
|
between 100 and 500 dollars,
|
or more than 500 dollars?
|
|
(1) Less than $25
|
(2) $25 to $99.99
|
(3) $100 to $499.99
|
(4) $500 or more
|
|
@
|
Page 322 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJDIVSP2Y
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than 100
|
dollars, between 100 and 500 dollars, |
between 500 and 1,000 dollars, or more |
than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
MJTANYWCH
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME2] jointly with
|{display names marked in JTWHO2}
***READ NAMES***.
|{star children's names}
|
What kind of dividends do [fill YOUTHEYFIL]|
[fill BOTHALLFIL] get from these joint |
[fill ASNAME2]? Do [fill YOUTHEYFIL] get |
dividend checks, or are the dividends |
credited against a margin account or
|
automatically reinvested?
|
H|
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
MNODIVCH
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
[fill TEMPNAME] and ***READ NAMES***
|{display names marked in JTWHO2}
have received no dividends of any kind |{star children's names}
from these joint [fill ASNAME2] since |
[MONTH1] 1st -- is that correct?
|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
Wednesday, August 27, 2003
Page 323 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MJTDIVCH_PD
What is the easiest way for you to tell |JOINT WITH:
me about the dividend income received |{display names marked in JTWHO2}
from those jointly held [fill ASNAME2]? |{star children's names}
(Can you give me the total dividends
|
for the last 4 months, or would it be |
easier for you to report monthly amounts, |
or a quarterly amount, or an
|
annual amount?)
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Multiple Entry
MJTDIVCH
[fill INCLUDEFIL] [fill CREDITEDFIL]
|JOINT WITH:
dividend income [fill ISWASFIL]
|{display names marked in JTWHO2}
[fill PRODUCEDFIL]
|{star children's names}
by all these joint [fill ASNAME2]?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL7]
|
Multiple Entry
MJTDIVCH2
[fill INCLUDEFIL] [fill CREDITEDFIL]
|JOINT WITH:
dividend income was produced by all
|{display names marked in JTWHO2}
these joint [fill ASNAME2]…
|{star children's names)
|
ENTER (N) FOR NONE OR NO MORE
|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43 @44 @45
|
How about in [fill MONTH3]?
@31 @32 @33 @34 @35
|
And [fill MONTH2]?
|
@21 @22 @23 @24 @25
|
And [fill MONTH1]?
|
@11 @12 @13 @14 @15
4-Month Total: $[fill JNTDIVCH]
Page 324 of 340
|
|
|
|
|
|
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MBIGAST6
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
MJDIVCH1Q
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 100 dollars, |
between 100 and 400 dollars,
|
between 400 and 1,000 dollars,
|
or more than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $399.99
|
(3) $400 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
MJDIVCH1Y
Asset Type: MUTUAL FUNDS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than 250
|
dollars, between 250 and 1,000 dollars, |
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Mark One Only
MJDIVCH2Q
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the [fill 4MONQTRFIL] amount
|
[fill SINCEFIL] less than 25 dollars, |
between 25 and 100 dollars,
|
between 100 and 500 dollars,
|
or more than 500 dollars?
|
|
(1) Less than $25
|
(2) $25 to $99.99
|
(3) $100 to $499.99
|
(4) $500 or more
|
|
@
|
Wednesday, August 27, 2003
Page 325 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MJDIVCH2Y
Asset Type: STOCKS
|JOINT WITH:
|{display names marked in JTWHO2}
[fill SORRYFIL]
|{star children's names}
Was the annual amount less than 100
|
dollars, between 100 and 500 dollars, |
between 500 and 1,000 dollars, or more |
than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $999.99
|
(4) $1,000 or more
|
|
@
|
Mark One Only
MJTOTHANY
Earlier I recorded that [fill TEMPNAME] |JOINT WITH:
owned [fill ASNAME2] jointly with
|{display names marked in JTWHO2}
***READ NAMES***.
|{star children's names}
|
What kind of dividends do these joint |
[fill ASNAME2] produce? Do they produce |
dividend checks, or are the dividends |
credited against a margin account or
|
automatically reinvested?
|
H|
(1) Dividend CHECKS
|
(2) CREDITED or AUTOMATICALLY
|
REINVESTED dividends
|
(3) Both
|
(4) Neither; no dividends received |
|
@
|
Mark One Only
MNODIVOTH
ASK IF NECESSARY: Just to be sure,
|JOINT WITH:
these joint [fill ASNAME2] produced no |{display names marked in JTWHO2}
dividends of any kind since [MONTH1] 1st |{star children's names}
-- is that correct?
|
|
(1) Yes; correct;
|
no dividends received
|
(2) No; incorrect;
|
DID RECEIVE dividends
|
|
@
|
Page 326 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJTOTHDIV_PD
What is the easiest way for you to tell |JOINT WITH:
me about the share of the dividend
|{display names marked in JTWHO2}
income [fill TEMPNAME]
|{star children's names}
[fill ANDSPKIDFIL] received from
|
those joint [fill ASNAME2]?
|
(Can you give me the total dividends
|
for the last 4 months, or would it be |
easier for you to report monthly amounts, |
or a quarterly amount, or an
|
annual amount?)
|
H|
(1) 4-month total
|
(2) Monthly amounts
|
(3) Quarterly amount
|
(4) Annual amount
|
(5) None of these
|
|
@
|
Multiple Entry
MJTOTHDIV
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
[fill INCLUDEFIL] [fill ISWASFIL]
|
[fill YOURTHEIRFIL] share of the
|
[fill CREDITEDFIL]
|
dividend income
|
[fill PRODUCEDFIL]
|
by all these joint [fill ASNAME2]?
|
H|
READ NAMES IF NECESSARY
|
ENTER (N) FOR NONE OR NO MORE
|
[fill ENTERLFIL]
|
|
$@1
|
$@2
|
$@3
|
$@4
|
$@5
|
$@6
|
|
Total: $[TOTALFIL9]
|
Wednesday, August 27, 2003
Page 327 of 340
Survey:
Section: Section: Missing
Items Booklet
Multiple Entry
MJTOTHDIV2
Income Share For:
[fill SHAREFIL]
|JOINT WITH:
|{display names marked in JTWHO2}
|{star children's names}
[fill INCLUDEFIL] was
|
[fill YOURTHEIRFIL] share of the
|
[fill CREDITEDFIL]
|
dividend income produced
|
by all these joint [fill ASNAME2]...
|
ENTER (N) FOR NONE OR NO MORE
H|
ENTER (S) FOR SAME AS PREVIOUS AMOUNT |
[fill ENTERFIL]
|
in [fill MONTH4]?
|
@41 @42 @43 @44 @45
|
How about in [fill MONTH3]?
|
@31 @32 @33 @34 @35
|
And [fill MONTH2]?
|
@21 @22 @23 @24 @25
|
And [fill MONTH1]?
|
@11 @12 @13 @14 @15
|
4-Month Total: $[fill JAMTDVOT]
|
Mark One Only
MBIGAST7
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Mark One Only
MJDIVOT1Q
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star children's names}
Asset Type: MUTUAL FUNDS
|
|
[fill SORRYFIL]
|
Was the [fill 4MONQRTFIL] amount
|
[fill SINCEFIL] less than 100 dollars, |
between 100 and 400 dollars,
|
between 400 and 1,000 dollars,
|
or more than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $399.99
|
(3) $400 to $999.99
|
(4) $1,000 or more
|
|
@
|
Page 328 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Mark One Only
MJDIVOT1Y
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star children's names}
Asset Type: MUTUAL FUNDS
|
|
[fill SORRYFIL]
|
Is the annual amount less than 250
|
dollars, between 250 and 1,000 dollars, |
between 1,000 and 2,500 dollars, or more |
than 2,500 dollars?
|
|
(1) Less than $250
|
(2) $250 to $999.99
|
(3) $1,000 to $2,499.99
|
(4) $2,500 or more
|
|
@
|
Mark One Only
MJDIVOT2Q
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star children's names}
Asset Type: STOCKS
|
|
[fill SORRYFIL]
|
Was the [fill 4MONQTRFIL] amount
|
[fill SINCEFIL] less than 25 dollars, |
between 25 and 100 dollars,
|
between 100 and 500 dollars,
|
or more than 500 dollars?
|
|
(1) Less than $25
|
(2) $25 to $99.99
|
(3) $100 to $499.99
|
(4) $500 or more
|
|
@
|
Mark One Only
MJDIVOT2Y
Income Share For: [fill TEMPNAME]
|JOINT WITH:
[fill ANDSPKIDFIL]
|{display names marked in JTWHO2}
|{star children's names}
Asset Type: STOCKS
|
|
[fill SORRYFIL]
|
Was the annual amount less than 100
|
dollars, between 100 and 500 dollars, |
between 500 and 1,000 dollars, or more |
than 1,000 dollars?
|
|
(1) Less than $100
|
(2) $100 to $499.99
|
(3) $500 to $999.99
|
(4) $1,000 or more
|
|
@
|
Wednesday, August 27, 2003
Page 329 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MEXCLUDE
Earlier I recorded that [fill TEMPNAME] [fill ALSOFIL] owned
[fill SOMEFIL] [fill FNDSTCK1FIL][fill INNAMEFIL]
Are these [fill FNDSTCK1FIL] included in
[fill PTEMPNAME] [fill IRA401FIL]
or [fill DODOES] [fill HESHE] own them separately
from any retirement account -- or both?
H
(1) All shares are included in IRA/Keogh/401k/
thrift accounts
(2) All shares are owned separately from retirement accounts
(3) Both -- some are included in retirement accounts
and some are owned separately
@
Mark One Only
MOWNTYPE
[fill EARLIERFIL]
What kind of dividends [fill DODOES] [fill TEMPNAME] get from these
[fill FNDSTCK1FIL]? [fill C_DODOES] [fill HESHE] get dividend checks, or
are the dividends credited against a margin account or automatically
reinvested?
(1)
(2)
(3)
(4)
Dividend CHECKS
CREDITED or AUTOMATICALLY REINVESTED dividends
Both
Neither; no dividends received
@
Mark One Only
MNODIVOWN
ASK IF NECESSARY:
Just to be sure, these [fill ASNAME2] produced no dividends
of any kind since [fill MONTH1] 1st -- is that correct?
(1) Yes; correct; no dividends received
(2) No; incorrect; DID RECEIVE dividends
@
Mark One Only
MOWNDIV_PD
[fill EARLIERFIL]
[fill INCOMENOWFIL]
What is the easiest way for you to tell me about [fill YOURNAMEFIL]
dividend income from [fill ASNAME2] [fill OWNNAMEFIL]
(Can you give me the total dividends for the last 4 months,
or would it be easier for you to report monthly amounts,
or a quarterly amount, or an annual amount?)
H
(1) 4-month total
(2) Monthly amounts
(3) Quarterly amount
(4) Annual amount
(5) None of these
@
Page 330 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MOWNDIV
[fill ANOTHERFIL]
[fill INCLUDEFIL]
[fill CREDITEDFIL] dividend income [fill ISWASFIL]
[fill PRODUCEDFIL]
by the [fill ASNAME2] [fill HESHE] owned in
[fill HISHER] own name?
H
ENTER (N) FOR NONE OR NO MORE
[fill ENTERLFIL]
$@1
$@2
$@3
$@4
$@5
$@6
Total: $[fill TOTALFIL11]
Multiple Entry
MOWNDIV2
[fill INCLUDEFIL] [fill CREDITEDFIL] dividend income did
[fill TEMPNAME] receive from the [fill NONRETFIL] [fill ASNAME2]
[fill HESHE] owned in [fill HISHER] own name...
H
ENTER (N) FOR NONE OR NO MORE
ENTER (S) FOR SAME AS PREVIOUS AMOUNT
[fill ENTERLFIL]
in [fill MONTH4]?
@41 @42 @43
How about in [fill MONTH3]?
@31 @32 @33
And [fill MONTH2]?
@21 @22 @23
And [fill MONTH1]?
@11 @12 @13
4-Month Total: $[fill OWNADV]
Mark One Only
MBIGAST8
THE AMOUNT ENTERED IS UNUSUALLY LARGE.
(1) BACKUP AND CORRECT
(P) Proceed
@
Wednesday, August 27, 2003
Page 331 of 340
Survey:
Section: Section: Missing
Items Booklet
Mark One Only
MODIV1Q
Asset Type: MUTUAL FUNDS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount[fill SINCEFIL] less than
100 dollars, between 100 and 400 dollars, between 400 and
1,000 dollars, or more than 1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $399.99
$400 to $999.99
$1,000 or more
@
Mark One Only
MODIV1Y
Asset Type: MUTUAL FUNDS
[fill SORRYFIL]
Is the annual amount less than 250 dollars, between 250 and
1,000 dollars, between 1,000 and 2,500 dollars, or more than
2,500 dollars?
(1)
(2)
(3)
(4)
Less than $250
$250 to $999.99
$1,000 to $2499.99
$2,500 or more
@
Mark One Only
MODIV2Q
Asset Type: STOCKS
[fill SORRYFIL]
Was the [fill 4MONQTRFIL] amount [fill SINCEFIL] less than
25 dollars, between 25 and 100 dollars, between 100 and 500 dollars,
or more than 500 dollars?
(1)
(2)
(3)
(4)
Less than $25
$25 to $99.99
$100 to $499.99
$500 or more
@
Mark One Only
MODIV2Y
Asset Type: STOCKS
[fill SORRYFIL]
Is the annual amount less than 100 dollars, between 100 and
500 dollars, between 500 and 1,000 dollars, or more than
1,000 dollars?
(1)
(2)
(3)
(4)
Less than $100
$100 to $499.99
$500 to $999.99
$1,000 or more
@
Page 332 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Missing
Multiple Entry
MPRIMNTH
[fill C_HAVHAS] [fill TEMPNAME] been covered [fill EITHERFIL]
at any time in this month?
H
(1) Yes
(2) No
@5
In which of the last four months -- [fill MONTH1], [fill MONTH2],
[fill MONTH3], and [fill MONTH4] -- [fill WASWERE] [fill HESHE]
[fill ALSOFIL] covered?
ENTER (A) FOR ALL REMAINING MONTHS
ENTER (N) FOR NO MORE
(1) Yes (2)
[fill MONTH1]?
[fill MONTH2]?
[fill MONTH3]?
[fill MONTH4]?
No
@1
@2
@3
@4
Mark One Only
MIAA
IF THE LIST BELOW IS BLANK, YOU HAVE ALREADY BACKED UP AND
ENTERED THE INFORMATION WE NEED. TRANSMIT THE CASE AS IS.
THE INFORMATION BELOW IS STILL MISSING FROM THIS INTERVIEW.
DO YOU WANT TO:
(1) Hold this case for additional callbacks
(2) Transmit the case as is - NO CALLBACKS
[display names and list of missing info, similar to MISITCB, but only
display things still missing at this point.]
@
Wednesday, August 27, 2003
Page 333 of 340
Survey:
Section: Section: Returns
Items Booklet
Mark One Only
RTSELF
I need to continue the interview with [fill NAME(L_NO)].
Is [fill NAME(L_NO)] available now?
(1) Yes
(2) No
@
Mark One Only
RTSELF2
Could you or someone else in the household answer these questions for
[fill NAME(L_NO)]?
(1) Yes, (take proxy interview)
(2) No
(4) TYPE-Z -- not available during entire interviewing period
@
Mark One Only
WHYTYPZ5
[fill NOINCOMPLETEFIL] survey data were collected for
[fill NAMEFIL].
Enter the reason that best describes why
[fill NAMEFIL]'s survey data were [fill NOTCOLLINCOMPFIL].
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@
Mark One Only
WHYSP5
Enter other TYPE-Z reason.
@
Mark One Only
RTPROXY
HOUSEHOLD ROSTER
LINE NAME
ASK IF NECESSARY
Who will be answering for [fill NAME(L_NO)]?
@
Page 334 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Back
Mark One Only
FIN
This case is not completed.
ENTER (X) TO EXIT THE INTERVIEW
@
Mark One Only
LTRADDR
|LINE NAME
ASK IF NECESSARY:
|Display PXYRS3 template
To whom should future correspondence |
be addressed?
|
|
NOTE THAT YOU MAY ONLY SELECT
|
ORIGINAL SAMPLE PEOPLE TO
|
RECEIVE FUTURE CORRESPONDENCE
|
|
@
|
Mark One Only
TELHHD
Since households included in this survey are interviewed
again in 4 months, we may attempt to conduct the followup
interview by telephone.
Is there a telephone in this house/apartment?
(1) Yes
(2) No
@
Mark One Only
TELAVL
Is there a telephone elsewhere on which people in
this household can be contacted?
(1) Yes
(2) No
@
Mark One Only
TELWHR
Where is this phone located?
@
Wednesday, August 27, 2003
Page 335 of 340
Survey:
Section: Section: Back
Items Booklet
Multiple Entry
TELPHN1
What is the telephone number where
you would like to be called?
Area Code: @AR1
Number: @NUM1
EXT: @EXT1 (IF NO EXTENSION, PRESS ENTER)
What type of telephone is it?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Home
Work
Cellular or Digital
Beeper/Pager/Answering Service
Public (Pay phone)
Toll Free
Other (Specify)
@TELTYP1
{pop-up} What was that?
@7
Mark One Only
TELHHD2
Is there a second telephone number where you can be contacted?
(1) Yes
(2) No
@
Multiple Entry
TELPHN2
What is the second telephone number where you would like to
be called?
Area Code: @AR2
New Number: @NUM2
EXT: @EXT2 (IF NO EXTENSION, PRESS ENTER)
What type of telephone is it?
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Home
Work
Cellular or Digital
Beeper/Pager/Answering Service
Public (Pay phone)
Toll Free
Other (Specify)
@TELTYP2
{pop-up} What was that?
@7
Page 336 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Back
Multiple Entry
BSTTI
When is the best time to contact you?
DO NOT READ CATEGORIES
(1) Morning (9am-12 noon)
(2) Noon/lunchtime (11am-1pm)
(3) Afternoon (12 noon-4pm)
(4) Suppertime/early evening/dinnertime(4pm-7pm)
(5) Evening (6pm-9pm)
(6) Anytime (9am-9pm)
(7) Late evening/night (7pm-9pm)
(8) Daytime (9am-4pm)
(9) After 5pm
(10) Other, specify
@1
{pop-up}
ENTER SPECIFIC BEST TIME TO CALL
@2
Mark One Only
PHONEO
Is a telephone interview acceptable?
(1) Yes
(2) No
@
Mark One Only
WHO
DO NOT READ TO RESPONDENT
|LN NAME
|Display HH members ages 15+
ENTER THE LINE NUMBER OF
|
PERSON YOU ARE SPEAKING WITH
|
RIGHT NOW.
|
|
@NOW
|
Multiple Entry
CPRSN1
Is there a close relative or friend who would know |TYPE OF TELEPHONE
how to reach [fill /<[REFPER]>]
|(1) Home
if we are unable to contact [fill //]? |(2) Work
H |(3) Cellular/Digital
(0) NO CONTACT PERSON INFORMATION AVAILABLE
|(4) Beeper/Pager/
| Answering Service
FIRST
MIDDLE
LAST
|(5) Public/Pay Phone
@CFNAME
@CMNAME
@CLNAME
|(6) Toll Free
|(7) Other(Specify)
RELATIONSHIP TO [YOU/[REFPER]>:
@CREL
STREET ADDRESS: @ADR1
STREET ADDRESS: @ADR2
CITY: @PO
STATE: @ST
ZIP CODE: @ZP5 @ZP4
(N) NO TELEPHONE NUMBER AVAILABLE
TELEPHONE NUMBER: @AR @NUM EXT: @EXT TYPE: @TELTYP1
pop-up
Wednesday, August 27, 2003
Page 337 of 340
Survey:
Section: Section: Back
Items Booklet
Multiple Entry
CPRSN2
Is there another person who would know how to reach |TYPE OF TELEPHONE
[fill YOUREPERFIL]?
|(1) Home
|(2) Work
(0) NO 2nd CONTACT PERSON
H |(3) Cellular/Digital
|(4) Beeper/Pager/
FIRST
MIDDLE
LAST
| Answering Service
@CFNAME
@CMNAME
@CLNAME
|(5) Public/Pay Phone
|(6) Toll Free
RELATIONSHIP TO [YOU/[REFPER]:
|(7) Other(Specify)
@CREL
STREET ADDRESS: @ADR1
STREET ADDRESS: @ADR2
CITY: @PO
STATE: @ST
ZIP CODE: @ZP5 @ZP4
(N) NO TELEPHONE NUMBER AVAILABLE
TELEPHONE NUMBER: @AR @NUM
EXT: @EXT TYPE: @TELTYP1
pop-up
Multiple Entry
CPRSN3
Is there a close relative or friend who would know |TYPE OF TELEPHONE
how to reach [fill /<[REFPER]>]
|(1) Home
if we are unable to contact [fill //]? |(2) Work
(0) NO CONTACT PERSON INFORMATION AVAILABLE
|(3) Cellular/Digital
(1) SAME AS HOUSEHOLD CONTACT #1
H |(4) Beeper/Pager/
(2) SAME AS HOUSEHOLD CONTACT #2
| Answering Service
FIRST
MIDDLE
LAST
|(5) Public/Pay Phone
@CFNAME
@CMNAME
@CLNAME
|(6) Toll Free
|(7) Other(Specify)
RELATIONSHIP TO [YOU/[REFPER]>:
@CREL
STREET ADDRESS: @ADR1
STREET ADDRESS: @ADR2
CITY: @PO
STATE: @ST
ZIP CODE: @ZP5 @ZP4
(N) NO TELEPHONE NUMBER AVAILABLE
TELEPHONE NUMBER: @AR @NUM EXT: @EXT TYPE: @TELTYP1
pop-up
Multiple Entry
BCINFO3
ENTER (R) FOR SPECIFIC ITEMS BELOW IF THEY ARE REFUSED
Name of person providing noninterview status:
Firstname: @FN Lastname: @LN
Title of contact person (relative, neighbor, etc.): @CPRELA
Contact person's address:
Street name: @R1
Street name: @R2
City: @PO State: @ST Zip Code: @ZP5 @ZP4
Telephone Number: Area: @AR Number: @NUM Extension: @EXT
Page 338 of 340
Wednesday, August 27, 2003
Items Booklet
Survey:
Section: Section: Back
Mark One Only
TRANS
ARE YOU READY TO TRANSMIT THIS CASE?
(1) Yes
(2) No
@
Mark One Only
NOWTYPEA
DO NOT READ TO RESPONDENT
THIS IS NOW A TYPE A[fill REASONFIL]
PRESS "ENTER" TO CONTINUE
@
Multiple Entry
WHYTYPZ6
No survey data were collected for
[fill NAMEFIL].
Enter the reason that best describes why
[fill HISHER]'s survey data were not collected.
(1)
(2)
(3)
(4)
Person was ill or in the hospital
Person was temporarily away from home
Refused
Other (specify)
@1
{pop-up}SPECIFY: @SP
Mark One Only
CALLBACK
|HOUSEHOLD MEMBERS STILL NEEDING
I'd like to schedule a return
|TO BE INTERVIEWED
visit to finish the interview.
|Display CBLST template
What DATE AND TIME would be best
|
to visit again to
|
[fill CONDUCTFIL]?
|
|
PROBE: May I come back later today? |
TODAY IS: [fill CDATE_C]
|
|
@
|
Mark One Only
THANKCB
Thank you for your help.
I will come back at the time suggested.
REVISIT DATE: [fill CALLBACK]
PRESS "ENTER" TO CONTINUE
@
Wednesday, August 27, 2003
Page 339 of 340
Survey:
Section: Section: Back
Items Booklet
Mark One Only
THANKYOU
Thank you for your cooperation. Since this is a survey
that measures the economic changes of people over time,
we contact respondents periodically for anywhere from
one to four years. I will call on you again in four
months, which will be in [fill TEMP]. Also, my office
may check to see if I have done my job properly.
Therefore, you may receive a call in the next several
weeks checking on my work. Thank you again.
[bold]PRESS "ENTER" TO END INTERVIEW[n]
@
Mark One Only
VISITCNT
DO NOT READ TO RESPONDENT
How many times have you attempted personal contact
(actually visited the address)?
@
Mark One Only
MODECOLL
DO NOT READ TO RESPONDENT
Was the majority of this interview done by
telephone interview, or by personal interview?
(1) Telephone interview
(2) Personal interview
@
Mark One Only
OTHNAME1
DO NOT READ TO RESPONDENT
|LN NAME
|(include HH members)
Identify the person who responded to
|
the majority of this interview.
|
|
ENTER LINE NUMBER
|
|
@
|
Mark One Only
SPAN1
DO NOT READ TO RESPONDENT
Did you conduct any of this household's interview in Spanish?
(1) Yes
(2) No
@
Page 340 of 340
Wednesday, August 27, 2003
| File Type | application/pdf |
| File Title | Items Booklet |
| Author | holbe001 |
| File Modified | 2003-08-27 |
| File Created | 2003-08-27 |