National Telephone Survey (cognitive pretesting)

IMPACT telephone survey instrument
Introductory script
Hello! My name is [name] and I’m calling from the University of Washington. We are conducting an important study about how people use the free computers, websites, databases, Internet connections, and other electronic resources offered by your public library. This information will be used to evaluate and improve library services all over the country. This research is sponsored by the Institute for Museum and Library Services, which is a department of the federal government that provides services to the nation’s museums and libraries. Your number was randomly selected for participation in our survey. You don’t have to answer any questions you don’t want to and your answers are completely anonymous. On average, the survey takes about 10-20 minutes.
PART 1: Qualifying questions
Q1	How many people live in your household?
	[If N=1, GO TO Q2]
	[N>1] Q1.1 May I speak with the person aged 14 or older who had the most recent birthday?
		[If NO] Q1.1.1 Do you know when a good time would be to call back?
		[If YES, READ introductory script and GO TO Q2]
Q2	May I take a few minutes to ask you some questions?
		[If NO] Q2.1 May I call you later at a more convenient time?
			[If YES] Q2.1.1 What time would be more convenient?
				[Record day and time for follow-up]
			[If NO] Thank you for your time.
				[End call]
		[If YES, Go to Q3]
Q3	What year were you born?
		[If 14 years or older, GO TO Q4]
		[If younger than 14 years] Q3.1 Is your mom or dad available to talk to, or maybe an older brother or sister?
			[If YES] Q3.1.1 May I please speak to him (or her)?
				[If YES, Go to Q1]
				[If NO] Q3.1.1.1 May I call you later at a more convenient time?
					[If YES] Q3.1.1.1.1 What time would be more convenient?
						[Record day and time for follow-up]
					[If NO] Thank you for your time.
						[End call]
Q4	Have you visited a public library or bookmobile in the past 12 months?
		[If YES] Q4.1 How Often?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
		[If NO, GO TO Q8]
Q5	In the past year, have you used a computer in the public library to access library resources, such as looking up books or placing holds, or to use online resources available through the library’s website like digital articles or books?
		[If YES] Q5.1 How often?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
Q6	Have you used a computer in the public library to access the Internet in the last 12 months?
		[If YES, qualify USER] Q6.1 How Often?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
Q7	In the past 12 months, have you connected to the Internet using a public library wireless network?
		[If YES, qualify USER] Q7.1 How often?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
Q8	In the past 12 months, have you used the Internet from outside of the library to access library resources through the library’s website, such as looking up books or placing holds, or to use online resources like digital articles or books?
		[If YES] Q8.1 How Often?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
Q9	Have you used a handheld mobile device like a cell phone, Blackberry, or iPhone to access library resources?
Q10	Do you currently have regular access to a computer and the Internet for your personal use somewhere other than the public library?
		[If YES] Q10.1 Is that access at:
			home school work a community center someplace else _________________________
Q11	[If NO on Q5-Q6 (NONUSER)] Even though you don’t use the library to connect to the Internet, how important is it to you that others in your community have access to these resources?
		Very important Important Moderately important Of little importance Unimportant
[If qualified USER, GO TO Part 2]
[If NO on Q6 AND Q7, GO TO Z1]
PART 2: General use questions
[Before beginning the next part of the survey, inform the participant of the following:]
Great. Since you use public library computers or Internet connections, we have some additional questions we would like to ask you. The remaining questions will take on average 15 minutes to complete. We very much appreciate you taking the time to help us with this important study. May I continue? [If Yes] I’m going to start by asking you some general questions about how you use the computers and Internet connections in the public library. All of these questions are about what you’ve done in the past 12 months from today. Okay? [If No] Is there a more convenient time I could call you back to complete the survey? [If YES] What time would be more convenient? [Record day and time for follow-up] [If NO] Thank you for your time. [End call]
U1	In the past year, have you used a public library computer or Internet connection while traveling?
U2	Have you participated in any computer-related training or classes , like how to use computer software or search the Internet, at your public library?
U3	Have library staff or volunteers helped you use a computer at the public library?
		[If YES] U3.1 What type of help did you get? [open ended]
			Help using the computer equipment Help finding a specific website Help finding information on the computer Help using word processing or spreadsheet programs like Word or Excel Help with printing or saving files (using other internal library resources) Other __________________
U4	Have you used a public library computer or Internet connection to help someone else in the past 12 months?
		[If YES] U4.1 What is your relationship to this/these people? [open-ended]
			Family member (parent/child/spouse) Friend Work related (boss/co-worker) Stranger (being good Samaritan)
		[If YES] U4.2 How frequently do you use a public library computer or Internet connection on behalf of other people?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
U5	[If Q1>1 AND over 18 years old] Do you have any children under 18 years old in your household?
		[If YES, qualify PARENT] U5.1 Can you give me their ages?
			U5.2 Have/has your child(ren) use the public library’s free Internet computers in the past year?
				[If YES] U5.1.1 Have you allowed your child(ren) to use the library computers when you are not at the library with them?
U6	[If 14-18 years old] In the past year, have you used the computers at the library without your parents or a guardian being with you?
U7	In the past year, have you used a public library computer or Internet connection to check or send email?
		[If YES] U7.1 How often?
			Every day or most days At least once a week About 1-3 times a month Less than once a month, but more than once a year About once a year or less often
[Go to PART 3]
PART 3: Domain specific questions
[Before beginning the next part of the survey, inform the participant of the following:]
“Now I’m going to ask you some questions about more specific ways you might use the library’s computers and Internet connections. Remember, these questions are only about things you’ve done with library computers or Internet connections in the past 12 months.”
[The following sections should be asked in random order. When all sections have been completed, ask the Demographic questions.]
EMPLOYMENT indicator questions
[If YES on U4]
M1.1	Have you used a public library computer or Internet connection for yourself or someone else for employment or career purposes, such as looking for work, writing a resume, or job-training in the past year?
		[If NO] M1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] M1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use… [GO TO M2]
				[If for someone else only, GO TO next domain]
[If NO on U4]
M1.2	Have you used a public library computer or Internet connection for employment or career purposes, such as looking for work, writing a resume, or job-training in the past year?
		[If NO] M1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES, GO TO M2]
Did you use the public library computer or Internet connection in the last 12 months to…
M2	search for a job opening or career opportunity?
		[If YES] M2.1 Did you fill out a job application or send a résumé using the library computers or Internet connection?
		[If YES] M2.2 Did you get a job interview?
			Yes No Not yet/still waiting to find out
			[If YES] M2.2.1 Did you get hired?
				Yes No Not yet/still waiting to find out
M3	create a resume?
M4	receive training to build skills related to your job or profession?
		[If YES] M4.1 What type of training did you receive? [open-ended]
M5	do research or find information related to your job or profession?
		[If YES] M5.1 What type of information did you find? [open-ended]
eCOMMERCE indicator questions
[If YES on U4]
C1.1	In the past 12 months, have you used a public library computer or Internet connection for yourself or someone else for commercial needs or to manage your finances, such as banking, buying or selling something, or paying bills?
		[If NO] C1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] C1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use… [GO TO M2]
				[If for someone else only, GO TO next domain]
[If NO on U4]
C1.2	In the past 12 months, have you used a public library computer or Internet connection for commercial needs or to manage your finances, such as banking, buying or selling something, or paying bills?
		[If NO] C1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES GO TO C2]
Did you use the public library computer or Internet connection in the last 12 months to…
C2	do on-line banking?
C3	pay bills?
C4	gather information about or compare products or services?
		[If YES] C4.1 Did this help you make a decision about whether to purchase something?
C5	purchase something online?
C6	attempt to sell anything online?
		[If YES] C6.1 Did you sell the item(s)?
C7	look up your credit rating?
C8	learn about getting out of debt?
		[If YES] C8.1 Did this help you reduce or better manage your debt?
C9	learn about a new loan or refinancing or consolidating an old loan?
		[If YES] C9.1 Did this help you get a new loan or restructure an old one?
C10	look-up or monitor investment information?
eBUSINESS indicator questions
[If YES on U4]
B1.1	Have you used a public library computer or Internet connection for yourself or someone else to start or manage a business in the past year?
		[If NO] B1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] B1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use… [GO TO B2]
				[If for someone else only, GO TO next domain]
[If NO on U4]
B1.2	Have you used a public library computer or Internet connection for yourself or someone else to start or manage a business in the past year?
		[If NO] B1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES, GO TO B2]
Did you use the public library computer or Internet connection in the last 12 months to…
B2	learn about starting your own business?
		[If YES] B2.1 Did you start a business?
B3	learn how to write a business plan?
		[If YES] B3.1 Did you write a business plan?
B4	find financial support for your business from a bank or venture capital firm?
B5	get information about a business license or permit?
		[If YES] B5.1 Did you get the license or permit?
B6	locate potential customers?
		B6.1 Did business sales increase?
B7	learn about government contract opportunities?
		[If YES] B7.1 Did you apply for a government contract?
			[If YES] B7.1.1 Did you receive a government contract?
HEALTH indicator questions
[If YES on U4]
H1.1	In the past 12 months, have you used a public library computer or Internet connection for yourself or someone else for health or wellness needs?
		[If NO] H1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] H1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use… [GO TO H2]
				[If for someone else only, GO TO next domain]
[If NO on U4]
H1.2	In the past 12 months, have you used a public library computer or Internet connection for health or wellness needs?
		[If NO] H1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES, GO TO H2]
Did you use the public library computer or Internet connection in the past 12 months to…
H2	learn about an illness, disease, or a medical condition?
H3	learn about a surgical procedure?
		[If YES] H3.1 Did this help you decide whether to have the surgery?
H4	learn about prescription or over-the-counter drugs?
		[If YES] H4.1 Did this help you decide whether to use a prescription or over-the-counter drug?
		[If YES] H4.2 Did you use a public library computer or Internet connection to purchase prescription or over-the-counter drugs online?
H5	learn about diet or nutrition?
		[If YES] H5.1 Did this help you decide whether to make changes to your diet?
H6	learn about exercise or fitness?
		[If YES] H6.1 Did this help you decide whether to make changes in your exercise habits?
H7	learn about online or face-to-face support groups for a health need?
		[If YES] H7.1 Did you become part of a support group?
H8	find information about a doctor or health care provider?
		[If YES] H8.1 Did you make an appointment?
			[If YES] H8.1.1 Did you receive the care you needed?
H9	find information about health insurance or a drug discount program?
		[If YES] H9.1 Did this help you decide whether to purchase insurance or enroll in a drug discount program?
SOCIAL INCLUSION/ENTERTAINMENT indicator questions
[If YES on U4]
S1.1	Have you used a public library computer or Internet connection for yourself or someone else for social or entertainment purposes in the last year? For example, chatting or messaging, playing games, pursuing hobbies, or surfing the Internet.
		[If NO] S1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] S1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use… [GO TO S2]
				[If for someone else only, GO TO next domain]
[If NO on U4]
S1.2	Have you used a public library computer or Internet connection for social or entertainment purposes in the last year? For example, chatting or messaging, playing games, pursuing hobbies, or surfing the Internet.
		[If NO] S1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES, GO TO S2]
Did you use the public library computer or Internet connection in the past 12 months to…
S2	communicate with friends or family?
		[If YES] S2.1 Do any of them live in your local community?
		[If YES] S2.2 Do any of them live outside of the United States?
		[If YES] S2.3 Do you communicate with them in languages other than English?
			[If YES] S2.3.1 What are those languages?
S3	visit a social networking site, such as MySpace or FaceBook?
S4	maintain a personal website?
S5	explore your family genealogy?
S6	There are many social or entertainment websites such as blogs, online games, YouTube, and Podcasts. In the past year, have visited one of these sites using a library computer or Internet connection to:
		S6.1 meet new friends?
		S6.2 keep in touch with friends?
		S6.3 get in touch with people you have lost contact with?
		S6.4 do something online with your children, family, or friends?
		S6.5 learn new skills?
		S6.6 pursue a hobby?
		S6.7 organize an event?
		S6.8 find support for a personal or family issue?
eGOVERNMENT indicator questions
[If YES on U4]
G1.1	In the past 12 months, have you used a public library computer or Internet connection for yourself or someone else for getting government or legal information or accessing government services? For example, contacting your representative, getting a license, filing taxes, or learning about regulations.
		[If NO] G1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[Go to next domain]
		[If YES] G1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use… [GO TO G2]
				[If for someone else only, GO TO next domain]
G1.2	In the past 12 months, have you used a public library computer or website for getting government or legal information or accessing government services? For example, contacting your representative, getting a license, filing taxes, or learning about regulations.
		[If NO] G1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
		[If YES, GO TO G2]
Did you use the public library computer or Internet connection in the past 12 months to…
G2	contact a government official or agency?
		[If YES] G2.1 Were you able to contact someone?
G3	get government forms?
		[If YES] G3.1 Did you find the forms you needed?
			[If YES] G3.1.1 Did you submit these forms online?
G4	learn about local, state, or Federal laws or regulations?
		[If YES] G4.1 Did you find the legal or regulatory information you needed?
G5	learn about permits or licenses?
		[If YES] G5.1 Did you find the information you needed?
		[If YES] G5.2 Did you apply for a permit or license online?
G6	look for advice or assistance with a legal question or problem?
		[If YES] G6.1 Did you find the help you needed?
G7	learn about other government programs or services?
		[If YES] G7.1 What kinds of programs or services did you learn about? [open-ended]
		[If YES] G7.2 Did you use the library computers to apply for a program or service?
CIVIC ENGAGEMENT indicator questions
[If YES on U4]
V1.1	Have you used a public library computer or Internet connection for yourself or someone else to learn about political or social causes or to participate in community life in the past year?
		[If NO] V1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] V1.1.2 Was it for yourself, someone else, or both?
			Self only Someone else only Both
				[If for self or both] Now thinking about just your own use…[Go to V2]
				[If for someone else only, GO TO next domain]
[If NO on U4]
V1.2	Have you used a public library computer or Internet connection to learn about political or social causes or to participate in community life in the past year?
		[If NO] V1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES, GO TO V2]
Did you use the public library computer or Internet connection in the past 12 months to…
V2	keep up with current events through a news website?
V3	learn about a political activity, social cause, or political candidate?
		[If YES] V3.1 Did this help you decide whether to support the cause or candidate?
V4	make a donation to a political candidate or cause?
V5	learn about starting a club or non-profit association?
		[If YES] V5.1 Did you actually start a club non-profit association?
V6	organize or manage activities of a club, civic group, community group, church, or non-profit association?
		[If YES] Did you use a public library computer or website to…
			V6.1 interact with others about schedules or meetings for your group?
			V6.2 promote activities or attract new members for your group?
			V6.3 look for grants or other types of funding for your group?
				[If YES] V6.3.1 Did you apply for a grant or other funding?
					[If YES] V6.3.1.1 Did you receive the funding?
EDUCATION indicator questions
[If YES on U4]
D1.1	In the past 12 months, have you used a public library computer or Internet connection for yourself or someone else for education or learning, such as getting homework help, taking a class, or applying for school?
		[If NO] D1.1.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
				[GO TO next domain]
		[If YES] D1.1.2 Was it for yourself, someone else, or both?
			[If for self or both] Now thinking about just your own use…
				[If YES and user is between the ages of 14 and 18, GO TO question DY1]1
				[If YES and user is a PARENT, GO TO DP1]
				[If YES and user is 18 years old or older but not parent, GO TO DA2]
			[If for someone else only, GO TO next domain]
[If NO on U4]
D1.2	In the past 12 months, have you used a public library computer or Internet connection for education or learning, such as getting homework help, taking a class, or applying for school?
		[If NO] D1.2.1 Was there a specific reason you didn’t use the public library for these purposes? [open-ended]
			security privacy lack of equipment limited help didn’t think of it didn’t have need library policies other _________________
		[If YES and user is between the ages of 14 and 18, GO TO question DY1]2
		[If YES and user is a PARENT, GO TO DP1]
		[If YES and user is 18 years old or older, GO TO DA2]
Questions for youth
Did you use the library computer or Internet connection in the last 12 months to…
DY1	do homework for a class you were taking?
DY2	do an on-line assignment or take an on-line course?
DY3	learn about admissions or financial aid for college or a career, technical, or trade school?
		[If YES] DY3.1 What kind of school?
			Career, technical, or trade 2-year school/community college 4-year school
DY4	apply for college or a career, technical, or trade school?
DY5	apply for financial aid?
[GO TO next domain]
Questions for parents
DP1	Do you have any children under the age of 5?
		[If YES] DP1.1 Have you used a library website to find daycare for your child(ren)
			[If YES] DP1.1.1 Were you able to arrange daycare?
DP2	Do you have any children in elementary, junior high or middle school, or high school?
		[If YES, GO TO DP4]
		[If NO, GO TO DP3]
DP3	Do you homeschool your child(ren)?
		[If YES, GO TO DP5]
		[If NO, GO TO DA1]
In the past 12 months, did you use the library computer or Internet connection to…
DP4	communicate with your child’s teachers or other people at your child’s school?
DP5	assist your child with their homework or a school project?
DP6	do an on-line assignment with your child?
DP7	learn about options for college or a career, technical, or trade school for your child(ren)?
		[If YES] DP7.1 What kind of school?
			Career, technical, or trade school 2-year school/community college 4-year school
DP8	learn about admissions or financial aid for private school, college, or a career, technical, or trade school for your child(ren)?
Now I’m going to ask you about your use of the library computers or Internet connection for your own educational needs.
	[GO TO DA1]
Questions for adults
In the past 12 months, did you use the library computer or Internet connection to…
DA1	learn about a degree or certificate program?
		[If YES] DA1.1 What type of program did you learn about?
			GED program Professional license or certificate Two-year degree Four-year degree Graduate degree
DA2	apply for a certificate or degree program?
		[If YES] DA2.1 What type of program was it?
			GED program Professional license or certificate Two-year degree Four-year degree Graduate degree
			[If YES] DA2.1.1 Were you admitted to the program?
DA3	apply for financial aid?
DA4	do an on-line tutorial?
DA5	take a class or workshop on-line
DA6	complete course work for a class you were taking?
DA7	communicate with your instructors or other people at your school about class assignments or projects?
PART 4: Open-ended section
E1	In the past year, have you used a library computer or Internet connection for any other purposes than the ones we have asked you about? (open-ended)
E2	How important are the library’s computers and Internet connection to you, personally?
		Very important Important Moderately important Of little importance Unimportant
E3	How important is it to you that others in your community have access to library’s computers and Internet connection?
		Very important Important Moderately important Of little importance Unimportant
E4	How satisfied are you with your access to computers and the Internet at the public library?
		Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied
E5	Do you have any suggestions for how the computers or Internet connection at the public library could be changed or improved? (open-ended)
		More terminals Longer session times Faster connections Other: ______________________
[Before beginning the next part of the survey, inform the participant of the following:]
“We’re just about done. I just have a few questions about you that will really help us with our research.“
PART 5: Demographic section
Z1	What is your zip code?
		[If DON’T KNOW] What city and state are you in right now?
Z2	Do you live in:
		a one-family house an apartment building mobile home boat, RV, van, etc. currently homeless
		[If 1-4, GO TO Z3; If 5 (HOMELESS), GO TO Z9]
Z3	Is your home:
		Owned by you or someone in your household? Rented? Occupied without payment of rent?
Z4	How many family members are living or staying in your household? Only include married spouses, children by birth or adoption, and blood relatives.
Z5	Do you speak a language other than English at home?
		[If YES] Z5.1 What languages do you speak at home? (open-ended)
Z6	Next I have a few questions about the number I dialed to reach you. Is the number [INSERT PHONE NUMBER FROM SAMPLE] a cell phone?
		[If YES] Z6.1 Do any other members of your household currently have a working cell phone?
			[If YES] Z6.1.1 Including yourself, how many people in your household have a cell phone?
		[If NO] Z6.2 Do you or any member or your household currently have a working cell phone?
			[If YES] Z6.2.1 Including yourself, how many people in your household have a cell phone?
Z7	I would like to ask about any regular, landline telephone numbers in your household, that is, all your phone numbers other than cell phone numbers. How many different landline telephone numbers does your household have?
		[If >=1] Z8.1 Excluding any landline numbers used exclusively for fax machines, security systems, the Internet, or a professional business, how many of these [INSERT RESPONSE FROM Z9] landline telephone numbers are used for incoming calls?
Z10	Thinking about all the different sources of income your family received in 2008, what was the combined total income from all sources before taxes and other deductions? Was it under [Insert AMT3 for family size] or was it [Insert AMT3 for family size] or more? [PROBE] Your best estimate is fine.
		[If UNDER] Z10.1 Was your household income below [Insert AMT1]?
		[If OVER] Z10.2 Was your household income above [Insert AMT5]?
Z11	In the last 2 weeks, did you work for pay at a job or business?
		[If YES] Z11.1 Are you working full-time, part-time, or temporary?
		[If YES] Z11.2 Are you:
			an employee of a PRIVATE FOR PROFIT company or business, or of an individual, for wages, salary, or commission? an employee of a PRIVATE NOT FOR PROFIT tax-exempt, or charitable organization? an employee of a GOVERNMENT agency? SELF-EMPLOYED in your business, professional practice, or farm? Working WITHOUT PAY in a family business or farm?
		[If YES] Z11.3 What kind of work are you doing? (Open-ended)
		[If NO] Z11.4 Are you a full-time homemaker?
		[If NO] Z11.5 Are you retired?
		[If NO] Z11.6 Do you have a disability that prevents you from working?
Z12	Are you looking for work?
Z13	What is the highest level of formal education you have completed?
		Grade school Some high school High school or GED Some college 2 year degree or career, technical, or trade school 4 year degree Post graduate study
Z14	At any time in the last 3 months, have you attended school or college?
Z15	Are you of Hispanic, Latino, or Spanish origin?
Z16	What is your race? You can choose more than one.
		American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
Z17	Were you born in the United States?
		[If NO] Z17.1 When did you move here? [YEAR]
		[If NO] Z17.2 Are you a U.S. citizen?
			[If YES] Z16.2.1 How did you become a U.S. citizen?
				Naturalized Through you or your spouse’s military service Adopted or born of U.S. citizen parents
Z18	What is your gender?
		Male Female
Z19	“Those are all the questions I have for you. Thank you very much for participating. If you have any further questions about the study, you may visit our website or contact Dr. Karen Fisher or the University of Washington. Would you like that information now? [If YES] “Our website is impact.ischool.washington.edu. You can reach Dr. Fisher at 206-543-6238 and if you have questions about your rights as a participant in this study or about the Human Subjects review process for this study, you may contact the University of Washington Human Subjects Division at 206-543-0098.”
Thank you for your time. Goodbye.
[Terminate call]

	2008 Poverty Guidelines,* rounded up to nearest thousand
	100%	150%	200%	250%	300%
FAMSIZE	AMT1	AMT2	AMT3	AMT4	AMT5
1	11000	16000	21000	26000	32000
2	14000	21000	28000	35000	42000
3	18000	27000	36000	44000	53000
4	22000	32000	43000	53000	64000
5	25000	38000	50000	62000	75000
6	29000	43000	57000	71000	86000
7	32000	48000	64000	80000	96000
8	36000	54000	72000	89000	107000

*From US. Health & Human Services Computations for the 2008 Annual Update of the HHS Poverty Guidelines for the 48 Contiguous States and the District of Columbia. Available at: http://aspe.hhs.gov/poverty/08computations.shtml#fd

1 Although some youth may also be parents, it is unlikely that they will have school-age children

2 Although some youth may also be parents, it is unlikely that they will have school-age children

Revised February 19, 2009 IMPACT telephone survey instrument|20