National Beneficiary Survey -- National Beneficiary Sample

Ticket to Work Program Evaluation Survey (National Beneficiary Survey)

National Beneficiary Survey (parts used for ticket participant sample as well)

National Beneficiary Survey -- National Beneficiary Sample

OMB: 0960-0666

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NATIONAL BENEFICIARY SURVEY

FINAL ROUND 4 Questionnaire

NATIONAL BENEFICIARY SURVEY

- TABLE OF CONTENTS -

Section Page

Screener A-1
Disability and Current Work Status B-1
Current Employment C-1
Jobs/Other Jobs During 2009 D-1
Awareness of SSA Work Incentive Programs and Ticket to Work E-1
Ticket Non-Participants in 2009 F-1
Employment-Related Services and Supports Used in 2009 G-1
Ticket Participants in 2009 H-1
Health and Functional Status I-1
Health Insurance J-1
Income and Other Assistance K-1
Sociodemographic Information L-1
Closing Information and Observations M-1

OMB NO. 0960-0666

SECTION A: SCREENER

PRELOADED INFORMATION

S1 (A01_a) CLUSTERED SAMPLE

YES = 01

NO = 02 (00, if you prefer) FYI: ONLY NON CLUSTERED = OUTCOMES ONLY PARTICIPANTS

S2 (A01_b) SAMPLE GROUP

S2 = 01 – Any first time completers (Round 3 beneficiaries, Round 1 longitudinal not responding to any prior rounds, Round 2 longitudinal not responding to prior round)

S2 = 02 – Longitudinal who completed the prior round (Round 1 Longitudinal Participants who responded to Round 1 and Round 2, Round 2 Longitudinal who responded to Round 2, and Round 1 Longitudinal who responded to Round 2 but not Round 1)

S2 = 04 – Round 1 longitudinal who completed Round 1, but not Round 2.

S3 (A01_c) REGION – VALUES = 01 – 08, where Region 8 = unclustered sample, that is where S1 = 02

S4 (A01_d) PSU – VALUES = 01010 – 55018; PSU=0 is unclustered sample, aka Region 8

S5 (A01_e) SDATE (DATE SAMPLE PULLED – believed to be June 30, 2005)

S6 (A02) ROUND OF DATA COLLECTION

Round 1 = 01

Round 2 = 02

Round 3 = 03 (This is Round 3)

Round 4 = 04

S7 (A03) PHASE - VALUES = 1, 2, 3 ( based on state of residence at time of sample selection – Frank/Nuria to set this value)

S8 (A04_a) FULLNAME (original – may be updated in another block: Current Full Name)

S9 (A04_b) FIRST NAME (original – may be updated in another block: Current First Name)

S10 (A04_c) LASTNAME (original – may be updated in another block: Current Last Name)

S11 (A04_d) BIRTHDATE (original – may be updated in another block: Current Birth Date)

S11a CURRENT AGE: IF A71 = 02 OR 03, USE A68 OR A69 TO CALCULATE CURRENT AGE

S12 (A04_e) GENDER

S13 (A04_f) BSTATUS (Benefit Type)

BSTATUS = 01 – SSI ONLY BENEFITS

BSTATUS = 02 – SSDI ONLY BENEFITS

BSTATUS = 03 – CONCURRENT (BOTH SSI AND SSDI) BENEFITS

S14 (A04_g) SSIAGE (from SSI records –age first received SSI benefits)

S15 (A04_h) TSTATUS (TICKET STATUS AS OF DATE SAMPLE PULLED)

TSTATUS = 01 PARTICIPANT

TSTATUS = 02 NONPARTICIPANT

S16 (A04_I) LOCALPAA (LOCAL PROTECTION & ADVOCACY GROUPS) (based on state of residence at (A67a)

S17 (A04_j) ENSAMPLE (EN TICKET ASSIGNED TO AT TIME SAMPLE DRAWN)

S18 (A04_k) STATE MED (STATE NAME FOR MEDICAID) (based on state of residence at A67a)

S19 (A04_l) VRNAME (STATE NAME FOR VRA) (based on state of residence at A67a)

S20 (A04_m) Sample Member’s Address at time sample was drawn (may be updated in Section A)

S21 (A04_n) Sample Member’s Phone Number at time sample was drawn

S22 PROXY – FULL NAME

S23 PROXY – PHONE NUMBER

S24 PROXY – ADDRESS 1, ADDRESS 2, CITY, STATE, ZIP

S25 INTERPRETER NAME – RETAIN SAMPLE MEMBER PHONE NUMBER ASSOCIATED WITH INTERPETER.

FIXE2 The spec is BSTATUS=01,03 and E3=missing in R1 then FIXE2=01

FIXE11 The spec is AGE<25 and SSIAGE<=22 and E12=missing in R1 the FIXE11=01

FIXE14 The spec is BSTATUS=02,03 and E15=missing in R1 then FIXE14=01

FIXE23 The spec is TSTATUS=01 and E21=00,d,r and E22=00,d,r and E24=missing in R1 then FIXE23=01

RTYPE: Set at A110 or A110a.

PROGRAMMER: INSTITUTE A PARALLEL BLOCK THAT ALLOWS THE INTERVIEWER TO SWITCH RESPONDENT FROM SAMPLE MEMBER TO PROXY OR FROM PROXY TO SAMPLE MEMBER AT ANY POINT IN THE INTERVIEW. UPDATE RTYPE BASED ON THE PARALLEL BLOCK.

PROGRAMMER: A CURRENT CONTACT BLOCK WILL STORE ANY UPDATES TO S8, S9, S10, S11, S20, and S21. UPDATES TO THE OTHER CURRENT CONTACT BLOCK CAN COME FROM THE SCREENER OR LOCATING.

PROGRAMMER: STORE UPDATED NAME, ADDRESS, AGE, PROXY, ETC INFORMATION IN ADDRESS UPDATE BLOCK OR NAME UPDATE BLOCK.

(All)

A0. CALL SCREEN. PROGRAMMER, DISPLAY: INTERVIEWER: YOU ARE CALLING…(ONE ONLY) NOTE: 01, 04, 07 THROUGH 15 ARE SET IN OVERNIGHT PROCESSING. 02, 03, 05 AND 06 WOULD BE IN THE FRONT END FOR THE INTERVIEWER TO SELECT.

SITUATION	DISPLAY, CALLING FOR	GO TO
01 NEW SCREENER FOR NAME	CALL TO {NAME}	A1
02 CATI CALL-IN	{NAME} CALLING IN	A11
03 CAPI INTERVIEW	{NAME – CAPI}	A64
04 CALL NAME AFTER REMAIL	{NAME , AFTER REMAIL}	A1
05 RELAY CALL IN	{NAME} CALLING IN – RELAY	A11
06 TTY CALL IN	{NAME} CALLING IN – TTY	A11
07 CALL NAME USING RELAY	{NAME} – RELAY	A10
08 CALL NAME USING TTY	{NAME} – TTY	A10
09 CALL NAME USING AMPLIFIER	{NAME} – AMPLIFIER	A1
10 CALL TO IDENTIFIED PROXY	PROXY NAME	A56
11 CALLBACK TO PROXY AFTER REMAIL	PROXY NAME	A56
12 INFORMANT/PROXY CALL IN		A11
13 CALL TO NEW PROXY	PROXY NAME	A56
14 CALL INTERPRETER	INTERPRETER NAME	A8
15 CALL TO NEW / UNNAMED INTERPRETER	INTERPRETER NAME	A4b

CALL TO RESPONDENT

(A0 = 01, 04, OR 09)

A1. Hello, my name is _________, calling on behalf of the Social Security Administration. May I please speak with {NAME}?

INTERVIEWER: We are not selling anything or asking for a contribution.

SPEAKING 01 (A10)

WANTS MORE INFORMATION 02

{NAME} COMES TO PHONE 03 (A10)

CALL BACK LATER 04 SET A100 = 01 (A100)

{NAME} MOVED 05 (A30)

POSSIBLE PARTICIPATION PROBLEM 06 (A13)

HOSPITALIZED 07 (A27a)

{NAME} DECEASED 08 (A103a)

{NAME} INCARCERATED 09 SET A103 = 01(A103)

LANGUAGE BARRIER (NOT SPANISH) 10 (A3)

INSTITUTIONALIZED 11 (A27a)

MILITARY DUTY 12 SET A103 = 02 (A103)

SWITCH TO AMPLIFIER / CONTINUE 13 (A10)

NO SUCH PERSON AT THIS NUMBER 14 SET A102 = 01 (A102)

OTHER: SUPERVISOR REVIEW NEEDED 15 SET A106 = 05 (A106)

HUNG UP DURING INTRODUCTION 16 SET STATUS = 640 (END)

UNAVAILABLE DURING FIELD PERIOD 17 SET A104 = 06 (A104)

LIVING OUTSIDE USA 18 SET A103 = 03 (A103)

REFUSED r SET A105 = 02 (A105)

REQUESTS INFORMATION

(A1=02)

A2. Social Security recently sent {NAME} a letter saying that we would be calling to ask {him/her} to participate in an important national health study we are conducting for them. I work for Mathematica Policy Research, a nationally recognized research company based in Princeton, New Jersey. We are conducting a scientific study. We are not selling anything or asking for contributions.

NAME SPEAKING 01 (A10)

{NAME} COMES TO PHONE 03 (A10)

CALL BACK LATER 04 SET A100 = 01 (A100)

{NAME} MOVED 05 (A30)

POSSIBLE PARTICIPATION PROBLEM 06 (A13)

HOSPITALIZED 07 (A27a)

{NAME} DECEASED 08 (A103a)

{NAME} INCARCERATED 09 SET A103 = 01 (A103)

LANGUAGE BARRIER (NOT SPANISH) 10

INSTITUTIONALIZED 11 (A27a)

MILITARY DUTY 12 SET A103 = 02 (A103)

SWITCH TO AMPLIFIER / CONTINUE 13 (A10)

NO SUCH PERSON AT THIS NUMBER 14 SET A102 = 01 (A102)

OTHER: SUPERVISOR REVIEW NEEDED 15 SET A106 = 05 (A106)

HUNG UP DURING INTRODUCTION 16 SET STATUS = 640 (END)

UNAVAILABLE DURING FIELD PERIOD 17 SET A104 = 06 (A104)

LIVING OUTSIDE USA 18 SET A103 = 03 (A103)

DID NOT RECEIVE LETTER 19 A22

REFUSED r SET A105 = 02 (A105)

LANGUAGE BARRIER

(A1 = 10) OR (A2 = 10)

A3. Can someone there speak English?

PERSON COMES TO PHONE 01

CALL BACK LATER 02 SET A100 = 09 (A100)

NO ONE SPEAKS ENGLISH 03 SET A106 = 01 (A106)

REFUSED/HUNG UP r SET A106 = 01 (A106)

POSSIBLE INTERPRETER COMES TO PHONE

(A3 = 01)

A4. Hello, my name is _____________, calling on behalf of the Social Security Administration. Social Security recently sent {NAME} a letter saying {he/she} was selected to participate in an important health survey we are conducting for them. It is called the National Beneficiary Survey. We are looking for someone who is 18 years or older to help {him/her} by interpreting the interview for us. Are you 18 years of age or older?

YES 01 (A4b)

NO 00

REFUSED/HUNG UP r SET A106 = 01 (A106)

(A4 = 00)

A4a. Is there someone else who is 18 years or older who could come to the phone and help with the interview?

YES, PERSON COMES TO PHONE 01

CALL BACK LATER 02 (A6)

NO ONE SPEAKS ENGLISH 03 SET A106 = 01 (A106)

REFUSED/HUNG UP r SET A106 = 01 (A106)

(A0 = 15) OR (A4 = 01) OR (A4a = 01)

A4b. IF (A0=15) or (A4a=01) FILL {Hello, my name is _____________, calling on behalf of the Social Security Administration. Social Security recently sent {NAME} a letter saying {he/she} was selected to participate in an important health survey we are conducting for them. It is called the National Beneficiary Survey. We are looking for an interpreter who is 18 years or older to help {him/her} with the interview.} Would you be able to help {NAME} by interpreting the interview?

PROBE: We are not selling anything or asking for contributions.

YES 01

CALL BACK LATER 02 (A6)

NO ONE +18 SPEAKS ENGLISH 03 SET A106 = 01 (A106)

{NAME} MOVED 04 (A30)

POSSIBLE PARTICIPATION PROBLEM 05 (A13)

HOSPITALIZED 06 (A27a)

{NAME} DECEASED 07 (A103a)

{NAME} INCARCERATED 08 SET A103 = 01 (A103)

INSTITUTIONALIZED 09 (A27a)

MILITARY DUTY 10 SET A103 = 02 (A103)

NO SUCH PERSON AT THIS NUMBER 11 SET A102 = 01 (A102)

OTHER: SUPERVISOR REVIEW NEEDED 12 SET A106 = 05 (A106)

UNAVAILABLE DURING FIELD PERIOD 13 SET A104 = 06 (A104)

LIVING OUTSIDE USA 14 SET A103 = 03 (A103)

REQUESTS IN-PERSON INTERVIEW 15 (A39)

REFUSED r SET A105 = 02 (A105)

(A4b = 01)

A5. If {NAME} is available and you are ready to interpret, we can begin now. If you or {NAME} get tired or need a break at any time, please tell me and we will call back later to finish the interview.

CONTINUE 01

CALL BACK LATER 02

INTERPRETER REFUSED r SET A105 = 02 (A105)

(A4a = 02) OR (A4b = 02) OR (A5 = 01 OR 02)

A6. {IF A5 = 01 DISPLAY Before we begin, please tell me your name.}

{IF A4a = 02 DISPLAY Please tell me that person’s name so we can ask for them when we call back later /
IF A5 = 02 OR A4b = 02 DISPLAY: Please tell me your name so we can ask for you when we call back later}.

PROBE: IF PERSON IS RELUCTANT TO GIVE NAME, SAY: The first name is all we need.

IF NAME IS REFUSED, CODE AS REFUSED AND CONTINUE

FIRST, MIDDLE, LAST

DON’T KNOW d

REFUSED r

PROGRAMMER: STORE INTERPRETER NAME IN S25 AND LOCATOR

(A6 = ANSWER OR r)

A7. And, what is {IF A5 = 01 OR 2) OR (A4b = 02) FILL your / IF A4a = 02 FILL their} relationship to {NAME}?

{NAME’S} SPOUSE 01

NAME’S} MOTHER 02

{NAME’S} FATHER 03

{NAME’S} CHILD 04

GRANDPARENT OF {NAME} 05

BROTHER/SISTER (NATURAL/STEP) OF {NAME} 06

AUNT/UNCLE OF {NAME} 07

OTHER RELATIVE 08

NOT RELATED 09

STAFF AT RESIDENCE 10

DON’T KNOW d

REFUSED r

(A7 = ANSWER OR d OR r)

A7a. PROGRAMMER:

IF A5 = 01 (CONTINUE) 01 (A10)

ELSE CALLBACK TO INTERPRETER 02 SET A100 = 03 (A100)

CALLBACK TO NAMED INTERPRETER

(A0=14)

A8. Hello, my name is ___________________, calling on behalf of the Social Security Administration. May I please speak to {INTERPRETER’S NAME}?

PROBE: We are not selling anything or asking for contributions.

SPEAKING 01

INTERPRETER COMES TO PHONE 02

CALL BACK LATER 03 SET A100 = 03 (A100)

HUNG UP DURING INTRODUCTION 04 SET STATUS = 640 (END)

INTERPRETER REFUSED r SET A105 = 02 (A105)

(A8 =01 OR 02)

A9. {IF A8 = 02 DISPLAY: Hello, my name is ________________, calling on behalf of the Social Security Administration.} When we spoke with you recently, you said this would be a good time for you to interpret the National Beneficiary Survey for {NAME}. Are you and {NAME} ready to begin?

PROBE: If you or {NAME} get tired or need a break at any time, please tell me and we will call back later to finish the interview.

YES, CONTINUE 01

CALL BACK LATER 03 SET A100 = 03 (A100)

HUNG UP DURING INTRODUCTION 04 SET STATUS = 640 (END)

INTERPRETER REFUSED 05

SET A105 = 02 (A105)

SPEAKING TO NAME OR INTERPRETER / NAME OR INTERPRETER COMES TO PHONE / TO NAME AFTER REMAIL

(A0 =07 OR 08) OR (A1 = 01, 03 OR 13) OR (A2 = 01, 03, OR 13) OR (A7a = 01) OR (A9 = 01)

A10. {PROGRAMMER, IF A7a = 01 DISPLAY “Please tell {NAME} that I said….”} {(IF A0 = 07 OR 08, OR 09) OR (A1 = 03) OR (A2 = 03 OR 13) DISPLAY Hello, my name is ________________, calling on behalf of the Social Security Administration.} Recently, Social Security sent you {PROGRAMMER IF A0 = 04 USE another} a letter explaining an important survey we are conducting for them. {IF A2 = 01 BEGIN HERE} The National Beneficiary Survey is about your health, daily activities, any jobs you may have, and any Social Security programs and services you may use. Congress requires that Social Security conduct this survey. [IF S2 = 01: I’m calling to ask you to participate. The information you and other participants give us will be used to help evaluate Social Security’s programs for disability beneficiaries.]

PROBE: We are not selling anything or asking for a contribution.

The interview {IF A0 = 08 FILL will take around 2 - 3 hours because we are using TTY / IF A0 = 07 FILL will take around 2 - 3 hours because we are using Relay. / IF (A0 = 04) OR (A1 = 01, 03 OR 13) OR (A2 = 01 OR 03 OR 13) FILL: will take between 45 and 60 minutes.} DISPLAY FOR ALL In appreciation for your time, we will mail you a check for $10.00 when we finish the interview. The questions are easy. If you get tired or need a break at any time, please tell me and we will call back later to finish the interview. Let’s start now.

CONTINUE 01 (A64)

{NAME} WILL CALL MPR 02 SET A108 = 01 (A108)

CALL BACK LATER 03 (IF A1 = 01, 03, 13 OR A2 = 01, 03, A13A;

OR A0 = 07, 08, 09 SET A100 = 01 (A100)
IF A7a = 01 OR A9 = 02 SET A100 = 03 (A100))

DID NOT RECEIVE LETTER/DOES NOT
RECALL LETTER 04 (A20)

REQUESTS PROXY 05 (A39)

REQUESTS IN-PERSON INTERVIEW 06 (A39)

POSSIBLE PARTICIPATION PROBLEM 07 (A13)

REFUSED r (IF A1 = 01, 03, 13 OR

A2 = 01, 03, A13A; OR A0 = 07, 08, 09
SET A105 = 01 (A105) / IF A7a = 01 OR
A9 = 01 SET A105 = 02 (A105)

NAME OR UNKNOWN INFORMANT CALLS IN

(A0=02, 05, OR 06)

A11. INTERVIEWER: CODE BASED ON SUPERVISOR INSTRUCTION.

{NAME} 01

{NAME} USING TTY 02

{NAME} USING RELAY 03

INFORMANT / POSSIBLE PROXY 04 (A13a)

(A11 = 01, 02, OR 03)

A12. Hello, my name is ________________________. I’ll be your interviewer today. The National Beneficiary Survey is about your health, daily activities, and any jobs you might have. It also asks about your use of Social Security programs and services. Congress requires that Social Security conduct this survey. The information you and other participants give us will be used to help evaluate Social Security’s programs for disability beneficiaries.

The interview {PROGRAMMER, IF A11 = 01 FILL will take between 45 and 60 minutes / IF A11 = 02 USE will take around 2 - 3 hours because we are using TTY / IF A11 = 03 FILL will take around 2 - 3 hours because we are using Relay.} In appreciation for your time, we will mail you a check for $10.00 when we finish the interview. The questions are easy. If you get tired need a break at any time, please tell me and we will call back later to finish the interview. Let’s start now.

CONTINUE 01 (A64)

WANTS TO SCHEDULE INTERVIEW 02 IF A11 = 01 SET A100 = 01 (A100)

IF A11 = 02 SET A100 = 04 (A100)

IF A11 = 03 SET A100 = 05 (A100)

NEEDS PROXY 03

NEEDS IN-PERSON 04 (A39)

POSSIBLE PARTICIPATION PROBLEM 05 (A13)

REFUSED r IF A11 = 01, 02, 03 SET A105 = 01 (A105)

IF A11 = 04 SET A105 = 02 (A105)

DIFFICULTY PARTICIPATING (SPEAKING WITH NAME / INFORMANT / UNKNOWN PROXY WHO CALLS IN)

(A1 = 06) OR (A2 = 06) OR (A4b = 05) OR (A10 = 07) OR (A11 = 04) OR (A12 = 05)

A13. INTERVIEWER: WHO ARE YOU SPEAKING WITH?

{NAME} / INTERPRETER 01

INFORMANT/POSSIBLE PROXY 02

(A11 = 04) OR (A13 = 01 OR 02)

A13a. INTERVIEWER: IF BARRIER ALREADY STATED, CODE RESPONSE THEN CONFIRM BY READING APPROPRIATE CATEGORY BELOW.

{PROGRAMMER: IF A11 = 04, USE: PROBE: Thank you very much for calling and offering to help.
IF NEEDED: What problem does {NAME} have that might prevent {him/her} from participating for {himself/herself}?

IF (A1 = 06) OR (A2 = 06) OR (A4b = 05) OR (A10 = 07) OR (A12 = 05) FILL: PROBE: Why {IF A13 = 01 FILL would you/ IF A13 = 02 FILL would {NAME}} have a problem participating in the survey?

INTERVIEWER: PROBE FOR DON’T KNOW. IF MORE THEN ONE PROBLEM, PROBE FOR THE MAIN PROBLEM.

HEARING DIFFICULTY 01

SPEECH DIFFICULTY 02

COGNITIVE BARRIER 03 (A46)

PHYSICAL BARRIER 04

INCARCERATED 06 SET A103 = 01 (A103)

INSTITUTIONALIZED 07 (A27a)

HOSPITALIZED 08 (A27a)

DECEASED 09 (A103a)

SERVING IN MILITARY 10 SET A103 = 02 (A103)

LIVING OUTSIDE USA 11 SET A103 = 03 (A103)

DON’T KNOW d

REFUSED r SET A105 = 02 (A105)

(A13a = 01, 02, 04, OR d)

A14. [IF S2 = 01 DISPLAY: Recently, Social Security sent {IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME} a letter saying {IF A13 = 01 FILL you were/ IF A13 = 02 FILL {him/her} he/she was} selected to take part in an important health survey we are conducting for them.} {IF A12 = 05 START HERE} We would like {IF A13 = 01 FILL you to have / IF A13 = 02 FILL {NAME} to have} the chance to answer the questions for {IF A13 = 01 FILL yourself / IF A13 = 02 FILL himself / herself} if at all possible. I’m going to read some ways that we can arrange for {IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME}} to take part in the study. PROBE: What would work best?

INTERVIEWER: READ LIST AND CODE ONE ONLY. IF MORE THAN ONE MENTIONED, ASK WHAT IS EASIEST FOR {NAME}.

We can break the interview into a few short calls to
{IF A13 = 01 FILL you / IF A13 = 02 FILL {NAME} 01 (A64)

We can use Relay or TTY for the interview 02 (A16)

{PROGRAMMER, DISPLAY 03 ONLY IF A13a = 01}
I can switch to a phone amplifier now 03 (A64)

{PROGRAMMER, DISPLAY 04 ONLY IF A13a = 01} We can call later using a phone amplifier 04 SET A100 = 06 (A100)

{PROGRAMMER, DISPLAY 05 ONLY IF IN CLUSTERED SAMPLE S1 = 01 We could send an interviewer to {{IF A13 = 01 FILL your /
IF A13 = 02 FILL {his/her} home 05 (A42)

{PROGRAMMER DISPLAY 06 ONLY IF A13 = 02} INFORMANT OFFERS TO BE PROXY 06 (A39)

{PROGRAMMER, DISPLAY 07 ONLY IF SAMPLE TYPE = UNCLUSTERED, S1 = 02 AND
A13 = 01} {NAME} REQUESTS IN-PERSON INTERVIEW 07 (A40)

{PROGRAMMER DISPLAY 08 ONLY IF A13 = 01} {NAME} REQUESTS PROXY 08 (A39)

PHYSICAL PROBLEM: {NAME} UNABLE TO PARTICIPATE 09 (A46)

SUGGESTS ANOTHER WAY {SPECIFY__) 10

DON’T KNOW d (A39)

REFUSED r IF A13 = 01 SET A105 = 01 (A105) /

IF A13 = 02 SET A105 = 02 (A105)

(A14 = 10)

A14a. What is that way?

< OPEN

DON’T KNOW d

REFUSED r

(A14 = 10)

A15. Thank you. I will ask my supervisor if that would work. We will call you back and let you know.

SET A106 = 05 (A106)

(A13a = 01, 02, 04, OR d) OR (A14 = 02)

A16. INTERVIEWER: WHO ARE YOU SPEAKING WITH?

NAME 01

INFORMANT / POSSIBLE PROXY 02 (A18)

(A16 =01)

A17. We can start the interview in a few minutes, by switching to our TTY or to a Relay operator and having them contact you. Alternatively, we can you back another time using TTY or Relay. What works best for you?

PROBE: PROBE FOR TTY OR RELAY IF UNCLEAR.

INTERVIEWER: IF "SWITCH IN A FEW MINUTES", CALL SUPERVISOR FOR HELP.

SWITCH (TTY) IN A FEW MINUTES 01 SET A100 = 04 (A100)

SWITCH (RELAY) IN A FEW MINUTES 02 SET A100 = 05 (A100)

CALL BACK LATER (TTY) 03 SET A100 = 04 (A100)

CALL BACK LATER (RELAY) 04 SET A100 = 05 (A100)

NO, {NAME} WILL CALL TTY 05 SET A108 = 02 (A108)

NO, {NAME} WILL CALL RELAY 06 SET A108 = 03 (A108)

REFUSED/HUNG UP r SET A105 = 01 (A105)

(A16 = 02)

A18. Can you help arrange a time when we can call {NAME} and complete the interview using either TTY or Relay? My supervisor will call you back later to find out what time you arranged for {NAME} to be interviewed.

PROBE: PROBE FOR TTY OR RELAY IF UNCLEAR.

INTERVIEWER: IF “SAMPLE MEMBER AVAILABLE, SWITCH IN A FEW MINUTES", CALL SUPERVISOR FOR HELP.

SM AVAILABLE, SWITCH (TTY) IN A FEW MINUTES 01 SET A100 = 04 (A100)

SM AVAILABLE NOW, SWITCH (RELAY) IN A FEW MINUTES 02 SET A100 = 05 (A100)

CALL BACK LATER (TTY) 03 SET A100 = 04 (A100)

CALL BACK LATER (RELAY) . 04 SET A100 = 05 (A100)

CALL BACK TO ARRANGE AN INTERVIEW TIME 05 SET A106 = 02 (A106)

DON’T KNOW d SET A106 = 02 (A106)

REFUSED r SET A105 = 02 (A105)

A19 DELETED

NAME REQUESTS LETTER

(A10 = 04)

A20. The letter said that you were selected from a list of all adults who currently receive Social Security benefits and that someone would call to ask you to participate. The National Beneficiary Survey asks about your health, your daily activities, any jobs you might have, and any Social Security programs or services you might use. If you get tired or need a break at any time, please tell me and we will call back later to finish the interview. Let’s start now.

CONTINUE 01 (A64)

CALL BACK LATER 02 SET A100 = 01 (A100)

NO, WANTS LETTER 00

REFUSED r SET A105 = 01 (A105)

(A20 = 00)

A21. You should receive the letter in about a week. Or, I can read it to you now and we can start the interview.

READ LETTER, CONTINUE 01 (A64)

NO, SEND LETTER 00

REFUSED r SET A105 = 01 (A105)

(A2=19 or A21 = 00)

A22. I want to make sure we have your correct name and address. The records show (READ BELOW). Is this correct?

PROGRAMMER: DISPLAY NAME FROM PRELOADS

NAME: PREFIX, FIRST, MIDDLE, LAST, SUFFIX

ADDRESS 1

ADDRESS 2

CITY, STATE, ZIP

YES 01 SET A109 = 01 (A109)

NO 00 (A23)

REFUSED/HUNG UP r SET A105 = 01 (A105)

(A22 = 00)

A23. PROGRAMMER: WAS A22 NAME UPDATED?

YES 01

NO 00 (A25)

(A23 = 01)

A24. This name is different from the name in our records – perhaps you married or changed your name. Can you confirm that you are the same {NAME} as in our records?

YES 01

NO 00 SET A102 = 04 (A102)

REFUSED/HUNG UP r SET A106 = 05 (A106)

(A22 = 00) OR (A24 = 01)

A25. PROGRAMMER CHECK: IS UPDATED STATE OUTSIDE THE UNITED STATES AND DC?

YES 01

NO 00 SET A109 = 01 (A109)

(A25 = 01)

A26. I might have recorded your address wrong. Are you now living outside the United States?

INTERVIEWER: IF NO (ADDRESS IS IN THE USA), GO BACK TO A22 AND CORRECT STATE.

YES 01 SET A103 = 04 (A103)

NO 00

REFUSED r SET A106 = 05 (A106)

PROGRAMMER: STORE CHANGED NAME IN S8 UPDATE

NAME INSTITUTIONALIZED / HOSPITALIZED

(A1 = 07 OR 11) OR (A2 = 07 OR 11) OR (A4b = 06 OR 09) OR (A13a = 07 OR 08)

A27a. I’m sorry to hear that. How much longer will {NAME} be staying there?

INTERVIEWER: ENTER THE NUMBER OF DAYS, WEEKS OR MONTHS

INTERVIEWER: (NEXT QUESTION SPECIFIES THE UNITS – DAYS, WEEKS OR MONTHS)

INTERVIEWER: ENTER 997 IF PERMANENTLY

|__|__|

DON’T KNOW d (A27b)

REFUSED r (A27b)

A27aa. Units.

DAYS 01

WEEKS 02

MONTHLY 03

(A27a = ANSWER OR d OR r)

A27b. I understand that {NAME} is not able to be at home just now. In order to help {him/her} participate, we could

PROBE: READ BELOW. What would work?

INTERVIEWER: CODE ONE ONLY

IF A27a = 01 AND DAYS LESS THAN 30 OR A27a=02 and WEEKS LESS THAN 4 OR A27a=03 (MONTHS) and MONTHS = 1 DISPLAY:
call after {he/she} returns home and is feeling better 01 SET A100 = 01 (A100)

ELSE DISPLAY

If {NAME} is well enough, we can call {him/her}

at the {IF (A1 = 11 AND A2 = 11 AND A4b = 09) OR (A13a = 07) FILL institution / IF (A1 = 07 AND A2 = 07 AND A4b = 06) OR (A13a = 08) FILL hospital 02

{PROGRAMMER, DISPLAY 03 IF SAMPLE TYPE = CLUSTERED S1 = 01) We could send an interviewer to visit {him/her} at the {(IF A1 = 11 AND A2 = 11 AND A4b = 09) OR (A13a = 07) FILL institution / (IF A1 = 07 AND A2 = 07 AND A4b = 06) OR (A13 = 08) FILL hospital}. 03 (A29)

NAME TOO ILL / SEEK PROXY 04 (A46)

DON’T KNOW d (A46)

REFUSED r SET A105 = 02 (A105)

(A27b = 02)

A28. Please tell me the name and phone number of the {IF (A1 = 11 AND A2 = 11 AND A4b = 09) OR (A13a = 07) FILL institution / IF (A1 = 07 AND A2 = 07 AND A4b = 06) OR (A13a = 08) FILL hospital}, where I can contact {NAME}. If you don’t have all the information, please tell me what you can.

NAME OF INSTITUTION / HOSPITAL

Please tell me the telephone number with the area code first.

PHONE NUMBER: { __ __ __ ) __ __ __ - __ __ __ __ SET A100 = 08 (A100)

PROGRAMMER: STORE NAME OF HOSPITAL OR INSTITUTION AND PHONE NUMBER IN LOCATOR

IF REFUSED SET A106 = 05 (A106)

(A27b = 03)

A29. Please tell me the name and phone number of the {IF (A1 = 11 AND A2 = 11 AND A4b = 09) OR (A13 = 07) FILL institution / IF (A1 = 07 AND A2 = 07 AND A4b = 06) OR (A13 = 08) FILL hospital}, where I can contact {NAME}. If you don’t have all the information, please tell me what you can.

NAME OF INSTITUTION / HOSPITAL

ADDRESS 1

ADDRESS 2

CITY, STATE, ZIP

Please tell me the telephone number with the area code first.

TELEPHONE: I__I__I__I – I__I__I__I – I__I__I__|__| SET A107 = 01 (A107)

REFUSED r SET A106 = 05 (A106)

PROGRAMMER: STORE NAME AND ALL CONTACT INFORMATION FOR HOSPITAL OR INSTITUTION IN LOCATOR

IF REFUSED SET A106 = 05 (A106)

NEW CONTACT INFORMATION FOR NAME

(A1 = 05) OR (A2 = 05) OR (A4b = 04)

A30. Do you know how I can reach {NAME}?

YES 01

NO 00 (A37)

REFUSED r SET A105 = 02 (A105)

(A30= 01)

A31. Please tell me {his/her} new address and phone number. Also, if {NAME’S} name has changed please tell me the new name. PROBE: If you don’t have all the information please tell me what you can.

NAME: PREFIX, FIRST, MIDDLE, LAST, SUFFIX

ADDRESS 1

ADDRESS 2

CITY, STATE, ZIP

Please tell me the telephone number with the area code first.

TELEPHONE: I__I__I__I – I__I__I__I – I__I__I__|__|

DON’T KNOW d

REFUSED r

(A31 = ANSWER OR d OR r)

A32. PROGRAMMER CHECK A31: IS STATE OUTSIDE THE UNITED STATES AND DC?

YES (OUTSIDE USA) 01

NO (INSIDE USA) 02 (A36)

(A32 = 01)

A33. I may have recorded something incorrectly. Is {NAME} now living outside the United States?

INTERVIEWER: IF NO (ADDRESS IS INSIDE THE USA), GO BACK TO A31 AND UPDATE STATE.

PROGRAMMER AFTER A31 IS UPDATED, GO TO A36.

YES 01 SET A103 = 04 (A103)

NO 00

GO BACK TO A31; AFTER STATE IS UPDATED GO TO A36.

A34 IS DELETED

A35 IS DELETED

(A34 = ANSWER OR d OR r)

A36. PROGRAMMER CHECK: DOES A31 CONTAIN A VALID PHONE NUMBER?

YES 01 SET A101 = 01(A101)

NO 00 SET A102 = 02 (A102)

PROGRAMMER: STORE {NAME} CONTACT DATA IN LOCATOR

LEAD INFORMATION

(A30 = 00)

A37. Is there someone else who might know how to reach {NAME}?

YES 01

NO 00 SET A102 = 03 (A102)

DON’T KNOW d SET A102 = 03 (A102)

REFUSED r SET A105 = 02 (A105)

(A37 = 01)

A38. What’s that person’s name and phone number?

PROBE: If you don’t have all the information, please tell me what you can.

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

Please give me the telephone number, area code first.

TELEPHONE: I__I__I__I – I__I__I__I – I__I__I__|__|

DON’T KNOW d

REFUSED r

PROGRAMMER: STORE NAME AND PHONE INFORMATION IN LOCATOR = LEADS;

SET A101 = 03 (A101)

IF MISSING/INVALID PHONE NUMBER SET A106 = 05 (A106)

CHECK FOR POSSIBLE IN-PERSON INTERVIEW

(A10 = 05 OR 06) OR (A12 = 03 OR 04) OR (A4b = 15) OR (A14 = 06, 08, d)

A39. PROGRAMMER CHECK FOR POSSIBLE IN-PERSON INTERVIEW. DID… ?

NAME REQUEST IN PERSON (A4b = 15) OR (A10 = 06)
OR (A12 = 04) AND SAMPLE TYPE = CLUSTERED
(S1 = 01) 01 (A42)

NAME REQUEST IN PERSON (A4b = 15) OR (A10 = 06)
OR (A12 = 04) AND SAMPLE TYPE = UNCLUSTERED (S1 = 02) 02

NAME/INFORMANT REQUESTS PROXY (A10 = 05)
OR (A12 = 03) OR (A14 = 06, 08 OR d) AND SAMPLE TYPE CLUSTERED (S1 = 01) 03 (A43)

NAME REQUEST PROXY (A10 = 05) OR (A12 = 03)
OR (A14 = 06, 08, d) AND SAMPLE TYPE = UNCLUSTERED (S1 = 02) 04 (A41)

NAME REQUESTS IN PERSON INTERVIEW AND NOT IN CLUSTERESAMPLE (S1 = 02)

(A14 = 07 OR A39 = 02)

A40. I’m sorry, but we have no field representatives working in your area. We can break the phone interview into as many short calls as you would like so the interview will not be tiring. Will that help {NAME/you} to participate? If you get tired or need a break at any time, please tell me and we will call back later to finish the interview. Let’s start now.

CONTINUE 01 (A64)

NO / SEEK PROXY 02 (A46)

DON’T KNOW d (A46)

REFUSED r SET A105 = 01 (A105)

NAME Requests proxy and not in clustered sample (S1 = 02)

(A39=04)

A41. If at all possible, we’d like {IF A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL you / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {NAME}} to answer for {IF (A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL yourself / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {himself/herself}}. We can break the interview into a few short calls so the interview won’t be tiring. If {(IF A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL you get tired or need a break / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {he/she} gets tired or needs a break} at any time, please tell me and we will call back later to finish the interview. Let’s start now.

CONTINUE 01 (A64)

NO, PREFERS PROXY 02 IF A14 = 06 (A48) ELSE (A46)

DON’T KNOW d IF A14 = 06 (A48) ELSE (A46)

REFUSED r SET A105 = 01 (A105)

NAME REQUESTED IN PERSON AND IN CLUSTERED SAMPLE (S1 = 01)

(A14 = 05) OR (A39=01)

A42. Our field representative will be working in your area shortly and will contact you to set up an interview in person.

GO TO A44

NAME REQUESTED PROXY AND IN CLUSTERED SAMPLE (S1 = 01)

(A39=03)

A43. Our interviewer will be working in {IF (A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL your / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {NAME’s area} shortly. If it would help {(IF A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL you / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {him/her} to answer for {(IF A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL yourself / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {himself/herself}, we can send an interviewer to interview {IF (A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL you / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {NAME}} at home. If {(IF A10 = 5) OR (A12 = 03) OR (A14 = 08) OR (A14 = d AND A13 = 01) FILL you get tired or need a break / IF (A14 = 06) OR (A14 = d AND A13 = 02) FILL {he/she gets tired or needs a break} at any time, the interviewer can come back at a later time to finish the interview. Will that help?

YES 01

NO, PREFER PROXY 02 (A46)

DON’T KNOW d (A46)

REFUSED r IF A13 = 01 SET A105 = 01 (A105) /

IF A13 = 02 SET A105 = 03 (A105)

(A42 = ANSWER OR d OR r) OR (A43 = 01)

A44. Let me confirm your address. Is it still…READ BELOW:

PROGRAMMER: DISPLAY NAME’S CONTACT INFORMATION FROM PRELOADED INFORMATION (S20)

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

ADDRESS 1

ADDRESS 2

CITY, STATE, ZIP

UPDATE PHONE NUMBER

YES 01 (A45)

NO 00

REFUSED r IF A13 = 01 SET A105 = 01 (A105)

IF A13 = 02 SET A105 = 03 (A105)

(A44 = 00)

A44a. INTERVIEWER – BACK UP TO A44 AND EDIT ALL CHANGES (A45)

(A44 = 01) AND (A44a = ANSWER)

A45. If your current address will change within the next month or two, please tell me the new address and phone number.

INTERVIEWER INSTRUCTION: IF ADDRESS OR PHONE NUMBER WILL CHANGE, GO BACK TO A44 AND CHANGE AS APPROPRIATE.

NO CHANGE 01 SET A107 = 01 (A107)

ADDRESS OR PHONE WILL CHANGE 02 SET A107 = 01 (A107)

DON’T KNOW d SET A107 = 01 (A107)

REFUSED r IF A13 = 01 SET A105 = 01 (A105) /

IF A13 = 02 SET A105 = 03 (A105)

PROGRAMMER: STORE UPDATED INFORMATION IN UPDATE ADDRESS BLOCK

SEEKING PROXY

(A13a = 03) OR (A14 = 09) OR (A27 = 04, OR d) OR (A40 = 02 OR d) OR (A41 = 02 OR d AND A14=8 OR d) OR (A43 = 02 OR d)

A46. Is there someone who can answer questions about {IF (A40 = 02 OR d) OR (A41 = 02 OR d) OR (A43 = 02 OR d) FILL your / IF (A13a = 03) OR (A14 = 09) OR (A27 = 04 OR d) FILL {NAME’s}} health, daily activities, any jobs {IF (A40 = 02 OR d) OR (A41 = 02 OR d) OR (A43 = 02 OR d) FILL you / IF (A13a = 03) OR (A14 = 09) OR (A27 = 04 OR d) FILL {he/she} might have, and use of Social Security programs or services? This could be someone who lives with {IF (A40 = 02 OR d) OR (A41 = 02 OR d) OR (A43 = 02 OR d) FILL you / IF (A13a = 03) OR (A14 = 09) OR (A27 = 04 OR d) FILL {NAME} such as a family member or friend, or someone like a social worker or case worker.

INFORMANT WILL SERVE AS PROXY 01 (A48)

PROXY COMES TO PHONE 02 (A48)

PROXY NOT AVAILABLE NOW 03

PROXY LIVES ELSEWHERE 04 (A51)

{NAME} HOSPITALIZED: NO PROXY 05 SET A104 = 01 (A104)

{NAME} INSTITUTIONALIZED: NO PROXY 06 SET A104 = 02 (A104)

{NAME} HAS COGNITIVE BARRIER:
NO PROXY 07 SET A104 = 03 (A104)

{NAME) HAS HEARING / SPEECH BARRIER/ NO PROXY 08 SET A104 = 04 (A104)

{NAME} HAS PHYSICAL BARRIER:

NO PROXY 09 SET A104 = 05 (A104)

DON’T KNOW d SET A106 = 03 (A106)

REFUSED r IF A40 = 02 OR d OR A41 = 02 OR d OR

A43 = O2 OR d SET A105 = 01 (A105) /

IF A13a – 03 OR A14 = O9 OR A27 – 04 OR

d SET A105 = 03 (A105)

(A46 = 03)

A47. What is that person’s name and phone number so we can call back and ask for that person by name?

NAME: PREFIX, FIRST, MIDDLE, LAST, SUFFIX

Please give me the telephone number, area code first.

PHONE NUMBER: __ __ __ - __ __ __ __ __ __ __ __

DON’T KNOW d SET A106 = 05 (A106)

REFUSED r SET A106 = 05 (A106)

PROGRAMMER: STORE PROXY NAME IN UPDATE ADDRESS BLOCK.
SET A100 = 02 (A100)

PROXY COMES TO PHONE

(A14=06 AND A41=02 OR d) OR (A46=01 OR 02)

A48. {IF (A46 = 02) USE Hello, my name is __________________, calling on behalf of the Social Security Administration.} {NAME} has been selected to participate in an important national health study we are conducting for SSA. Congress requires Social Security to conduct the National Beneficiary Survey. The information we collect will be used to evaluate Social Security’s programs for disability beneficiaries. Are you the person who is most knowledgeable about {NAME’s} health, daily activities, any jobs {he/she} may have, and about any Social Security programs and services {he/she} might use?

YES 01 A53)

WANTS MORE INFORMATION 02

NO 00 (A50)

DON’T KNOW d (A50)

REFUSED r SET A105 = 03 (A105)

(A48 = 02)

A49. Social Security recently sent {NAME} a letter saying that we would be calling to ask {him/her} to participate in an important national health study we are conducting for Social Security. I work for Mathematica Policy Research, a nationally recognized research firm based in Princeton, New Jersey. We are conducting a scientific study. We are not selling anything or asking for contributions.

CONTINUE 01 (A53)

FIND ANOTHER PROXY 02

REQUESTS LETTER 03 (A58)

REFUSED r SET A105 = 03 (A105)

(A48 = 00 OR d) OR (A49 = 02)

A50. Is there someone else who knows about {NAME’s} health, daily activities, and any jobs {he/she} might have?

YES 01

NO OTHER PROXY AVAILABLE 02 SET A106 = 03 (A106)

REFUSED 00 SET A105 = 03 (A105)

ANOTHER PROXY LIVES ELSEWHERE

(A50 = 01)

A51. What is this person’s name and phone number?

PROBE: If you don’t have all the information, please tell me what you have.

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

DON’T KNOW d

REFUSED r

Please give me the telephone number, area code first.

TELEPHONE: I__I__I__I – I__I__I__I – I__I__I__|__|

DON’T KNOW d

REFUSED r

PROGRAMMER: STORE PROXY CONTACT INFORMATION IN LOCATING DATABASE AND GO TO A52.

IF BOTH NAME AND PHONE NUMBER REFUSED SET A106 = 05 (A106)

(A51 = ANSWER)

A52. PROGRAMMER: IS THERE A VALID PHONE NUMBER AT A51?

YES 01 SET A101 = 02 (A101)

NO 00 SET A102 = 06 (A102)

SPEAKING WITH PROXY

(A48 = 01) OR (A49 = 01)

A53. The interview will take from 45 to 60 minutes. In appreciation for your time, we will mail you a check for $10.00 when we finish the interview. If you get tired or need a break at any time, please tell me and we will call back later to finish the interview. Let’s start now.

CONTINUE 01

CALL BACK LATER 02

PROXY WANTS LETTER 03 (A58)

REFUSED r SET A105 = 03 (A105)

(A53 = 01 OR 02)

A54. {IF A53 = 01 USE Before we start} please tell me your name (IF A53 = 02 USE so we can call back and ask for you.} PROBE: Your first name is fine.

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

DON’T KNOW d

REFUSED r

CONTINUE

PROGRAMMER STORE PROXY NAME IN DATABASE

(A54 = ANSWER OR r)

A55. PROGRAMMER: IF

IF A53 = 01 01 (A64)

IF A53 = 02 02 SET A100 = 02 (A100)

CALLING FOR IDENTIFIED PROXY / PROXY AFTER REMAIL

(A0 = 10 OR 11 OR 13)

A56. Hello, my name is ________________, calling on behalf of the Social Security Administration. May I please speak with {PROXY NAME}?

PROBE: We are not selling anything or asking for a contribution.

PROXY SPEAKING 01 IF A0 = 13 (A85) / ELSE CONTINUE

PROXY COMES TO PHONE 02 IF A0 = 13 (A85) / ELSE CONTINUE

CALL BACK LATER (PROXY) 03 SET A100 = 02 (A100)

{PROXY} MOVED 04 (A61)

{PROXY} DECEASED 05 SET A106 = 03 (A106)

LANGUAGE BARRIER (NOT SPANISH) 06 SET A104 = 07 (A104)

NO SUCH PERSON AT THIS NUMBER 07 SET A102 = 05 (A105)

OTHER: SUPERVISOR REVIEW NEEDED 08 SET A106 = 05 (A106)

HUNG UP DURING INTRODUCTION 09 SET STATUS = 640 (END)

REFUSED r SET A105 = 03 (A105)

PROXY COMES TO PHONE

(A56 = 01 OR 02)

A57. {IF {PROXY} COMES TO PHONE (A56=02), USE Hello, my name is ________________, calling on behalf of the Social Security Administration.} Recently, Social Security sent {IF (A0 = 10) FILL {NAME} / IF (A0 = 11) FILL you} a letter explaining that {he/she} had been selected to participate in an important survey we are conducting for them. The National Beneficiary Survey is about {NAME’s} health, daily activities daily activities, any jobs {he/she} might have, and about any Social Security programs or services {he/she} might use. Congress requires that Social Security conduct this study. We were told that you are the most knowledgeable person to respond to the survey on behalf of {NAME}. The interview will take from 45 to 60 minutes. In appreciation for your time, we will mail you a check for $10.00 when we finish the interview. Would you be able to help us?

CONTINUE 01 (A64)

CALL BACK LATER 02 SET A100 = 02 (A100)

SEEK ANOTHER PROXY 03 (A60)

PROGRAMMER: DISPLAY THIS OPTION

ONLY IF A0 = 10 WANTS LETTER SENT 04

DON’T KNOW d (A59)

REFUSED r SET A105 = 03 (A105)

(A57 = 04)

A58. The letter explained that {NAME} was selected from a list of all adults currently receiving Social Security benefits and that someone would be calling to ask {him/her} to participate in an interview. Social Security is required by Congress to conduct this survey. The information we collect will be used to help evaluate Social Security’s programs for disability beneficiaries. If you need a break, let me know and we will call back later to finish the interview. Let’s start now.

CONTINUE 01

CALL BACK LATER 02

WANTS LETTER SENT 03 (A59)

DON’T KNOW d (A59)

REFUSED r SET A105 = 03 (A105)

(A58 = 01 OR 02)

A58a. {IF (A58=01) Before we start,} Please tell me your name {IF (A58=02) so we can call back and ask for you.}

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

REFUSED r

CONTINUE

IF A58=01 GO TO A64

IF A58=02 SET A100 = 02 (A100)

PROGRAMMER STORE PROXY NAME IN DATABASE

(A57=d) OR (A58 = 03 or d)

A59. Please tell me your name and address so we can mail the letter to you.

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

ADDRESS 1

ADDRESS 2

CITY, STATE, ZIPCODE

PROGRAMMER STORE PROXY INFORMATION IN LOCATING DATABASE

SET A109 = 02 (A109)

SEEK ANOTHER PROXY - CONTACT INFORMATION

(A57 = 03)

A60. Can you give me the name and phone number for someone else who might be knowledgeable about {NAME’s} health, daily activities, any jobs {he/she} might have, and about any Social Security programs or services {he/she} might use?

YES 01

NO 00 SET A106 = 03 (A106)

DON’T KNOW d SET A106 = 03 (A106)

REFUSED r SET A105 = 02 (A105)

(A60 = 1)

A61. What is that person’s name and telephone number?

PROBE FOR A60 = 01 ONLY: If you don’t have all the information, please tell me what you have.

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

DON’T KNOW d

REFUSED r

Please give me the telephone number, area code first.

TELEPHONE NUMBER: I__I__I__I – I__I__I__I – I__I__I__I__I

DON’T KNOW d

REFUSED r

PROGRAMMER: STORE PROXY INFORMATION IN LOCATING DATABASE AND GO TO A62.

IF NAME AND PHONE NUMBER REFUSED SET A105 = 02 (A105)

(A61 = ANSWER)

A62. PROGRAMMER: WHAT KIND OF PROXY CONTACT INFORMATION DOES A61 CONTAIN?

NO PHONE NUMBER 01 SET A102 = 06 (A102)

INVALID PHONE NUMBER 02 SET A102 = 06 (A102)

VALID PHONE NUMBER 03 SET A101 = 02 (A101)

A63 DELETED

RESPONDENT VERIFICATION

(A0 = 18) OR (A10 = 1) OR (A12 = 01) OR (A14 = 01 OR 03) OR (A40 = 01) OR (A41 = 01) OR (A55 = 01) OR (A57 = 01) OR (A58 = 01)

A64. INTERVIEWER: WHO ARE YOU SPEAKING WITH?

INTERVIEWER: IF YOU ARE SPEAKING WITH AN INTERPRETER, CODE SPEAKING WITH {NAME}.

NAME 01

PROXY 02

A65. DELETED

(A64 = ANSWER)

A66. Before we start, I need to confirm that I’ve reached the right person. Is {IF (A64 = 01) FILL your/IF (A64 = 02) FILL {NAME’s}} full name:

PROGRAMMER: IF A0 = 03, DISPLAY: CAPI INTERVIEWER: DO NOT READ QUESTION; CODE 01, OR 02 AS APPROPRIATE.

PROGRAMMER: DISPLAY SAMPLE MEMBER’S FULL NAME BELOW FROM S8.

YES 01 (A67a)

YES, NAME NOW CHANGED 02

NO 00 (A72)

DON’T KNOW d (A72)

REFUSED r IF A64 = 01 SET A105 = 01 (A105)

IF A64 = 02 SET A105 = 03 (A105)

(A66 = 02)

A67. For the record, what is {your/NAME’s} new name?

PROGRAMMER: IF A0 = 03 DISPLAY: CAPI INTERVIEWER: DO NOT READ QUESTION: RECORD NAME CHANGE AND CONTINUE.

NEW NAME

DON’T KNOW d (A72)

REFUSED r IF A64 = 01 SET A105 = 01 (A105)

IF A64 = 02 SET A105 = 03 (A105)

PROGRAMMER STORE NAME CHANGE IN NAME UPDATE BLOCK.

(A65 = 01) OR (A66 = 01) OR (A67 = ANSWER OR r)

A67a. {PROGRAMMER: IF A22 OR A44 CONTAIN UPDATED STATE, GO TO A68, ELSE CONTINUE} And in what state {IF (A64 = 01) FILL are you / IF (A64 = 02) FILL IS {NAME}} now living?

CAPI INTERVIEWER: DO NO READ QUESTION: RECORD STATE BELOW AND CONTINUE.

STATE REFUSED r IF A64 = 01 SET A105 = 01 (A105)

IF A64 = 02 SET A105 = 03 (A105)

DON’T KNOW d

PROGRAMMER: CHECK AREA CODE AND RECORD STATE.

PROGRAMMER STORE STATE CHANGE FOR USE IN FUTURE QUESTIONS AT STATE UPDATE BLOCK (S20).

(A67a = ANSWER OR r)

A68. What is {your/NAME’S} date of birth?

PROGRAMMER: IF (A0 = 03) DISPLAY: CAPI INTERVIEWER: DO NOT READ QUESTION. RECORD DATE OF BIRTH OR d AND CONTINUE.

I__I__I I__I__I I__I__I__I__I

MONTH DAY YEAR

(1 – 12) (1 - 31) (1937 – 1986)

[A68] [A68a] [A68b]

ANSWERED 01 (A71)

DON’T KNOW d

REFUSED r IF A64 = 01 SET A105 = 01 (A105)

IF A64 = 02 SET A105 = 03 (A105)

(A68 = d)

A69. How old {IF (A64 = 01) FILL are you/IF (A64 = 02) FILL is {NAME}? PROBE: Your best guess is fine.

PROGRAMMER IF A0 = 03 DISPLAY: CAPI INTERVIEWER: DO NOT READ QUESTION, RECORD AGE AND CONTINUE

RECORD AGE: |__|__| YEARS (16 – 67)

DON’T KNOW d

(A69 = ANSWER OR d)

A70. PROGRAMMER CHECK S11: IS A69 AGE = +2 OR – 2 YEARS OF NAME’S AGE?

YES 01

NO 00

(A68 = ANSWER) OR (A70 = ANSWER)

A71. PROGRAMMER CHECK BIRTHDATE: IS MONTH, DAY, YEAR OF BIRTH AT A68 = MONTH, DAY, AND YEAR OF BIRTH ON RECORD (S11) OR IS A70 = 01?

NO MATCH 00

1 MATCHES 01

2 MATCH 02

3 MATCH 03

(A65 = ANSWER) OR (A66 = 01,00, OR d AND A70 = 01) OR (A71 => 02) OR (A67=d)

A72 PROGRAMMER CHECK: IS {NAME’S} IDENTITY VERIFIED (NAME VERIFIED {A66 = 01 OR 02} AND IS BIRTHDATE VERIFIED (A70 = 01) OR (A71 = 01 OR 02)?

YES (VERIFIED) 01

NO (FAILED VERIFICATION) 00 SET A102 = 04 (A102)

PROGRAMMER: CALCULATE AGE AT INTERVIEW (CURRENTAGE) USING DATE OF INTERVIEW - SELF-REPORTED DATE OF BIRTH GIVEN IN A68 (TO BE USED IN SECTION E). DO NOT RE-CALCULATE UPON RE-ENTRY.

NAME/PROXY COGNITIVE TEST

(A72 = 01)

A73. INTERVIEWER: WHO ARE YOU SPEAKING WITH?

NAME – CATI OR CAPI INTERVIEW 01

NAME, TTY INTERVIEW 02 SET A110 = 01 (A110)

NAME, RELAY INTERVIEW 03 SET A110 = 01 (A110)

PROXY (CATI) 04

PROXY (CAPI) 05

(A73=01, 04 OR 05)

A74. Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be sure my explanation was clear.

Here’s the first explanation. The survey asks about {IF (A73 = 03) FILL your / IF (A73 = 04 OR 05) FILL {NAME’s}} health, daily activities, and any jobs {IF (A73 = 03) FILL you / IF (A73 = 04 OR 05) FILL {NAME}} might have. Please tell me in your own words what the survey is about.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”

LISTS NONE 00

LISTS ONLY 1 TOPIC 01

LISTS ANY 2 TOPICS 02 (A77)

LISTS 3 TOPICS 03 (A77)

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

A75 IS DELETED

(A74 = 00 OR 01)

A76. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.

Let’s try that again. The survey asks about {your/NAME}’s health, daily activities , and any jobs {IF (A73 = 03) FILL you / IF (A73 = 04 OR 05) FILL {NAME}} might have. Please tell me in your own words, what the survey is about.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”

LISTS NONE 00 (A80)

LISTS ONLY 1 TOPIC 01 (A80)

LISTS ANY 2 TOPICS 02

LISTS 3 TOPICS 03

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

(A74 = 02 OR 03) OR (A76=02 OR 03)

A77. Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do not like and you can stop the interview at any time you choose. Whether you choose to take part or not, {your/NAME’s} disability benefits will not be affected in any way.

When I say your participation is completely voluntary, what does that mean to you?

PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?

INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part. I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away my benefits if I refuse, etc.

INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01 (A78)

INACCURATE ANSWER 02

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

(A77=02)

A77a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.

Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do not like and you can stop the interview at any time you choose. Whether you choose to take part or not, {your/NAME’s} disability benefits will not be affected in any way. When I say your participation is completely voluntary, what does that mean to you?

PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?

INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01

INACCURATE ANSWER 02 (A80)

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

(A77 = 01 OR A77a = 01)

A78. Here’s the last explanation. All your answers will be kept confidential and used only for the research purposes of the study. When I say that your answers will be kept confidential, what does that mean to you?

PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?

INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.

INTERVIEWER: IF RESPONDENT SAYS: “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01 (A110)

INACCURATE ANSWER 02

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

(A78 = 02)

A78a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.

Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the study.

When I say that your answers will be kept confidential, what does that mean to you?

PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?

INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01 IF A73 = 03 SET A110 = 01 (A110) /

IF A73 = 04 OR 05 SET A110 = 02 (A110)

INACCURATE ANSWER - FAILED 02

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

A79 IS DELETED

RESPONDENT OR PROXY FAILS COGNITIVE TEST. FIND A PROXY/ANOTHER PROXY

(A76 = 00 OR 01) OR (A77a = 02 OR A78a = 02)

A80. Thank you. Our study rules say that we need to find {IF (A73 = 03) USE someone / IF (A73 = 04) USE someone else} who can help {IF (A64 = 01) FILL you / IF (A64 = 02) FILL {NAME}} answer the survey questions. Is there someone there who could answer questions about {(IF A64 = 01) FILL your / IF (A64 = 02) FILL {NAME’s}} health, daily activities, and any jobs {IF (A64 = 01) FILL you / IF (A64 = 02) FILL he/she} might have?

PROBE: This might be someone who lives with {you/NAME}, a friend, or someone like a social worker or case worker.

YES, PROXY COMES TO PHONE 01 (A85)

YES, CALL BACK PROXY LATER 02

YES, PROXY LIVES ELSEWHERE 03 (A82)

NO PROXY AVAILABLE 04 SET A106 = 04 (A106)

DON’T KNOW d SET A106 = 04 (A106)

REFUSED r IF A73 = 03 SET A105 = 01 (A105) /

IF A73 = 04 OR 05 SET A105 = 03 (A105)

(A80 = 02)

A81. What is that person’s name so that we can call back and ask for them?

NAME: PREFIX, FIRST, `MIDDLE, LAST, SUFFIX

PROGRAMMER: RECORD NAME LOCATING DATABASE

SET A100 = 02 (A100)

(A80 = 03)

A82. Do you have that person’s name and/or telephone number? If you don’t have all the information please tell me what you can.

YES 01

NO 00 SET A102 = 07 (A102)

(A82 = 01)

A83.

PREFIX, FIRST, MIDDLE, LAST, SUFFIX

DON’T KNOW d

REFUSED r

Please give me the telephone number, area code first.

TELEPHONE NUMBER: I__I__I__I – I__I__I__I – I__I__I__I__I

DON’T KNOW d

REFUSED r

PROGRAMMER: STORE PROXY NAME AND PHONE NUMBER IN LOCATING DATABASE.

IF BOTH NAME AND PHONE NUMBER REFUSED, SET A106 = 05 (A106)

(A83 = ANSWER)

A84. PROGRAMMER: WHAT KIND OF PROXY CONTACT INFORMATION DOES A83 CONTAIN?

VALID PHONE NUMBER 01 SET A101 = 02 (A101)

INVALID PHONE NUMBER 02 SET A106 = 05 (A106)

NO PHONE NUMBER 03 SET A106 = 05 (A106)

CALL TO NEW PROXY/NEW PROXY COMES TO PHONE

(A1 = 13) OR (A56 = 01 OR O2) OR (A80 = 01)

A85. {IF (A56 = 01 OR 02) OR (A80 = 01) USE Hello, my name is ________________, calling on behalf of the Social Security Administration.} Recently, Social Security contacted {NAME} about an important survey we are conducting for them. The National Beneficiary Survey is about beneficiaries’ health, daily activities, and any jobs they might have. Congress requires that Social Security conduct this study. I’ve been told that you are knowledgeable about these topics and are the best person to answer the survey on behalf of {NAME}.

The interview will take from 45 to 60 minutes. In appreciation for your time, we will mail you a check for $10.00 when we finish the interview. Would you be able to help us?

YES 01

CALL BACK LATER 02 SET A100 = 02 (A100)

DON’T KNOW d SET A106 = 03 (A106)

REFUSED r SET A105 = 03 (A105)

(A85=01)

A85a. Before we start, please tell me your name.

FIRST, MIDDLE, LAST

DON’T KNOW d

REFUSED r

NEW PROXY/ NEW PROXY COMES-TO-PHONE COGNITIVE TEST

(A85 = 01)

A86. Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be sure my explanation was clear.

Here’s the first explanation. The survey asks about {NAME’s} health, daily activities, and any jobs {he/she} might have. Please tell me in your own words what the survey is about.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “LISTS NONE”

LISTS NONE 00

LISTS ONLY 1 TOPIC 01

LISTS ANY 2 TOPICS 02 (A89)

LISTS 3 TOPICS 03 (A89)

REFUSED r SET A105 = 03 (A105)

A87 IS DELETED

(A86= 00 OR 01)

A88. INTERVIEWER YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.

Let’s try that again. The survey asks about {NAME}’s health, daily activities, and any jobs {he/she} might have. Please tell me in your own words what the survey is about.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”

LISTS NONE 00 (A92)

LISTS ONLY 1 TOPIC 01 (A92)

LISTS ANY 2 TOPICS 02

LISTS 3 TOPICS 03

REFUSED r SET A105 = 03 (A105)

(A86 = 02 OR 03) OR (A88 = 02 OR 03)

A89. Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do not like and you can stop the interview at any time you choose. Whether you choose to take part or not, {NAME’s} disability benefits will not be affected in any way.

When I say your taking part is completely voluntary, what does that mean to you?

PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01 (A90)

INACCURATE ANSWER 02

REFUSED r SET A105 = 03 (A105)

(A89 = 02)

A89a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.

Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do not like and you can stop the interview at any time you choose. Whether you choose to take part or not, {NAME’s} disability benefits will not be affected in any way. When I say your taking part is completely voluntary, what does that mean to you?

PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01

INACCURATE ANSWER 02 (A92)

REFUSED r SET A105 = 03 (A105)

(A89a = 01)

A90. Here’s the last explanation. All your answers will be kept confidential and used only for the research purposes of the study. When I say that your answers will be kept confidential, what does that mean to you?

PROBE: IF RESPONDENT SAYS: It is confidential, PROBE: What does that mean?

INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01 SET A110 = 02 (A110)

INACCURATE ANSWER 02

REFUSED r SET A105 = 03 (A105)

(A90 = 02)

A90a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.

Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the study.

When I say that your answers will be kept confidential, what does that mean to you?

PROXY: IF RESPONDENT SAYS: It is confidential, PROBE: What does that mean?

INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.

INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”

ACCURATE ANSWER 01 SET A110 = 02 (A110)

INACCURATE ANSWER 02 (A92)

REFUSED r SET A105 = 03 (A105)

A91 IS DELETED

(A88 = 00 OR 01) OR (A89a = 02) OR (A90a = 02)

A92. Thanks for your patience. There seems to be a problem and I need to check with my supervisor about what to do next. My supervisor will get back to you.

PROXY FAILED COGNITIVE TEST 01 SET A106 = 04 (A106)

CALL BACK LATER TO SAME NUMBER (INTERIM)

(A1 = 04) OR (A3 = 02) OR (A5 = 02) OR (A7a = 01) OR (A8 = 03) OR (A9=03) OR (A10 = 03) OR (A12 = 02) OR (A14 = 04) OR (A17 = 01, 02, 03 OR 04) OR (A18=01 or 02 or 03) OR (A20 = 02; OR A27b = 01) OR (A28 = ANSWER) OR (A47 = ANSWER) OR (A52 = 01) OR (A55 = 02) OR (A56 = 03) OR (A57 = 02) OR (A58 = 02) OR (A81 = ANSWER) OR (A84 = 01) OR (A85 = 02)

A100. (INTERNAL VARIABLE – NOT DISPLAYED FOR USER – SHOW FOR TESTING PURPOSES ONLY)

PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.

START NEXT SCREENER AT…

{YOUR NAME} 01 A0 = 01

{PROXY NAME} 02 A0 = 10

{INTERPRETER NAME} 03 A0 = 14

{NAME} using TTY 04 A0 = 08

{NAME} using Relay 05 A0 = 07

{NAME} using a phone amplifier 06 A0 = 09

{NEW PROXY NAME} AFTER FIRST PROXY FAILED COGNITIVE TEST 07 A0 = 10

{NAME} at {IF A1 = 07; OR A2 = 07; OR A4b = 07;
OR A13a = 08 FILL HOSPITAL NAME FROM A28/
IF A1 = 11; OR A2 = 11; OR A4b = 09; OR A13a = 07 FILL INSTITUTION NAME FROM A28 08 A0 = 01

IF A4a = 02 AND A6 = ANSWER {NEW INTERPRETER NAME} 09 A0 = 15

PROGRAMMER: SEND TO CALLBACK SCREEN AND INTERVIEWER WILL SET CALL BACK STATUS THERE.

GO TO END

NEW PHONE NUMBER FOR NAME/PROXY/LEAD TO NAME/LEAD TO PROXY

(A36 = 01) OR (A38 = ANSWER) OR (A52 = 01) OR (A62 = 03, 05, OR 09) OR (A84 = 03, 05, OR 09)

A101. Thank you very much; we will be calling {NAME/PROXY/LEAD FROM BELOW} shortly.

PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND 01 OR 02 VALUES BELOW. 03 SHOULD NOT BE DISPLAYED.

START NEXT SCREENER AT…

{NAME} 01 A0 = 01

{PROXY} WHO LIVES ELSEWHERE 02 A0 = 10

LEAD 03 SET A106 = 06 (A106)

A101a. PROGRAMMER: GO TO END.

SEND TO LOCATING: NAME OR PROXY (INTERIM)

(A1 = 14) OR (A2 = 14) OR (A4b = 11) OR (A24 = 00) OR (A36 = 00) OR (A37 = 00 OR d) OR (A52 = 00) OR (A56 = 07) OR (A62 = 01, OR 02) OR (A72 = 00) OR (A82 = 00) OR (A84 = 01, 02, 04, 05, 07, OR 08)

A102. Thank you very much. Goodbye.

PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.

INTERVIEWER: PRESS 1 TO CONTINUE

START NEXT SCREENER AT…

{NAME}: NO SUCH PERSON HERE 01 SET STATUS = 530 (END) A0 = 01

{NAME}: NEED PHONE NUMBER ONLY 02 SET STATUS = 530 (END) A0 = 01

{NAME} NEED ALL CONTACT INFORMATION 03 SET STATUS = 530 (END) A0 = 01

{NAME} FAILED VERIFICATION – FIND NAME 04 SET STATUS = 530 (END) A0 = 01

{PROXY}: NO SUCH PERSON HERE 05 SET STATUS = 380 (END) A0 = 13

{PROXY}: NEED PHONE NUMBER 06 SET STATUS = 380 (END) A0 = 13

PROGRAMMER: FOR 05 – 06 SUPERVISOR WILL SET NEXT STARTING QUESTION AND MAY OVERWRITE CODES

INELIGIBLE (INTERIM / POSSIBLE FINAL)

(A1 =09, 12, OR 18) OR (A2 = 09, 12, OR 18) OR (A4b = 08,10, OR 14) OR (A13a = 06, 10 OR 11) OR (A26 = 01) OR

(A33 = 01)

A103. Thank you for explaining. That’s all the questions we have for you. Goodbye.

PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.

NOTE: PROGRAMMER, THESE CASES ARE INTERIM UNTIL AFTER SUPERVISOR REVIEW. THEY WILL NOT CYCLE THROUGH THE SCREENER AGAIN UNLESS SUPERVISOR/PROGRAMMER RESETS CASE STATUS.

INTERVIEWER: PRESS ENTER TO CONTINUE

INCARCERATED 01 SET STATUS = 421 (END)

IN ACTIVE MILITARY 02 SET STATUS = 422 (END)

LIVING OUTSIDE THE USA 03 SET STATUS = 461 (END)

(A1=08) OR (A2=08) 0R (A4b=07) OR (A13a=09)

A103a. I am sorry to hear {NAME} has passed away. I was calling about a study we are conducting for the Social Security Administration. You might have seen a letter we recently sent [NAME} explaining the study. When did {NAME} pass away?

|__|__| / |__|__| / |__|__|__|__|

MONTH DAY YEAR

(1 – 12) (1 – 31) (2000 – 2009)

DON’T KNOW d

REFUSED r

Thank you. Please accept my condolences. Goodbye.

PROGRAMMER: SET STATUS = 440

GOTO END

BARRIERS TO PARTICIPATION – (INTERIM NON-RESPONSE / POSSIBLE FINAL NON-RESPONSE)

(A1 = 17) OR (A2 = 17) OR (A4b = 13) OR (A46 = 05, 06, 07, 08, OR 09) OR (A56 = 06)

A104. Thank you very much for explaining. That’s all the questions I have. Thanks for your time. Goodbye.

PROGRAMMER: DISPLAY ONLY APPROPRIATE TEXT AND VALUE BELOW.

PROGRAMMER, THESE CASES ARE INTERIM UNTIL AFTER SUPERVISOR REVIEW. THEY WILL NOT CYCLE

THROUGH THE SCREENER AGAIN UNLESS SUPERVISOR/PROGRAMMER RESETS CASE STATUS.

INTERVIEWER: PRESS ENTER TO CONTINUE

HOSPITALIZED 01 SET STATUS = 420 (END)

INSTITUTIONALIZED 02 SET STATUS = 420 (END)

COGNITIVE BARRIER 03 SET STATUS = 412 (END)

HEARING/SPEECH BARRIER 04 SET STATUS = 411 (END)

PHYSICAL BARRIER 05 SET STATUS = 410 (END)

UNAVAILABLE DURING FP 06 SET STATUS = 430 (END)

FINAL LANGUAGE BARRIER 07 SET STATUS = 400 (END)

REFUSALS (INTERIM / FINAL)

(IF ANY OF THE FOLLOWING QUESTIONS = r: A1, A2, A4b, A5, A8, A9, A10, A12, A13a, A14, A17, A18, A20, A21, A22, A27b, A29, A30, A37, A40, A41, A43, A44, A45, A46, A48, A49, A50, A53, A56, A57, A58, A60, A61, A66, A67, A67a, A68, A74, A76, A77, A78, A78a, A80, A85, A86, A88, A89, A89a, A90, A90a)

A105. Thank you for your time. Goodbye.

PROGRAMMER: GO TO REFUSAL SCREEN SO INTERVIEWER CAN RECORD REASON FOR REFUSAL. WHILE THE CASE IS STILL IN INTERIM STATUS, THESE CASES WILL BE SUBJECT TO CALL SCHEDULER RULES THAT WILL DETERMINE WHETHER AND WHEN TO START THE NEXT SCREENER CALL (A0 – 01 OR A0 = 10) OR SET AS 860 (END) (REVIEW NEEDED FOR FIELD BY SUPERVISOR , AKA HOLD FOR CAPI)

START NEXT SCREENER AT:

{NAME} REFUSED 01 SET STATUS = 200 (REFUSAL SCREEN) A0 = 01

{UNKNOWN} REFUSED 02 SET STATUS = 220 (REFUSAL SCREEN) A0 = 01

{PROXY} REFUSED 03 SET STATUS = 210 (REFUSAL SCREEN) A0 = 10

INTERVIEWER: PRESS ENTER TO RECORD REASONS FOR REFUSAL IN REFUSAL SCREEN.

SUPERVISOR REVIEW (INTERIM)

(A1 = 15) OR (A2 = 15) OR (A3 = 03 OR r) OR (A4 = r) OR (A4a = 03 OR r) OR (A4b = 03 OR 12) OR (A15 = ANSWER) OR (A18 = 05 OR d) OR (A24 = r) OR (A26=r) OR (A28 = r) OR (A29 = r) OR (A47 =d OR r) OR (A50 = 2) OR (A51 = r) OR (A56 = 05 OR 08) OR (A60 = 00 OR d) OR (A80 = 04 OR d) OR (A101 = 03)

A106. Thank you for your time. Goodbye.

INTERVIEWER: IF CASE NEEDS A SPANISH INTERVIEWER, PLEASE RECORD IN APPOINTMENT OR EXIT, AS APPROPRIATE.

POSSIBLE LANGUAGE PROBLEM 01 SET STATUS = 380 (END)

CALL INFORMANT TO SET TTY/RELAY CALL BACK TIME 02 SET STATUS = 380 (END)

NEED TO LOCATE NEW PROXY 03 SET STATUS = 380 (END)

PROXY FAILED COGNITIVE TEST / NO OTHER PROXY AVAILABLE 04 SET STATUS = 380 (END)

OTHER SUPERVISOR REVIEW 05 SET STATUS = 380 (END)

CALL LEAD FOR NAME/PROXY INFO 06 SET STATUS = 380 (END)

HOLD FOR CAPI (INTERIM - REQUIRES SUPERVISOR REVIEW)

(A29 = ANSWER) OR (A45 = 01,02, OR d)

A107. Thank you very much. Our field interviewer will call to arrange a time for the interview.

PROGRAMMER: IN ADDITION TO THESE CASES BEING HELD FOR CAPI, REFUSALS AND UNLOCATABLES WILL ALSO BE HELD FOR CAPI UNDER CERTAIN CIRCUMSTANCES THAT THE SUPERVISORS WILL DECIDE. NOTE ALSO THAT ALL CAPI CASES WILL START THE CAPI SCREENER AT A0 = 01.

INTERVIEWER: PRESS 1TO CONTINUE

HOLD FOR CAPI 0 SET STATUS = 860 (END) A0 = 01

RESPONDENT WILL CALL MPR (INTERIM)

(A10 = 02) OR (A17 = 05 OR 06)

A108. Thanks for offering to call in. Please write down our toll-free number. {IF (A10 = 02 OR A17 = 06) FILL 877-293-5740. / IF (A17 = 05) FILL Call 877-293-5741 for a TTY interview.} We are available days, evenings, and weekends. If you call after hours, please leave a message and we will get back to you the next day.

INTERVIEWER: PRESS ENTER TO CONTINUE

{NAME} WILL CALL 01 SET STATUS = 830 (END) A0 = 02

{NAME} WILL CALL/TTY 02 SET STATUS = 830 (END) A0 = 08

{NAME} WILL CALL/RELAY 03 SET STATUS = 830 (END) A0 = 07

REQUEST FOR LETTER (INTERIM)

(A22 = 01) OR (A25 = 00) OR (A26 = r) OR (A59 = 02)

A109. You should receive the letter in about a week. Thank you for your time. Goodbye.

INTERVIEWER: PRESS 1 TO CONTINUE

START NEXT SCREENER AT…

{NAME} REQUESTS LETTER 01 SET STATUS = 831 (END) A0 = 04

PROXY REQUESTS LETTER 02 SET STATUS = 831 (END) A0 = 11

CONTINUE WITH INTERVIEW

(A78a = 01) OR (A90a = 01)

A110. RESPONDENT CHECK SCREEN

INTERVIEWER: WE SHOW THE RESPONDENT IS

(IF A73 = 01, 02; OR A73 = 03 AND A78a = 01 FILL {NAME}

(IF A73 = 04 OR 05 AND A78a = 01; OR A90a = 01 FILL PROXY

INTERVIEWER: IS THIS INFORMATION CORRECT?

YES 01 (B1)

NO 00

(A110 = 00)

A110a. INTERVIEWER: WHO IS THE RESPONDENT?

SAMPLE MEMBER 01 (B1)

PROXY 02

SECTION B: DISABILITY AND CURRENT WORK STATUS

DISABILITY STATUS

(All)

B1.

First, I have some questions about how {your/NAME’s} health affects {your/his/her} daily activities.

Does a physical or mental condition limit the kind or amount of work or other daily activities {you/NAME} can do?

PROBE 1: In other words, are there things {you/NAME} can’t do as much or can’t do at all that people the same age can?

PROBE 2: Daily activities include cooking, shopping, getting around the home, paying bills, or working at a job.

YES 01

NO 00 (B5)

DON’T KNOW d (B5)

REFUSED r (B5)

(B1=01)

B2. What physical or mental condition is the main reason {you are/NAME is} limited?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name do doctors call {your/NAME’s} health condition?

PROBE 2: What causes this condition?

<OPEN>

DON’T KNOW d

REFUSED r

(B1=01)

B3. {Do you/Does NAME} have any other physical or mental conditions that limit the kind or amount of work or other daily activities {you/he/she} can do?

PROBE 1: In other words, are there things {you/NAME} can’t do as much or can’t do at all that people the same age can?

PROBE 2: Daily activities include cooking, shopping, getting around the home, paying bills, or working at a job.

YES 01

NO 00 (B18_age)

DON’T KNOW d (B18_ age)

REFUSED r (B18_ age)

(B1=01 and B3=01)

B4. What are those conditions?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name do doctors call {your/NAME’s} health condition?

PROBE 2: What causes this condition?

<OPEN>

DON’T KNOW d

REFUSED r

GO TO B18_age

(B1=00, d, r)

B5. {Are you/Is NAME} currently receiving disability benefits from Social Security?

YES 01

NO 00 (B9)

DON’T KNOW d (B9)

REFUSED r (B9)

(B1=00, d, r and B5=01)

B6. What physical or mental condition is the main reason {you are/NAME is} eligible for disability benefits?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name do doctors call {your/NAME’s} health condition?

PROBE 2: What causes this condition?

<OPEN>

DON’T KNOW d

REFUSED r

(B1=00, d, r and B5=01)

B7. {Do you/Does NAME} have any other physical or mental conditions that make {you/him/her} eligible for disability benefits?

YES 01

NO 00 (B18_age)

DON’T KNOW d (B18_ age)

REFUSED r (B18_ age)

(B1=00, d, r and B5=01 and B7=01)

B8. What are those conditions?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name do doctors call {your/NAME’s} health condition?

PROBE 2: What causes this condition?

<OPEN>

DON’T KNOW d

REFUSED r

GO TO B18_ age

(S2=01) and (B1=00, d, r and B5=00,d, r)

B9. {Have you/Has NAME} received disability benefits from Social Security at any time during the last five years?

YES 01 (B11)

NO 00

DON’T KNOW d

REFUSED r

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=00,d,r)

B10. We are only interviewing people who have received disability benefits in the past five years. I need to check with my supervisor and get back to you. Thank you for your help.

PRESS 1 TO CONTINUE 01

END CALL. STATUS ”SUPERVISOR REVIEW 380.”

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01)

B11. {Do you/Does NAME} still have the physical or mental conditions that made {you/him/her} eligible for Social Security disability benefits?

YES 01

NO 00 (B15)

DON’T KNOW d (B15)

REFUSED r (B15)

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01 and B11=01)

B12. What physical or mental condition is the main reason {you were/NAME was} eligible for disability benefits?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name do doctors call {your/NAME’s} health condition?

PROBE 2: What causes this condition?

<OPEN>

DON’T KNOW d

REFUSED r

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01 and B11=01)

B13. {Do you/Does NAME} have any other physical or mental conditions that made {you/him/her} eligible for disability benefits?

YES 01

NO 00 (B18_age)

DON’T KNOW d (B18_age)

REFUSED r (B18_age)

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01 and B11=01 and B13=01)

B14. What are those conditions?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name do doctors call {your/NAME’s} health condition?

PROBE 2: What causes this condition?

<OPEN>

DON’T KNOW d

REFUSED r

GO TO B18_age

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01 and B11=00,d,r)

B15. What physical or mental condition was the main reason {you were/NAME was} limited when {you/he/she} first started getting disability benefits from Social Security?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name did doctors call {your/NAME’s} health condition?

PROBE 2: What caused this condition?

<OPEN>

DON’T KNOW d

REFUSED r

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01 and B11=00,d,r)

B16. Did {you/NAME} have any other physical or mental conditions that limited the kind or amount of work or other daily activities {you/he/she} could do when {you/he/she} first started getting disability benefits?

YES 01

NO 00 (B18_age)

DON’T KNOW d (B18_age)

REFUSED r (B18_age)

(S2=01) and (B1=00, d, r and B5=00,d,r and B9=01 and B11=00,d,r and B16=01)

B17. What were those conditions?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: By what name did doctors call {your/NAME’s} health condition?

PROBE 2: What caused this condition?

<OPEN>

DON’T KNOW d

REFUSED r

(S2=01)

B18_age. How old {were you/was NAME} when {you/he/she} first became limited in the kind or amount of work or other daily activities {you/he/she} could do? Your best estimate is fine.

INTERVIEWER: IF AGE IS NOT KNOWN, ENTER ‘99’ TO PROBE FOR A YEAR.

INTERVIEWER: IF LESS THAN ONE YEAR OR SINCE BIRTH, ENTER ‘0’ IN AGE.

|__|__| (B20 IF AGE 0-64)

AGE

(0-64) (or ‘99’ to probe for year)

SINCE BIRTH 00 (B20)

DON’T KNOW d (B19)

REFUSED r (B19)

(S2=01) and (B18_age=99)

B18_year.

PROBE: READ IF NECESSARY: In what year?

|__|__|__|__|

YEAR

(1933-2009) (B20)

DON’T KNOW d

REFUSED r

(S2=01) and (B18_age=d, r) or (B18_age=99 and B18_year=d,r)

B19. Did {you/NAME} become limited before the age of 18 or after age 18?

PROBE: Your best guess is fine.

LESS THAN 18 01

18 OR OLDER 02

DON’T KNOW d

REFUSED r

PROGRAMMER: CALCULATE AGE OF ONSET BASED ON B18_AGE AND B18_YEAR:

If B18_age=0-64, then B18_age_calc=B18_age. Else if B18_age=99 and B18_yr ≠ d or r and B18_year=A68b, B18_age_calc=0. Else if B18_age=99 and B18_yr ≠ d or r and B18_year ≠ A68b, B18_age_calc= B18yr - A68b. Else, if B18_age=99 and B18_yr=d or r, B18_age_calc= B18_yr. Else, if B18_age=d or r, B18_age_calc=B18_age.

(S2=01

B20. SOFT EDIT: B18_age_calc SHOULD NOT EXCEED CURRENT AGE. IF B18_age_calc>CURRENTAGE_ TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER: AGE OF DISABILITY ONSET IS GREATER THAN CURRENT AGE. CHECK ENTRY. IF NECESSARY READ: I must have recorded an incorrect answer. I show that {you are/NAME is} now (CURRENTAGE), and {you/he/she} became limited when {you were/(he/she) was} (B18_age_calc). Should I change {your/NAME’s} the age when {you/NAME} first became limited?

CHANGE AGE WHEN FIRST BECAME LIMITED 01

(CHANGE B18_age) SUPPRESS 02

(S2=01

B21. CHECK: HAS {NAME} BEEN LIMITED SINCE ADULTHOOD ( B18_age_calc NE D OR R, AND B18_age_calcIS > OR = 18) OR (IF B18_age_calc=D OR R and B19=02)?

YES 01

NO 00 (B23_2)

(S2=01and (B21=01)

B22. {Were you/Was NAME} working at a job for pay when {you/he/she} first became limited?

YES 01

NO 00 (B24)

DON’T KNOW d (B24)

REFUSED r (B24)

(S2=01) and (B21=01 and B22=01)

B23. Did the job {you/NAME} had at that time require {you/him/her} to use a computer?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(ALL)

B23_2 . How often do you {now} use a computer to access the Internet or World Wide Web?

Never 01 (B24)

Daily 02

A few times a week 03

Once a week 04

Less than once a week 05

DON’T KNOW d

REFUSED r

B23_3. Have you ever used a computer to access information about your disability, services, or work-related information via the Internet?

YES 01

NO 00

DON’T KNOW d

REFUSED r

CURRENT WORK STATUS

(All)

B24. These next questions are about {your/NAME’s} personal goals and {your/his/her} current work-related activities. {Are you/Is NAME} currently working at a job or business for pay or profit?

YES 01 (B30)

NO 00

DON’T KNOW d

REFUSED r

B25. ITEM MOVED TO FOLLOW B29_10_Other

B26. ITEM MOVED TO FOLLOW B25

B27. ITEM MOVED TO FOLLOW B26

(B24=00,d,r)

B28. {Have you/Has NAME} been looking for work during the last four weeks?

YES 01

NO 00 (B25, new position)

DON’T KNOW d (B25, new position)

REFUSED r (B25, new position)

(B28=01)

B28a. Are {you/NAME} looking for part-time or full-time work?

FULL-TIME 01 (B29)

PART-TIME 02

DON’T KNOW d (B29)

REFUSED r (B29)

(B28=01)

B28b. About how many hours per week would {you/NAME} like to work?

|__|__| (1-60) (1-168)

HOURS

DON’T KNOW d

REFUSED r

(B28=01)

B29. Next, I am going to read you a list of things that some people do to look for work. Please tell me whether or not {you/NAME} did any of these things during the last four weeks. To look for work in the last four weeks did {you/NAME}:

YES NO DK REF

a. Contact {your/NAME’S} state’s unemployment office? 01 00 d r

b. Ask friends or relatives? 01 00 d r

c. Look through job advertisements in a newspaper or on the Internet? 01 00 d r

d. Contact the State Vocational Rehabilitation Agency or {VRNAME
FROM {NAME’S} CURRENT STATE}? 01 00 d r

e. Contact a local independent living center? 01 00 d r

f. Contact a private employment agency or program? 01 00 d r

g. Contact any employers in person, by mail, or by phone? 01 00 d r

h. Do anything else that I didn’t mention? 01 00 d r

PROGRAMMER: IF B29h=01, GO TO B29h_OTHERWISE, GO TO B29_1a.

(B28=01 and B29_h=01)

B29h_Other. What was it?

INTERVIEWER: PLEASE SPECIFY

<OPEN>

DON’T KNOW d

REFUSED r

(B28=01)

B29_1a. {Have/Has} {you/NAME} received any job offers within the past four weeks?

YES 01

NO 00 (B29_7)

DON’T KNOW d (B25, new position)

REFUSED r (B25, new position)

NEW ITEM

(B29_1a=01)

B29_1b. Did {you/NAME} turn any of these job offers down?

YES 01

NO 00 (B30)

DON’T KNOW d (B25, new position)

REFUSED r (B25, new position)

NEW ITEM

(B29_1a=01 and B29_1b=01)

B29_2. Now, I am going to read you a list of reasons why people sometimes do not accept a job offer. Please tell me if any of these are reasons why {you/NAME} did not accept a job that {you/he/she} {were/was} offered in the past four weeks.

YES NO DK REF

a. {You/NAME} would have needed special equipment or medical devices that {you do / he does /she does} not currently have in order to do the work 01 00 d r

b. [You/NAME} did not have the personal assistance [you/he/she] needed to get ready for work each day
(Example if needed: This includes things like dressing and bathing) 01 00 d r

c. {You/NAME} could not get the help that {you/he/she] needed caring for children or others 01 00 d r

d. {You/NAME} did not have reliable transportation to and from the job 01 00 d r

e. The job did not offer a flexible enough schedule 01 00 d r

f. The job {you/NAME} {were/was} offered did not pay enough 01 00 d r

g. The job did not offer health insurance benefits 01 00 d r

h. {You/NAME} would have lost benefits (you need /he needs /she needs) like Social Security, disability insurance, workers’ compensation, or Medicaid, if [you/he/she] accepted the job 01 00 d r

i. Is there anything else that I did not mention that made {you/NAME} turn down a recent job offer 01 00 d r

(B29_2_i=01)

B29_2_i_Oth. What other reasons?

<OPEN>

DON’T KNOW d

REFUSED r

(B29_1a=01 and B29_1b=01)

B29_2CHECK.CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?

YES 01 (B29_5CHECK)

NO 00

(B29_1a=01 and B29_1b=01 AND RTYPE=01)

B29_3CHECK: IS PAY A REASON RESPONDENT DID NOT ACCEPT JOB (B29_2f=01)?

YES 01 (B29_3a)

NO 00 (B29_3b)

NEW ITEM

(B29_2f=01 AND RTYPE=01)

B29_3a. You said that one of the reasons you did not accept a job you were offered was because it did not pay enough. What is the lowest wage or salary you would have accepted for this job?

INTERVIEWER: Read only if necessary, otherwise code:

$|__| |__|__|__|.|__|__|

DON’T KNOW d (B29_5CHECK)

REFUSED r (B29_5CHECK)

B29_3ahop. Is this:

HOURLY 01 (1-25) (1-300) (B29_5CHECK)

DAILY 02 (1-384) (1-1,922) (B29_4a)

WEEKLY 03 (1-1,923) (1-9,615) (B29_4a)

BI-WEEKLY 04 (1-4,166) (1-20,833) (B29_4a)

TWICE A MONTH 05 (1-4,166) (1-20,833) (B29_4a)

MONTHLY 06 (1-8,333) (1-41,666) (B29_4a)

ANNUALLY 07 (1-100,000) (1-500,000) (B29_4a)

DON’T KNOW d (B29_4a)

REFUSED r (B29_4a)

NEW ITEM

(B29_2f=00, d, OR r AND RTYPE=01)

B29_3b. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary you would be willing to accept for such a job?

INTERVIEWER: If they hesitate or seem to be having difficulty, add: If you have no idea, just say so.

INTERVIEWER: Read only if necessary, otherwise code:

$|__| |__|__|__|.|__|__|

DON’T KNOW d (Skip to B29_5CHECK)

REFUSED r (Skip to B29_5CHECK)

B29_3bhop Is this:

HOURLY 01 (1-25) (1-300) (B29_5CHECK)

DAILY 02 (1-384) (1-1,922) (B29_4a)

WEEKLY 03 (1-1,923) (1-9,615) (B29_4a)

BI-WEEKLY 04 (1-4,166) (1-20,833) (B29_4a)

TWICE A MONTH 05 (1-4,166) (1-20,833) (B29_4a)

MONTHLY 06 (1-8,333) (1-41,666) (B29_4a)

ANNUALLY 07 (1-100,000) (1-500,000) (B29_4a)

DON’T KNOW d (B29_4a)

REFUSED r (B29_4a)

PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_3ahop or B29_3bhop OUT OF RANGE

B29_3check: Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary you would have accepted for this job is [insert ((B29_3a and B29_3ahop) OR (B29_3b and B29_3hop)). Is this correct?”

CHANGE LOWEST WAGE OR SALARY 01 (CHANGE B29_3a

OR B29_3b)

CHANGE PAY PERIOD 02 (CHANGE B29_3ahop

OR B29_3bhop)

SUPPRESS 03

NEW ITEM

(B29_3ahop=02, 03, 04, 05, 06, d or r) or (B29_3bhop=02, 03, 04, 05, 06, d, or r)

B29_4a. How many hours per week would you expect to work for this amount of pay?

|__|__| (Skip to B29_5CHECK)

HOURS

(1-99)

DON’T KNOW d (B29_4b)

REFUSE r (B29_4b)

NEW ITEM

(B29_4a=d or r)

B29_4b. Would you expect to work full-time or part-time?

Full-time 01

Part-time 02

Don’t know d

Refused r

(B29_1a=01 and B29_1b=01)

B29_5CHECK. IS LOSING BENEFITS REASON DID NOT ACCEPT JOB (B29_h=1)?

YES 01 (B29_5)

NO 00 (B30)

NEW ITEM

(B29_2 h=1)

B29_5. You said that one of the reasons {you/NAME} did not accept a job was because (you/he/she) would have lost benefits (you/he/she) needed such as Social Security, disability insurance, workers’ compensation, or Medicaid. There are many ways people find out about how working will affect their benefits. For example, some people call the Social Security office, some search the Internet, and others contact disability service organizations. Did {you/NAME} contact anyone or do any of these things in order to find out how [your/his/her] benefits would be affected if {you/he/she} went to work?

YES 01

NO 00

DON’T KNOW d

REFUSED r

NEW ITEM

(B29_2 h=1)

B29_6. What benefits {were/was} {you/NAME} most worried about losing?

INTERVIEWER: MARK ALL THAT APPLY

PRIVATE DISABILITY INSURANCE 01

WORKERS’ COMPENSATION 02

VETERANS’ BENEFITS 03

MEDICARE 04

MEDICAID 05

SSA DISABILITY BENEFITS 06

PUBLIC ASSISTANCE OR WELFARE 07

FOOD STAMPS 08

PERSONAL ASSISTANCE SERVICES (PAS) 09

UNEMPLOYMENT BENEFITS 10

OTHER STATE DISABILITY BENEFITS 11

OTHER GOVERNMENT PROGRAMS 12

OTHER 13

(B29_6=13)

B29_6_Other: What other benefits?

<OPEN>

DON’T KNOW d

REFUSED r

GO TO B30

NEW ITEM

(B29_1a=00)

B29_7. Now, I am going to read you a list of reasons why people are sometimes unable to find a job. Please tell me if any of these are reasons why {you/NAME} {have/has} not found a job that {you/he/she} {think/thinks} is right for {you/him/her}.

YES NO DK REF

a. {You/NAME} would need special equipment or medical devices

to work which {you do /he does /she does} not currently have. 01 00 d r

b. [You/NAME} [do/does] not have the personal assistance [you/he/she] [need/needs] to get ready for work each day

(Example if needed: This includes things like dressing and bathing). . 01 00 d r

c. {You/NAME} cannot get the help that {you need/ he needs/ she needs] caring for children or others. 01 00 d r

d. {You/NAME] [do/does] not have reliable transportation to and from work 01 00 d r

e. The jobs that are available do not offer a flexible enough schedule. 01 00 d r

f. {You/NAME} cannot find a job {you are/he is/she is} qualified for. 01 00 d r

g. The jobs that are available do not pay enough. 01 00 d r

h. Employers will not give {you/NAME} a chance to show that {you/he/she} can work. 01 00 d r

i. The jobs that are available do not offer health insurance benefits. 01 00 d r

j. {You/NAME} would lose benefits (you need / he needs / she needs) like Social Security, disability insurance, workers’ compensation, or Medicaid if {you/he/she} took a job. 01 00 d r

k. Is there anything else that I did not mention that is a reason why (you/Name) (have/has) not been able to find a job? . 01 00 d r

(B29_7_k=01)

B29_7_k_Oth. What other reasons?

<OPEN>

DON’T KNOW d

REFUSED r

(B29_1a=00)

B29_7CHECK. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?

YES 01 (B29_9CHECK)

NO 00

(B29_1a=00 AND RTYPE=01)

B29_8CHECK: IS PAY A REASON RESPONDENT DID NOT ACCEPT JOB (B29_7g=1)?

YES 01 (B29_8a)

NO 00 (B29_8b)

NEW ITEM

(B29_7g=1 AND RTYPE=01)

B29_8a. You said that one of the reasons you are unable to find a job is that the jobs that are available do not pay enough. What is the lowest wage or salary you would accept for a job that matched your current needs and abilities?

INTERVIEWER: Read only if necessary, otherwise code:

$||__| |__|__|__|.|__|__|

DON’T KNOW d (B29_9CHECK)

REFUSED r (B29_9CHECK)

B29_8ahop. Is this:

HOURLY 01 (1-25) (1-300) (B29_9CHECK)

DAILY 02 (1-384) (1-1,922) (B29_8c)

WEEKLY 03 (1-1,923) (1-9,615) (B29_8c)

BI-WEEKLY 04 (1-4,166) (1-20,833) (B29_8c)

TWICE A MONTH 05 (1-4,166) (1-20,833) (B29_8c)

MONTHLY 06 (1-8,333) (1-41,666) (B29_8c)

ANNUALLY 07 (1-100,000) (1-500,000) (B29_8c)

DON’T KNOW d (B29_8c)

REFUSED r (B29_8c)

NEW ITEM

(B29_7g=00, d, OR r AND RTYPE=01)

B29_8b. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary you would be willing to accept for such a job?

INTERVIEW: IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: If you have no idea, just say so.

IF R SAYS HAS NO INTEREST IN WORKING, CODE AS DON’T KNOW.

INTERVIEWER: Read only if necessary, otherwise code:

$||__| |__|__|__|.|__|__|

DON’T KNOW d (B29_9CHECK)

REFUSED r (B29_9CHECK)

B29_8bhop. Is this:

HOURLY 01 (1-25) (1-300) (B29_9CHECK)

DAILY 02 (1-384) (1-1,922) (B29_8c)

WEEKLY 03 (1-1,923) (1-9,615) (B29_8c)

BI-WEEKLY 04 (1-4,166) (1-20,833) (B29_8c)

TWICE A MONTH 05 (1-4,166) (1-20,833) (B29_8c)

MONTHLY 06 (1-8,333) (1-41,666) (B29_8c)

ANNUALLY 07 (1-100,000) (1-500,000) (B29_8c)

DON’T KNOW d (B29_8c)

REFUSED r (B29_8c)

PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_8ahop or B29_8bhop) OUT OF RANGE

B29_8check: Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary you would have accepted for this job is [insert ((B29_8a and B29_8ahop) OR (B29_8b and B29_8hop)). Is this correct?”

CHANGE LOWEST WAGE OR SALARY 01 (CHANGE B29_8a

OR B29_8b)

CHANGE PAY PERIOD 02 (CHANGE B29_8ahop

OR B29_8bhop)

SUPPRESS 03

NEW ITEM

(B28_8ahop=02, 03, 04, 05, 06, d, or r) or (B28_8bhop=02, 03, 04, 05, 06, d, or r)

B29_8c. How many hours per week would you expect to work for this amount of pay?

|__|__| (Skip TO B29_9CHECK)

HOURS

(1-99)

DON’T KNOW d (B29_8d)

REFUSED r (B29_8d)

NEW ITEM

(B29_8c=d or r)

B29_8d. Would you expect to work full-time or part-time?

FULL-TIME 01

PART-TIME 02

DON’T KNOW d

REFUSED r

(B29_1a=00)

B29_9CHECK. IS LOSING BENEFITS REASON DID NOT ACCEPT JOB (B29_7=j)?

YES 01 (B29_9)

NO 00 (B30)

NEW ITEM

(B29_7=j)

B29_9. You said that one of the reasons {you/NAME} {have/has} not been able to find a job is because {you/he/she} would lose benefits (you need / he needs / she needs) such as Social Security, disability insurance, workers’ compensation, or Medicaid if {you/he/she} did get a job. There are many ways people find out about how working will affect their benefits. For example, some people call the Social Security office, some search the Internet, and others contact disability service organizations. {Have/Has} {you/NAME} contacted anyone or done any of these things in order to find out how {your/his/her} benefits will be affected if {you/he/she} did go to work?

YES 01

NO 00

DON’T KNOW d

REFUSED r

NEW ITEM

(B29_7=j)

B29_10. What benefits {are/is} {you/NAME} most worried about losing?

INTERVIEWER: MARK ALL THAT APPLY

PRIVATE DISABILITY INSURANCE 01

WORKERS’ COMPENSATION 02

VETERANS’ BENEFITS 03

MEDICARE 04

MEDICAID 05

SSA DISABILITY BENEFITS 06

PUBLIC ASSISTANCE OR WELFARE 07

FOOD STAMPS 08

PERSONAL ASSISTANCE SERVICES (PAS) 09

UNEMPLOYMENT BENEFITS 10

OTHER STATE DISABILITY BENEFITS 11

OTHER GOVERNMENT PROGRAMS 12

OTHER 13

(B29_10=13)

B29_10_Other: What other benefits?

<OPEN>

DON’T KNOW d

REFUSED r

GO TO B30

(B28=00,d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r)

B25. Other beneficiaries have said that they are not working for a number of reasons. I am going to read you a list of these reasons. For each, please tell me if it is a reason why {you are/NAME is} not currently working. {Are you/ Is NAME} not working because PROBE: I need to read the entire list even though some of the reasons may not apply to {you/NAME}. If a reason does not apply to {you/NAME}, please just say so.

INTERVIEWER: IF RESPONDENTS SAYS 'DOES NOT APPLY' CODE AS 'NO'.

DON’T
YES NO KNOW REFUSED

A physical or mental condition prevents {you/NAME} from working. 01 00 d r
{You/NAME} cannot find a job that {you are/ he is /she is} qualified for. 01 00 d r
{You do/NAME does} not have reliable transportation to and from work. 01 00 d r
{You are/NAME is} caring for children or others. 01 00 d r
ITEM DELETED

{You/NAME} cannot find a job {you want/ he wants / she wants}. 01 00 d r
{You are/NAME is} waiting to finish school or a training program. 01 00 d r
Workplaces are not accessible to people with {your/NAME’s} disability. 01 00 d r
{You do/NAME does} not want to lose benefits (you need / he needs / she needs) like Social Security, disability insurance, workers’ compensation, or Medicaid. 01 00 d r
{Your/NAME’s} previous attempts to work have been discouraging. 01 00 d r
ITEM DELETED
Others do not think {you/NAME} can work. 01 00 d r

m. Employers will not give {you/NAME} a chance to show that {you/he/she} can work. 01 00 d r

n. {You/NAME} does not have the special equipment or medical devices that {you/he/she} would need in order to work. 01 00 d r

o. {You/NAME} cannot get the personal assistance [you need / he needs / she needs] in order to get ready for work each day (Example if needed: This includes things like dressing and bathing). 01 00 d r

(B28=00,d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r)

B26. Are there any other reasons why {you are/NAME is} not working that I did not mention?

YES 01

NO 00 (B29_11CHECK)

DON’T KNOW d (B29_11CHECK)

REFUSED r (B29_11CHECK)

(B26=01)

B27. What are they?

INTERVIEWER: ENTER VERBATIM RESPONSE

<OPEN>

DON’T KNOW d

REFUSED r

(B28=00,d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r)

B29_11CHECK. IS LOSING BENEFITS REASON DID NOT ACCEPT JOB (B25i=01)?

YES 01 (B29_11a)

NO 00 (B29_12CHECK)

NEW ITEM

(If B25i=01)

B29_11a. You said that one of the reasons {you/he/NAME} {are/is} not working is because {you do / he does / she does} not want to lose benefits (you need / he needs / she needs) such as Social Security, disability insurance, workers’ compensation, or Medicaid. There are many ways people find out about how working will affect their benefits. For example, some people call the Social Security office, some search the Internet, and others contact disability service organizations. Did {you/NAME} contact anyone or do any of these things in order to find out how {your/his/her} benefits would be affected if {you/he/she} went to work?

YES 01

NO 00

DON’T KNOW d

REFUSED r

NEW ITEM

(If B25i=01)

B29_11b. What benefits {were/was} {you/NAME} most worried about losing?

INTERVIEWER: MARK ALL THAT APPLY.

PRIVATE DISABILITY INSURANCE 01

WORKERS’ COMPENSATION 02

VETERANS’ BENEFITS 03

MEDICARE 04

MEDICAID 05

SSA DISABILITY BENEFITS 06

PUBLIC ASSISTANCE OR WELFARE 07

FOOD STAMPS 08

PERSONAL ASSISTANCE SERVICES (PAS) 09

UNEMPLOYMENT BENEFITS 10

OTHER STATE DISABILITY BENEFITS 11

OTHER GOVERNMENT PROGRAMS 12

OTHER 13

(B29_11b=13)

B29_11b_Other: What other benefits?

<OPEN>

DON’T KNOW d

REFUSED r

(B28=00,d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r)

B29_12CHECK. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?

YES 01 (B30)

NO 00

((B28=00,d, or r) OR (B29_1a= d or r) OR (B29_1b=d or r) AND (RTYPE=01)

B29_8CHECK: DID RESPONDENT GIVE CONDITION AS ONLY REASON NOT WORKING (B25_a=01 and (B25_b, B25_c, B25_d, B25_f, B25_g, B25_h, B25_i, B25_j, B25_l, B25_m, B25_n, B25_o=00, d, OR r)?

YES 01 (B30)

NO 00 (B29_12a)

NEW ITEM

((B25_a=01 and (B25_b, B25_c, B25_d, B25_f, B25_g, B25_h, B25_i, B25_j, B25_l, B25_m, B25_n, or B25_o=01)) AND (RTYPE=01))

B29_12a. If you did get a job offer that matched your current needs and abilities, what is the lowest wage or salary you would be willing to accept for such a job?

INTERVIEWER:IF R HESITATES OR SEEMS TO BE HAVING DIFFICULTY: If you have no idea, just say so. IF R SAYS HAS NO INTEREST IN WORKING, CODE AS DON’T KNOW.

INTERVIEWER: Read only if necessary, otherwise code:

$|__|__|__|__|__|.|__|__|

DON’T KNOW d (B30)

REFUSED r (B30)

B29_12ahop. Is this:

HOURLY 01 (1-25) (1-300) (B30)

DAILY 02 (1-384) (1-1,922) (B29_12b)

WEEKLY 03 (1-1,923) (1-9,615) (B29_12b)

BI-WEEKLY 04 (1-4,166) (1-20,833) (B29_12b)

TWICE A MONTH 05 (1-4,166) (1-20,833) (B29_12b)

MONTHLY 06 (1-8,333) (1-41,666) (B29_12b)

ANNUALLY 07 (1-100,000) (1-500,000) (B29_12b)

DON’T KNOW d (B29_12b)

REFUSED r (B29_12b)

PROGRAMMER NOTE: FOLLOWING SOFT CHECK IF B29_12ahop OUT OF RANGE

B29_12check: Soft edit: “Let me make sure I did not make a mistake. You just indicated that the wage or salary you would have accepted for this job is [insert ((B29_12a and B29_12ahop). Is this correct?”

CHANGE LOWEST WAGE OR SALARY 01 (CHANGE B29_12a)

CHANGE PAY PERIOD 02 (CHANGE B29_12ahop)

SUPPRESS 03

NEW ITEM

(B29_12ahop=02, 03, 04, 05, 06, d, or r)

B29_12b. How many hours per week would you expect to work for this amount of pay?

|__|__| (B30)

HOURS

(1-99)

DON’T KNOW d (B29_12c)

REFUSED r (B29_12c)

NEW ITEM

(B29_12b=d or r)

B29_12c. Would you expect to work full-time or part-time?

FULL-TIME 01

PART-TIME 02

DON’T KNOW d

REFUSED r

(All)

B30. Did {you/NAME} work at a job or business for pay or profit anytime in 2009?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

B30_b. Have you worked for pay since {you/NAME} started receiving disability benefits?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

B33. CHECK: WAS {NAME} WORKING WHEN LIMITATION BEGAN (B22=01)?

YES 01 (B37)

NO 00

B33=00)

B34. CHECK: IS {NAME} CURRENTLY WORKING (B24=01)?

YES 01 (B37)

NO 00

(B33=00 and B34=00)

B35. CHECK: DID {NAME} WORK IN 2009 (B30=01)?

YES 01 (B37)

NO 00

(S2=01) and (B33=00 and B34=00 and B35=00)

B36. {Have you/Has NAME} ever worked for pay?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

B37. Do {your/NAME’s} personal goals include {(IF B36=00) getting a job,} moving up in a job or learning new job skills?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

B37a. Do {your/NAME’s} personal goals include someday working and earning enough to stop receiving Social Security disability benefits?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

B38. {Do you/Does NAME} ever discuss work and career goals with family, friends, or anyone else?

YES 01

NO 00 (B47)

DON’T KNOW d (B47)

REFUSED r (B47)

(B38 =01)

B39. Who {do you/does NAME} discuss {your/his/her} work goals with the most?

INTERVIEWER: MARK ONLY ONE.

PARENT/GUARDIAN 01 (B40)

SPOUSE/PARTNER 02 (B40)

FRIEND 03 (B40)

JOB COACH 04 (B40)

EMPLOYER/SUPERVISOR 05 (B40)

OTHER RELATIVE 06 (B40)

CASEWORKER/COUNSELOR/PROGRAM STAFF 07 (B40)

MEDICAL PROVIDER 08 (B40)

OTHER 09

DON’T KNOW d (B47)

REFUSED r (B47)

(B38 =01 and B39=09)

B39_oth. Who was it?

INTERVIEWER: PLEASE SPECIFY

<OPEN>

DON’T KNOW d

REFUSED r

(B38=01 and B39=01-09)

B40. Please tell me how much you agree or disagree with the following statement. Would you say you strongly agree, agree, disagree, or strongly disagree?

STRONGLY STRONGLY REF-
AGREE AGREE DISAGREE DISAGREE DK USED

{Your/NAME’s} {RESPONSE FROM B39} thinks {your/NAME’s} personal goals should include working at a job, moving up in a job, or learning new job skills. 01 02 03 04 d r

(B38=01 and B39=01-09)

B41. {Do you/Does NAME} discuss {your/his/her} work goals with anyone else?

YES 01

NO 00 (B47)

DON’T KNOW d (B47)

REFUSED r (B47)

(B38=01 and B39=01-09 and B41=01)

B42. Who else {do you/does NAME} discuss {your/his/her} work goals with?

INTERVIEWER: MARK ONLY ONE.

PARENT/GUARDIAN 01 (B43)

SPOUSE/PARTNER 02 (B43)

FRIEND 03 (B43)

JOB COACH 04 (B43)

EMPLOYER/SUPERVISOR 05 (B43)

OTHER RELATIVE 06 (B3)

CASEWORKER/COUNSELOR/PROGRAM STAFF 07 (B43)

MEDICAL PROVIDER 08 (B43)

OTHER 09 (B42_oth)

DON’T KNOW d (B47)

REFUSED r (B47)

(B38=01 and B39=01-09 and B41=01 and B42=09)

B42_oth. Who was it?

INTERVIEWER: PLEASE SPECIFY

<OPEN>

DON’T KNOW d

REFUSED r

(B38=01 and B39=01-09 and B41=01 and B42=01-09)

B43. Please tell me how much you agree or disagree with the following statement. Would you say you strongly agree, agree, disagree, or strongly disagree?

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

DON’T KNOW

REF-USED

{Your/NAME’s} {RESPONSE FROM B42} thinks {your/NAME’s} personal goals should include working at a job, moving up in a job, or learning new job skills.

(B38=01 and B39=01-09 and B41=01 and B42=01-09)

B44. {Do you/Does NAME} discuss {your/his/her} work goals with anyone else?

YES 01

NO 00 (B47)

DON’T KNOW d (B47)

REFUSED r (B47)

(B38=01 and B39=01-09 and B41=01 and B42=01-09 and B44=01)

B45. Who else {do you/does NAME} discuss {your/his/her} work goals with?

INTERVIEWER: MARK ONLY ONE.

PARENT/GUARDIAN 01 (B46)

SPOUSE/PARTNER 02 (B46)

FRIEND 03 (B46)

JOB COACH 04 (B46)

EMPLOYER/SUPERVISOR 05 (B46)

OTHER RELATIVE 06 (B46)

CASEWORKER/COUNSELOR/PROGRAM STAFF 07 (B46)

MEDICAL PROVIDER 08 (B46)

OTHER 09 (B45_oth)

DON’T KNOW d (B47)

REFUSED r (B47)

(B38=01 and B39=01-09 and B41=01 and B42=01-09 and B44=01 and B45=09)

B45_oth. Who was it?

INTERVIEWER: PLEASE SPECIFY

<OPEN>

DON’T KNOW d

REFUSED r

(B38=01 and B39=01-09 and B41=01 and B42=01-09 and B44=01 and B45=01-09)

B46. Please tell me how much you agree or disagree with the following statement. Would you say you strongly agree, agree, disagree, or strongly disagree?

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

DON’T KNOW

REF-USED

{Your/NAME’s} {RESPONSE FROM B5} thinks {your/NAME’s} personal goals should include working at a job, moving up in a job, or learning new job skills.

(All)

B47. Please tell me how much you agree with the following statements. Would you say you strongly agree, agree, disagree, or strongly disagree?

	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE	DON’T KNOW	REF-USED
You see {yourself/NAME} {(IF B24=01) continuing to work/ (IF B24=00,d,r) working} for pay in the next year.	01	02	03	04	d	r
(ASK B47b IF B47a=01,02, OTHERWISE GO TO B47c) You see {yourself/NAME} working and earning enough to stop receiving disability benefits in the next year	01	02	03	04	d	r
You see {yourself/NAME} {(IF B24=01) continuing to work/ (IF B24=00,d,r) working} for pay in the next five years.	01	02	03	04	d	r
{ASK B47d IF B47c=01,02, OTHERWISE GO TO B48) You see {yourself/NAME} working and earning enough to stop receiving disability benefits in the next five years	01	02	03	04	d	r

(All)

B48. CHECK: IS {NAME} CURRENTLY WORKING (B24 = 01)?

YES 01 (C1)

NO 00

(B48=00)

B49. CHECK: WAS {NAME} WORKING IN 2009 (B30 = 01)?

YES 01 (D1)

NO 00

SECTION C: CURRENT EMPLOYMENT

(All)

C1. Now I am going to ask some questions about the jobs {you/NAME} currently {have/has}. When answering these questions, please include both part-time and full-time jobs, but only include jobs {you hold/NAME holds} for pay or profit.

How many jobs {do you/does NAME} currently have?

|__|__| NUMBER OF JOBS (1-5)

(1-15)

DON’T KNOW d

REFUSED r

PROGRAMMER: C2 THROUGH C14 ASKED FOR ALL JOBS WHEN C1>01

(All)

C2. PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND FIRST JOB:

Let us start with {your/NAME’s} main job – that is, the job at which {you work/(he/she) works} the most hours.

What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?

PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:

Now I would like to ask about {your/NAME’S} {second/third/fourth} job.

What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?

ELSE (C1=01):

What kind of work {do you/does NAME} do, that is, what is {your/NAME’s} occupation?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high school; sales clerk in a women’s shoe store.

PROBE 2: What are {your/NAME’S} main activities or duties? What else {do you/does NAME} do?
What else? {Do you /Does NAME} supervise anyone?

<OPEN>

DON’T KNOW d

REFUSED r

(All)

C3. What kind of business is this?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: For what type of organization or industry do you work? For example: accounting firm, daycare center, educational facility, food services.

PROBE 2: What do they make, sell, or do where {you work/NAME works}?

PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses), or retail trade (selling to customers) or something else?

<OPEN>

DON’T KNOW d

REFUSED r

(All)

C4mth. In what month and year did {you/NAME} start working there?

INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN

PROBE: Your best estimate is fine.

|__|__| (1-12)

DON’T KNOW d

REFUSED r

(All)

C4yr. PROBE 1: In what month and year did {you/NAME} start working there?

INTERVIEWER: ENTER YEAR

PROBE 2: Your best estimate is fine.

|__|__|__|__| (1981-2010)

YEAR (1951-2010)

DON’T KNOW d

REFUSED r

(All)

C5. SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (C4yr) SHOULD BE GREATER THAN OR EQUAL TO YEAR OF BIRTH (A04_d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born in (A04_d) and {you/NAME} started working at this job in (C4yr), which means {you/NAME} started working at this job when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE: C4YR – YEAR OF BIRTH) years old. Is that correct?

YES 01

NO 02 (CHANGE C4YR)

SUPPRESS 03

(All)

C5A. Beneficiaries do not always know that they should report a change in work status to Social Security. Around that time did {you/NAME} let Social Security know that {you were/ (he/she) was} working?

YES 01

NO 00 (C6)

DON’T KNOW d (C6)

REFUSED r (C6)

(C5a=01)

C5B. How soon after {you/NAME} started this job did {you/NAME} tell Social Security {you were/(he/she) was} working?

PROBE: Your best estimate is fine.

INTERVIEWER: IF R TOLD SSA BEFORE STARTED WORKING, CODE AS 1 WEEK.

WEEKS 01 (C5BWeek)

MONTHS 02 (C5BMonth)

DON’T KNOW d (C6)

REFUSED r (C6)

(C5a=01 and C5b=01)

C5BWEEK. INTERVIEWER: ENTER NUMBER OF WEEKS

|__|__| WEEKS

(1-52)

DON’T d (C6)

REFUSED r (C6)

(C5a=01 and C5b=02)

C5BMonth. INTERVIEWER: ENTER NUMBER OF MONTHS

|__|__| WEEKS/MONTHS

(1-12)

DON’T d (C6)

REFUSED r (C6)

(All)

C6. {Are you/Is NAME} self-employed at this job?

PROBE: Self-employed means that you work for yourself/ or own your} own business.

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

C7. There are a number of special work programs available to people with disabilities. Is {your/NAME’s} job part of a sheltered workshop program, transitional employment program, the Business Enterprise Program for the blind, or a supported employment program?

The Business Enterprise Program for the blind offers legally blind persons the opportunity to own their own businesses. Supported employment programs provide job coaches or other on-the-job supports to help individuals with disabilities get and keep jobs.

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

C8. How many hours per week {do you/does NAME} usually work at this job?

PROBE: Include overtime if {you/he/she} usually {work/works} overtime.

|__|__|__| HOURS PER WEEK (1-60)

(1-168)

DON’T KNOW d

REFUSED r

(All)

C9. How many weeks per year {do you/does NAME} usually work at this job, including paid vacation and holidays?

PROBE 1: There are 52 weeks in a year.

PROBE 2: Please include time off for vacation and holidays if {you are/NAME is} paid for that time.

PROBE 3: If {you have/NAME has} worked less than a year, please answer for the number of weeks{you expect/NAME expects} to work.

|__|__| WEEKS PER YEAR (1-52)

DON’T KNOW d

REFUSED r

(All)

C10. PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND FIRST JOB:

For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is} paid on this job. On {your/NAME’s} main job {are you/is (he/she} paid by the hour?

PROGRAMMER: IF MORE THAN ONE JOB (C1>01) AND SECOND, THIRD, FOURTH, ETC. JOB:

For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is} paid on {your/(his/her)} {second/third/fourth} job. On {your/NAME’s} {second/third/fourth} job {are you/is (he/she} paid by the hour? ELSE (C1=01): For the purpose of this survey, it is important to obtain some information on how much {you are/NAME is} paid on {your/(his/her)} current job. On {your/NAME’s} current job {are you/is (he/she} paid by the hour?

PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.

PROBE: {Your/NAME’s} main job is the job we have been talking about. The one at which {you work/(he/she) works} the most hours.

YES 01

NO 00 (C12amt)

DON’T KNOW d (C12amt)

REFUSED r (C12amt)

(C10=01)

C11. What is {your/NAME’s} regular hourly pay, including tips and commissions?

PROBE: IF LESS THAN $5.00 AN HOUR: Does this include tips and commissions?

INTERVIEWER: IF ENTERING AN AMOUNT WITH CENTS, PLEASE ENTER DECIMAL POINT

$|___|___|___|. |___|___| PER HOUR (1 – 25.00) (1 - 300.00)

DON’T KNOW d

REFUSED r

GO TO C15

(C10=00, d, or r)

C12amt. Before taxes and other deductions how much {are you/is NAME} paid on this job, including tips and commissions.

PROBE: Is that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN

$|___|___|___|,|___|___|___| . 00

DON’T KNOW d

REFUSED r

(C10=00, d, or r)

C12hop.

INTERVIEWER: ENTER HOW OFTEN PAID

DAILY 01 (1-384) (1-1,922)

WEEKLY 02 (1-1,923) (1-9,615)

BI-WEEKLY 03 (1-4,166) (1-20,833)

TWICE A MONTH 04 (1-4,166) (1-20,833)

MONTHLY 05 (1-8,333) (1-41,666)

ANNUALLY 06 (1-100,000) (1-500,000)

DON’T KNOW d

REFUSED r

PROGRAMMER, CALCULATE MONTHLY PRE-TAX PAY BASED ON C12AMT AND C12HOP FOR EACH JOB:

If C10=1, and C11and C8≠d or r, C_JobMnthPay(1)=c11*c8*4.35.

If C10=1 and C8 or C11=d, C_JobMnthPay(1)=d.

If C10=1 and C8 or C11=r and neither are d, C_JobMnthPay(1)=r.

If C10=0, d, or r and C12amt or C12hop=d, C_JobMnthPay(1)=d.

If C10=0, d, or r and C12amt or C12hop=r, and neither are d, C_JobMnthPay(1)=r.

If C10=0, d, or r and c12hop=1, C_JobMnthPay(1)=c12amt*21.74.

If C10=0, d, or r and c12hop=2, C_JobMnthPay(1)=c12amt*4.35.

If C10=0, d, or r and c12hop=3, C_JobMnthPay(1)=c12amt*2.17.

If C10=0, d, or r and c12hop=4, C_JobMnthPay(1)=c12amt*2.

If C10=0, d, or r and c12hop=5, C_JobMnthPay(1)=c12amt.

If C10=0, d, or r and c12hop=6, C_JobMnthPay(1)=c12amt/12.

(C10=00, d, or r)

C13amt. For this job, about how much is left as take-home pay after taxes and other deductions?

PROBE: Is that amount paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR AND ENTER HOW OFTEN PAID ON NEXT SCREEN

$|___|___|___|,|___|___|___| . 00

DON’T KNOW d

REFUSED r

(C10=00, d, or r)

C13hop. INTERVIEWER: ENTER HOW OFTEN PAID

DAILY 01 (1-346) (1-1,730)

WEEKLY 02 (1-1,730) (1 –8,653)

BI-WEEKLY 03 (1-3,750) (1-18,750)

TWICE A MONTH 04 (1-3,750) (1-18,750)

MONTHLY 05 (1-7,500) (1-37,500)

ANNUALLY 06 (1 –90,000) (1-450,000)

DON’T KNOW d

REFUSED r

PROGRAMMER, CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON C13AMT AND C13HOP:

If C10=1 and C11 and C8≠d or r, C_JobMnthPayTH(1)=c11*c8*4.35.

If C10=1 and C8_1 or C11=d, C_JobMnthPayTH(1)=d.

If C10=1 and C8_1 or C11=r and neither are d, C_JobMnthPayTH(1)=r.

If C10=0, d, or r and C13amt or C13hop=d, C_JobMnthPayTH(1)=d.

If C10=0, d, or r and C13amt or C13hop=r, and neither are d, C_JobMnthPayTH(1)=r.

If C10=0, d, or r and c13hop=1, C_JobMnthPayTH(1)=c13amt*21.74.

If C10=0, d, or r and c13hop=2, C_JobMnthPayTH(1) =c13amt*4.35.

If C10=0, d, or r and c13hop=3, C_JobMnthPayTH(1)=c13amt*2.17.

If C10=0, d, or r and c13hop=4, C_JobMnthPayTH(1)=c13amt*2.

If C10=0, d, or r and c13hop=5, C_JobMnthPayTH(1)=c13amt.

If C10=0, d, or r and c13hop=6, C_JobMnthPayTH(1)=c13amt/12.

(C10=00, d, or r) and (C12hop=01, 02, 03, 04, 05, or 06) and (C13hop=01, 02, 03, 04, 05, or 06)

C14. SOFT EDIT: AMOUNT OF TAKE-HOME PAY MUST BE LESS THAN OR EQUAL T0 PRE-TAX PAY. IF AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF CALCULATED MONTLY PRE-TAX PAY (C_JobMnthPay(1)) NE D OR R, AND C_JobMnthPayTH(1) > C_JobMnthPay(1), TRIGGER EDIT AND DISPLAY FOLLOWING TEXT:. INTERVIEWER, AMOUNT OF CALCULATED MONTLY TAKE HOME PAY IS GREATER THAN AMOUNT OF CACLUATED PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an incorrect answer. You said that {you are/NAME is} paid (C12amt) per (C12hop) before taxes and other deductions which would be about (C_JobMnthPay(1) per month and that (C13amt) per (C13hop), or about (C_JobMnthPayTH(1) per month,is left as take-home pay after taxes and other deductions. Based on what I recorded, your take home pay is more than your pre-tax pay. Should I change the amount {you are/NAME

is} paid before taxes and other deductions or the amount {you take/NAME takes} home after taxes and other deductions?

CHANGE AMOUNT PAID BEFORE TAXES AND OTHER DEDUCTIONS 01 CHANGE C12amt)

CHANGE AMOUNT OF TAKE-HOME PAY 02 (CHANGE C13amt)

SUPPRESS 03

(C10=00, d, or r) and (C12hop=01, 02, 03, 04, 05, or 06) and (C13hop=01, 02, 03, 04, 05, or 06)

C14a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCUATED MONTHLY TAKE HOME PAY AND CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF TAKE MONTHLY HOME PAY (C_JobMnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY (C_JobMnthPay(1)) NE D OR R, AND (C_JobMnthPay(1) - C_JobMnthPayTH(1) / C_JobMnthPayTH(1) > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, DIFFERENCE IN AMOUNT OF CALCUATED MONTHLY TAKE HOME PAY AND CACLUATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said that {you are/NAME is} paid (C12amt) per (C12hop) before taxes and other deductions which would be about (C_JobMnthPay(1) per month and that (C13amt) per (C13hop), or about (C_JobMnthPayTH(1) per month is left as take-home pay after taxes and other deductions. Is this correct or should I change the amount {you are/NAME is} paid before taxes and other deductions or the amount {you take/NAME takes} home after taxes and other deductions?

CHANGE AMOUNT PAID BEFORE TAXES AND OTHER DEDUCTIONS 01 CHANGE C12amt)

CHANGE AMOUNT OF TAKE-HOME PAY 02 (CHANGE C13amt)

SUPPRESS 03

PROGRAMMER: CALCULATE TOTAL MONTHLY PAY FROM ALL JOBS COMBINED (TO BE USED LATER IN SECTION K):
If C_JobMnthPay(1) or C_JobMnthPay(2) or C_JobMnthPay(3) (for all jobs listed)=d, C_CurMnthPay=d.
If C_JobMnthPay(1) or C_JobMnthPay(2) or C_JobMnthPay(3) (for all jobs listed)=r, and none=d, C_CurMnthPay=r. Else, C_CurMnthPay=Sum of (C_JobMnthPay(1) AND C_JobMnthPay(2) AND C_JobMnthPay(3), etc (for all jobs listed)).

(All)

C15.CHECK: IS {NAME} SELF EMPLOYED (C6=01)?

YES 01 (C17)

NO 00

(C15=00)

C16. {Have you/Has NAME} received any promotions at this job during the past 12 months?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

C17.CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?

YES 01 (C19)

NO 00

(C17=00)

C18. Taking all things into account, how satisfied are you with your {main/current} job? Would you say:

PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”

VERY SATISFIED, 01

SOMEWHAT SATISFIED, 02

NOT VERY SATISFIED, OR 03

NOT AT ALL SATISFIED? 04

DON’T KNOW d

REFUSED r

(All)

C19. CHECK: IS {NAME} SELF EMPLOYED (C6=01)?

YES 01 (C21)

NO 00

(C19=00)

C20. Now, I’d like to ask you a few more questions about {your/NAME’s} {main/current} job. I am going to read to you a list of benefits that some employers offer their employees. Please tell me whether or not {your/NAME’s} {main/current} employer offers {you/him/her} any of these benefits.

PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”

Does {your/NAME’s} employer offer {you/NAME}

PROBE: Please answer ‘yes’ if {you are/NAME is} eligible for the benefit but {haven’t/hasn’t} yet started to receive it.

DON’T

YES NO KNOW REFUSED

a. Health care insurance? (IF NECESSARY: medical and/or hospital) 01 00 d r

b. Dental benefits? 01 00 d r

c. Sick days with pay? 01 00 d r

d. Paid vacation? 01 00 d r

e. Free or low-cost childcare? 01 00 d r

f. Transportation, a transportation allowance, or transportation discounts? 01 00 d r

g. Long-term disability benefits? 01 00 d r

h. Pension or retirement benefits? 01 00 d r

i. Flexible health or dependent care spending accounts? 01 00 d r

(All)

C21. CHECK: DOES {NAME} HAVE MORE THAN ONE CURRENT JOB (C1>01)?

YES 01 (REPEAT C2 THROUGH C14 FOR EACH JOB )

NO 00

(All)

C22. {Do you/Does NAME} use any special equipment related to {your/his/her} disability that helps {you/him/her} work at {your /his/her} job{s}, for example a brace, cane, wheelchair, modified computer hardware or modified computer software?

YES 01

NO 00 (C27)

DON’T KNOW d (C27)

REFUSED r (C27)

(C22=01)

C23. What kind of special equipment {do you/does NAME} use?

PROBE: Anything else?

INTERVIEWER: CODE ALL THAT APPLY.

BRACE 01 (C24)

CANE/CRUTCHES/WALKER 02 (C24)

WHEELCHAIR 03 (C24)

MODIFIED COMPUTER HARDWARE 04 (C24)

MODIFIED COMPUTER SOFTWARE 05 (C24)

OTHER ___________________________________________ 06

DON’T KNOW d (C24)

REFUSED r (C24)

(C22=01 and C23=06)

C23_Other. What kind of other special equipment?

<OPEN>

DON’T KNOW d

REFUSED r

(C22=01)

C24. Who paid for the equipment {you use/he/she uses}?

PROBE: For example, {you or your family/NAME or (his/her) family}, insurance or Medicaid, or someone else?

INTERVIEWER: CODE ALL THAT APPLY.

{NAME} 01 (C26amt)

FAMILY 02 (C26amt)

HEALTH INSURANCE 03 (C25)

MEDICARE 04 (C25)

MEDICAID 05 (C25)

EMPLOYER 06 (C25)

STATE VOCATIONAL REHABILITATION AGENCY 07 (C25)

NON-PROFIT ORGANIZATION SERVING PEOPLE WITH DISABILITIES 08 (C25)

WORKER’S COMPENSATION 09 (C25)

DISABILITY INSURANCE 10 (C25)

OTHER 11

DON’T KNOW d (C25)

REFUSED r (C25)

(C22=01 and C24=11)

C24_Other. Who else paid for the equipment {you use/NAME uses}?

<OPEN>

DON’T KNOW d

REFUSED r

(C22=01 and C24=03, 04, 05, 06, 07, 08, 09, 10, 11, d, or r)

C25. {Do you or your/Does NAME or (his/her)} family have to pay for any part of the cost of the equipment {you use/(he/she) uses}?

YES 01

NO 00 (C27)

DON’T KNOW d (C27)

REFUSED r (C27)

(C22=01) and (C24=01 or 02) or (C25=01)

C26amt. How much {do you or your/does NAME or (his/her)} family have to pay?

INTERVIEWER: ROUND TO NEAREST DOLLAR HERE AND ENTER HOW OFTEN PAID ON NEXT SCREEN

$|___|___|___|,|___|___|___| . 00

DON’T KNOW d

REFUSED r

(C22=01) and (C24=01 or 02) or (C25=01)

C26hop. PROBE: How much {do you or your/does NAME or (his/her)} family have to pay?

IF NECESSARY: Is that a one-time payment, per week, per month, or per year?

INTERVIEWER: ENTER HOW OFTEN PAID

ONE TIME PAYMENT 01 (1-25,000) (1-99,000)

PER WEEK 02 (1-480) (1-1,903)

PER MONTH 03 (1-2,083) (1-8,250)

PER YEAR 04 (1-25,000) (1-99,000)

DON’T KNOW d

REFUSED r

(All)

C27. {Do you/Does NAME} use any personal assistance services related to {your/his/her} disability that help {you/him/her} work, for example, a job coach, a sign language interpreter, a reader or interpreter for the blind, or a personal care attendant?

YES 01

NO 00 (C32)

DON’T KNOW d (C32)

REFUSED r (C32)

(C27=01)

C28. What kind of personal assistance services {do you/does NAME} use?

PROBE: Anything else?

INTERVIEWER: CODE ALL THAT APPLY.

JOB COACH 01 (C29)

SIGN LANGUAGE INTERPRETER 02 (C29)

READER/INTERPRETER FOR THE BLIND 03 (C29)

PERSONAL CARE ATTENDANT/PERSONAL ASSISTANT 04 (C29)

OTHER 05

DON’T KNOW d (C29)

REFUSED r (C29)

(C27=01 and C28=05)

C28_Other. What is the other kind of personal assistance services {you/NAME} use?

<OPEN>

DON’T KNOW d

REFUSED r

(C27=01)

C29. Who paid for the personal assistance services {you use/NAME uses}?

PROBE: For example, {you or your family/NAME or (his/her) family}, insurance or Medicaid, or someone else?

INTERIVEWER: READ LIST IF NEEDED.

INTERVIEWER: CODE ALL THAT APPLY.

{NAME} 01 (C31amt)

FAMILY 02 (C31amt)

HEALTH INSURANCE 03 (C30)

MEDICARE 04 (C30)

MEDICAID 05 (C30)

EMPLOYER 06 (C30)

STATE VOCATIONAL REHABILITATION AGENCY 07 (C30)

NON-PROFIT ORGANIZATION SERVING PEOPLE WITH DISABILITIES 08 (C30)

WORKER’S COMPENSATION 09 (C30)

DISABILITY INSURANCE 10 (C30)

OTHER 11

DON’T KNOW d (C30)

REFUSED r (C30)

(C27=01 and C29=11)

C29_Other. Who else paid for the personal assistant services {you use/NAME uses}?

<OPEN>

DON’T KNOW d

REFUSED r

(C27=01 and C29=03, 04, 05, 06, 07, 08, 09, 10, 11, d, or r)

C30. {Do you or your/Does NAME or (his/her)} family have to pay for any part of the cost of the personal assistance services {you use/(he/she) uses}?

YES 01

NO 00 (C32)

DON’T KNOW d (C32)

REFUSED r (C32)

(C27=01) and ( C29=01 or 02) or (C30=01)

C31amt. How much {do you or your/does NAME or (his/her)} family have to pay?

INTERVIEWER: ROUND TO NEAREST DOLLAR HERE AND ENTER HOW OFTEN PAID ON NEXT SCREEN

$|___|___|___|,|___|___|___| . 00

DON’T KNOW d

REFUSED r

(C27=01) and (C29=01 or 02) or (C30=01)

C31hop. PROBE: How much {do you or your/does NAME or (his/her)} family have to pay?

IF NECESSARY: Is that a one-time payment, per week, per month, or per year?

INTERVIEWER: ENTER HOW OFTEN

ONE TIME PAYMENT 01 (1-25,000) (1-99,000)

PER WEEK 02 (1-480) (1-1,903)

PER MONTH 03 (1-2,083) (1-8,250)

PER YEAR 04 (1-25,000) (1-99,000)

DON’T KNOW d

REFUSED r

(All)

C32. CHECK: IS {NAME} SELF EMPLOYED (C6=01)?

YES 01 (C34)

NO 00

(C32=00)

C33. PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”

Please tell me whether or not {your/NAME’s} {main/current} employer has made any of these changes because of {your/his/her} physical or mental condition. Has {your/NAME’s} employer because of {your/his/her} physical or mental condition.

PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.

PROBE: {Your/NAME’s} main job is the job we have been talking about. The one at which {you work/(he/she) works} the most hours.

YES NO NEEDED DK REF

Provided {you/NAME} with any special equipment or assistive technology?
(PROBE: For example special tools or equipment, software, or devices to accommodate {your/NAME’s} condition in the workplace.) 01 00 02 d r
Made any changes in {your/NAME’s} work schedule?
(PROBE: For example, working fewer hours, changing the time {you arrive or leave/(he/she) arrives or leaves}, or taking more breaks to accommodate {your/NAME’s} condition in the workplace.) 01 00 02 d r
Made any changes to the tasks {you were/NAME was} assigned or how they are performed?
(PROBE: For example, a light duty job or less demanding job tasks to accommodate {your/NAME’s} condition in the workplace.) 01 00 02 d r
Made any changes to the physical work environment to make things easier for {you/NAME}? (PROBE: For example, modifying {your/his/her} work area, improving accessibility in the building, or providing assigned parking to accommodate {your/NAME’s} condition in the workplace.) 01 00 02 d r
Arranged for co-workers or others to assist {you/NAME}?
(PROBE: For example, providing a personal care attendant, interpreter, or job coach while at work.) 01 00 02 d r
Made any other changes that I didn’t mention to accommodate {your/NAME’s}condition in the workplace? 01 00 02 d r

PROGRAMMER: IF C33f=01, GO TO C33f_Other, ELSE GO TO C34.

(C32=00 and C33f=01)

C33f_Other. What other changes?

<OPEN>

DON’T KNOW d

REFUSED r

(All)

C34. Are there any changes in {your/NAME’s} {main/current} job or workplace related to {your/his/her} physical or mental condition that {you need/(he/she) needs}, but that have not been made?

PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”

PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.

PROBE: {Your/NAME’s} main job is the job that we have been talking about. The one at which {you work/(he/she) works} the most hours.

YES 01

NO 00 (C38)

DON’T KNOW d (C38)

REFUSED r (C38)

(C34=01)

C35. What are those changes?

PROBE: Anything else?

INTERVIEWER: ENTER VERBATIM RESPONSE

<OPEN>

DON’T KNOW d

REFUSED r

(All)

C36. CHECK: IS {NAME} SELF EMPLOYED (C6=01)?

YES 01 (C38)

NO 00

(C34=01 and C36=00)

C37. Did {you/NAME} or anyone else ask {your/his/her} employer for (any of) these changes?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

C38. CHECK: IS {NAME} A PROXY RESPONDENT (RTYPE=2)?

YES 01 (C39a2)

NO 00

(RTYPE=1)

C39. Again, thinking about your {main/current} job, how much do you agree with each of the following statements? Would you say you strongly agree, agree, disagree, or strongly disagree?

PROGRAMMER: USE “MAIN” IF C1>01, OTHERWISE USE “CURRENT.”

PROGRAMMER: USE PROBE IF MORE THAN ONE JOB (C1>01) AND FIRST JOB.

PROBE: Your main job is the job that we have been talking about. The one at which you work the most hours.

	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE	NA	DON’T KNOW	REF-USED
The pay is good.	01	02	03	04	05	d	r
The benefits are good.	01	02	03	04	05	d	r
IF {NAME} IS NOT SELF-EMPLOYED (C6=00, d, or r): The job security is good. IF {NAME} IS SELF-EMPLOYED (C6=01): The work is steady	01	02	03	04	05	d	r
IF {NAME} IS NOT SELF-EMPLOYED (C6=00, d, or r): You have a chance for promotion. ELSE: SKIPTO C39e	01	02	03	04	05	d	r
You have a chance to develop your abilities.	01	02	03	04	05	d	r
You have recognition or respect from others.	01	02	03	04	05	d	r
You can work on your own in your job if you want to.	01	02	03	04	05	d	r
You can work with others in a group or team if you want to.	01	02	03	04	05	d	r
Your work is interesting or enjoyable	01	02	03	04	05	d	r
Your work gives you a feeling of accomplishment or contribution.	01	02	03	04	05	d	r
IF {NAME} IS NOT SELF-EMPLOYED (C6=00, d, or r): Your supervisor is supportive. ELSE: SKIPTO C39l	01	02	03	04	05	d	r
Your co-workers are friendly and supportive.	01	02	03	04	05	d	r

(All)

C39a2. Sometimes people work fewer hours or earn less money than they could in order to care for family members, keep the cash benefits they need, or just to have more free time. In (your/NAME’s) (main/current job), (do you/ does he/ does she) work fewer hours or earn less money than (you/he/she) could for any reason?

YES 01

NO 00 (C39_1)

DON’T KNOW d (C39_1)

REFUSED r (C39_1)

(C39a=01)

C39b. (Do you/Does NAME) work fewer hours or earn less money than (you/he/she) could because (you/he/she)…

PROBE: I need to ask everyone in our study the same questions, even if they don’t seem to apply to (you/NAME).

DON’T
YES NO KNOW REFUSED

a. {Are/Is} taking care of children or others? 01 00 d r

b. {Are/Is} enrolled in school or a training program? 01 00 d r

c. Want(s) to keep Medicare or Medicaid coverage? 01 00 d r

d. Want(s) to keep cash benefits (you/he/she) need such as disability or workers compensation? 01 00 d r

e. Just (do/does) not want to work more? 01 00 d r

f. Are there any reasons I didn’t mention why (you are/NAME is) working or earning less than (you/he/she) could? 01 00 d r

PROGRAMMER: IF C39b_f=01 GO TO C39f_Other, ELSE SKIP TO C39_1

(C39b_f=01)

C39f_Other What other reason?

<OPEN>

DON’T KNOW d

REFUSED r

(All)

C39_1. Have any of {your/NAME’s} disability-related benefits been reduced or ended because of {your/his/her} (main/current) job?

YES 01

NO 00 (C39_3)

DON’T KNOW d (C39_3)

REFUSED r (C39_3)

(C39_1=01)

C39_2 What benefits have been reduced or ended as a result of {your/NAME’s} (main/current) job]?

INTERVIEWER: MARK ALL THAT APPLY.

PRIVATE DISABILITY INSURANCE 01

WORKERS’ COMPENSATION 02

VETERANS’ BENEFITS 03

MEDICARE 04

MEDICAID 05

SSA DISABILITY BENEFITS 06

PUBLIC ASSISTANCE OR WELFARE 07

FOOD STAMPS 08

PERSONAL ASSISTANCE SERVICES (PAS) 09

UNEMPLOYMENT BENEFITS 10

OTHER STATE DISABILITY BENEFITS 11

OTHER GOVERNMENT PROGRAMS 12

OTHER 13

(All)

C39_3. Now, I am going to read you a list of things that sometimes help people to work more hours or earn more money. If any of these do not apply to {you/NAME}, please just say so. At [your/NAME’s] (main/current) job, do you think that [you/she/he] could work or earn more if you/he/she had

YES NO NA DK REF

Help caring for {your/his/her} children or others in the household? 01 00 02 d r
Help with {your/his/her} own personal care such as bathing, dressing,

preparing meals, and doing housework? 01 00 02 d r

c. Reliable transportation to and from work? 01 00 02 d r

d. Better job skills? 01 00 02 d r

e. A job with a flexible work schedule? 01 00 02 d r

f. Help with finding and getting a better job? 01 00 02 d r

g. Any special equipment or medical devices? 01 00 02 d r

PROGRAMMER: IF C39_3g=01, GO TO C39_3g_Other,

ELSE GO TO C39_3h.

Is there anything else that I didn’t mention that would help [you/NAME] work or earn more? 01 00 02 d r

PROGRAMMER: IF C39_3h=01, GO TO C39_3h_Other, ELSE GO TO C39_4.

(C39_3g=01)

C39_3g_Other. What other special equipment or medical devices?

<OPEN>

DON’T KNOW d

REFUSED r

(C39_3h=01)

C39_3h_Other What else?

<OPEN>

DON’T KNOW d

REFUSED r

(All)

C39_4. One last question about (your / NAME’s) (main/current) job. Because of {your/his/her} work, has Social Security needed to make any changes to the amount of {your/his/her} disability benefits?

PROBE: Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?

YES 01

NO 00 (C39_5)

DON’T KNOW d (C39_5)

REFUSED r (C39_5)

(C39_4=01)

C39_4a. Because of these changes has the Social Security Administration paid {you/NAME} the wrong benefit amount?

YES 01

NO 00

DON’T KNOW d

REFUSED r

NEW ITEM

C39_5. {Were you/Was NAME} asked to re-pay benefits because the Social Security Administration overpaid {you/him/her}?

YES 01

NO 00 (C40)

DON’T KNOW d (C40)

REFUSED r (C40)

(C39_5=01)

C39_6. {Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/(he was /she was} working while receiving benefits?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

C40. CHECK: WAS {NAME} WORKING IN 2009 (B30 = 01)?

YES 01 (D1)

NO 00 (E1)

SECTION D: JOBS/OTHER JOBS DURING 2009

(All)

D1. Now, I will ask you about jobs {you/NAME} had during 2009. When answering these questions, please include both part-time and full-time jobs, but only include jobs {you/NAME} held for pay or profit for one month or longer.

PROGRAMMER: IF C1=01 AND C4 YEAR < 2009, ASK:

Other than (your/NAME’s) current job that you already told me about, in 2009 did {you/NAME} work for pay at any other jobs for longer than a month?

PROGRAMMER: IF C1>01 AND C4 YEAR < 2009 FOR ONE OR MORE CURRENT JOBS IN SECTION C, ASK:

Other than (your/NAME’s) current jobs that you already told me about, in 2009 did {you/NAME} work for pay at any other jobs for longer than a month?

ELSE:

In 2009 did {you/NAME} work for pay at any jobs for longer than a month?

YES 01 (D3)

NO 00

DON’T KNOW d

REFUSED r

(D1=00, d, or r)

D2. SOFT EDIT: IF {NAME} WORKED IN 2009 (B30=01) AND {NAME} DID NOT WORK IN 2009 (D1=0,d,r) INTERVIEWER READ: “Earlier you said that {you/NAME} worked for pay in 2009. Let me repeat the question I just read and verify your response.”

PROGRAMMER: IF C1=01 AND C4 YEAR < 2009, ASK:

Other than (your/NAME’s) current job that you already told me about, in 2009 did {you/NAME} work for pay at any other jobs for longer than a month?

PROGRAMMER: IF C1>01 AND C4 YEAR < 2009 FOR ONE OR MORE CURRENT JOBS IN SECTION C, ASK:

Other than (your/NAME’s) current jobs that you already told me about, in 2009 did {you/NAME} work for pay at any other jobs for longer than a month?

ELSE:

In 2009 did {you/NAME} work for pay at any jobs for longer than a month?

YES 01

NO 00 (E1)

DON’T KNOW d (E1)

REFUSED r (E1)

(D1=01 or D2=01)

D3. PROGRAMMER: IF C1=01 AND C4 YEAR < 2009, ASK:

Other than (your/NAME’s) current job that you already told me about, how many other jobs did {you/NAME} hold for at least one month in 2009?

PROGRAMMER: IF C1>01 AND C4 YEAR < 2009 FOR ONE OR MORE CURRENT JOBS IN SECTION C, ASK:

Other than (your/NAME’s) current jobs that you already told me about, how many other jobs did {you/NAME} hold for at least one month in 2009?

ELSE:

How many jobs did {you/NAME} hold for at least one month in 2009?

|__|__| NUMBER OF JOBS (1-5)

DON’T KNOW d

REFUSED r

PROGRAMMER: D4 THROUGH D23 ASKED FOR ALL JOBS WHEN D3>01

(D1=01 or D2=01)

D4. PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:

Let us start with {your/NAME’s} main job in 2009 – that is, the job at which {you worked/(he/she) worked} the most hours.

What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?

PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND SECOND, THIRD, FOURTH, ETC. JOB:

Now I would like to ask about {your/NAME’S} {second/third/fourth} job in 2009.

What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?

ELSE (D3=01):

What kind of work {did you/did NAME} do, that is, what was {your/NAME’s} occupation?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: For example, a child-care provider at a private preschool; geometry teacher in a public high school; sales clerk in a women’s shoe store.

PROBE 2: What are {your/NAME’S} main activities or duties? What else do you do? What else? Do you supervise anyone?

<OPEN>

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D5. What kind of business was this?

INTERVIEWER: ENTER VERBATIM RESPONSE

PROBE 1: For what type of organization or industry did you work? For example: accounting firm, daycare center, educational facility, food services.

PROBE 2: What do they make, sell, or do where {you/NAME} worked?

PROBE 3: Is this mainly manufacturing (making a product), wholesale trade (selling to other businesses) or retail trade (selling to customers) or something else?

<OPEN>

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D6mth. In what month and year did {you/NAME} start working there?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN

|__|__| (1-12)

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D6yr. PROBE 1: In what month and year did {you/NAME} start working there?

PROBE 2: Your best estimate is fine.

INTERVIEWER: ENTER YEAR

|__|__|__|__| (1981-2009)

YEAR (1951-2009)

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D7. SOFT EDIT: YEAR {NAME} STARTED WORKING AT THIS JOB (D6 YEAR) SHOULD BE GREATER THAN OR EQUAL TO YEAR OF BIRTH (A04d) PLUS 14 YEARS. IF RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you were/NAME was} born in (A04d) and {you/NAME} started working at this job in (D6 YEAR), which means {you/NAME} started working at this job when {you were/he was/she was} (PROGRAMMER CALCULATE AND FILL AGE: D6 YEAR – YEAR OF BIRTH) years old. Is that correct?

YES 01

NO 02 (CHANGE D6 YEAR)

SUPPRESS 03

(D1=01 or D2=01)

D8mth. In what month and year did {you/NAME} stop working there?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCEEN

|__|__| (1-12)

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D8yr. PROBE 1: In what month and year did {you/NAME} stop working there?

PROBE 2: Your best estimate is fine.

INTERVIEWER: ENTER YEAR

|__|__|__|__| (1981-2010)

YEAR (1951-2010)

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D9. SOFT EDIT: DATE {NAME} STOPPED WORKING AT THIS JOB (D8 MONTH, D8 YEAR) SHOULD BE LATER THAN DATE {NAME} STARTED WORKING AT THIS JOB (D6 MONTH, D6 YEAR). IF RESPONDENT FAILS EDIT, INTERVIEWER READ: I must have recorded an incorrect answer. I show that {you/NAME} started working at this job in (D6 MONTH, D6 YEAR) and that (you/NAME) stopped working at this job in (D8 MONTH, D8 YEAR). Is that correct?

YES 01

NO, CHANGE ANSWER TO D6 02 (CHANGE D6)

NO, CHANGE ANSWER TO D8 03 (CHANGE D8)

NO, CHANGE ANSWERS FOR BOTH D6 AND D8 04 (CHANGE D6 AND D8)

SUPPRESS 05

(D1=01 or D2=01)

D10. SOFT EDIT: IF DATE {NAME} STOPPED WORKING AT THIS JOB (D8 MONTH, D8 YEAR ) AND DATE {NAME} STARTED WORKING AT THIS JOB (D6 MONTH, D6 YEAR) ARE THE SAME (D8 MONTH, D8 YEAR – D6 MONTH, D6 YEAR = 0), INTERVIEWER READ: You said that {you/NAME} started and stopped working at this job in (D8 MONTH, D8 YEAR). I’d like to verify that {you/NAME} worked at this job for less than one month. Is this correct?

YES, WORKED AT JOB FOR LESS THAN ONE MONTH 01

NO, WORKED AT JOB FOR MORE THAN ONE MONTH 02

SUPPRESS 03

(D1=01 or D2=01)

D11. SOFT EDIT: IF YEAR {NAME} STOPPED WORKING AT THIS JOB (D8 YEAR) IS BEFORE 2009, INTERVIEWER READ: You said that {you/NAME} stopped working at this job in (D8 YEAR). I’d like to verify that this job ended before 2009. Is this correct?

YES, JOB ENDED BEFORE 2009 01

NO, JOB DID NOT END BEFORE 2009 02

SUPPRESS 03

(D1=01 or D2=01)

D12. CHECK: DID {NAME} WORK AT THIS JOB FOR LESS THAN ONE MONTH (D10=01)?

YES 01 (D23)

NO 00

(D12=00)

D13. CHECK: DID THIS JOB END BEFORE 2009 (D11=01)?

YES 01 (D23)

NO 00

((D1=01 or D2=01) and D12=00 and D13=00)

D14. {Were you/Was NAME} self-employed at this job?

PROBE: Self-employed means that you work for yourself or own your own business.

YES 01

NO 00

DON’T KNOW d

REFUSED r

((D1=01 or D2=01) and D12=00 and D13=00)

D15. Was this job part of a sheltered workshop, transitional employment program, the Business Enterprise Program for the blind, or supported employment program?

PROBE: A sheltered workshop is a program that provides employment with subsidized wages (or special wages that would not be available in a regular job) for people with disabilities. A transitional employment program . A transitional employment program allows workers. A transitional employment program allows workers. A transitional employment program allows workers with disabilities to work at reduced levels while they ease back into the workplace. The Business Enterprise Program for the blind offers legally blind persons for the blind offers legally blind persons the opportunity to own their own businesses. Supported employment programs provide job coaches or other on-the-job supports to help individuals with disabilities get and keep jobs.

YES 01

NO 00

DON’T KNOW d

REFUSED r

((D1=01 or D2=01) and D12=00 and D13=00)

D16. How many hours per week did {you/NAME} usually work at this job?

PROBE: Include overtime if {you/he/she} usually worked overtime.

|__|__|__| HOURS PER WEEK (1-60)

(1-168)

DON’T KNOW d

REFUSED r

((D1=01 or D2=01) and, D12=00 and D13=00)

D17. How many weeks per year did {you/NAME} usually work at this job, including paid vacation and holidays?

PROBE 1: Please include time off for vacations and holidays if {you were/NAME was} paid for that time.

PROBE 2: There are 52 weeks in a year.

|__|__| WEEKS PER YEAR (1-52)

DON’T KNOW d

REFUSED r

((D1=01 or D2=01) andD12=00 and D13=00)

D18. PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:

For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was} paid on {your/(his/her)} main job in 2009. On {your/NAME’s} main job {were you/was (he/she} paid by the hour?

PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND SECOND, THIRD, FOURTH, ETC. JOB:

For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was} paid on {your/(his/her)} {second/third/fourth} job in 2009. On {your/NAME’s} {second/third/fourth} job {were you/was (he/she} paid by the hour?

ELSE (D3=01): For the purpose of this survey, it is important to obtain some information on how much {you were/NAME was} paid on {your/(his/her)} job in 2009. On {your/NAME’s} job {were you/was (he/she} paid by the hour?

PROGRAMMER: IF MORE THAN ONE JOB (D3>01) AND FIRST JOB:

PROBE: {Your/NAME’s} main job in 2009 was the job at which {you worked/(he/she) worked} the most hours.

YES 01

NO 00 (D20amt)

DON’T KNOW d (D20amt)

REFUSED r (D20amt)

((D1=01or D2=01) and D12=00 and D13=00 and D18=01)

D19. What was {your/NAME’S} regular hourly pay, including tips and commissions?

PROBE: IF LESS THAN $5.00 AN HOUR: Does this include tips and commissions?

$ |___|___|___|. |___|___| PER HOUR (1 - 25.00)

(1 - 300.00)

DON’T KNOW d

REFUSED r

GO TO D23

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00,d,r)

D20amt. Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips and commissions?

PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR

$|___|___|___| , |___|___|___|. 00

DON’T KNOW d

REFUSED r

((D1=01 or D2=01) and, D12=00 and D13=00 and D18=00,d,r)

D20hop. Before taxes and other deductions how much {were you/was NAME} paid on this job, including tips and commissions?

PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ENTER HOW OFTEN PAID

DAILY 01 (1-384) (1-1,922)

WEEKLY 02 (1-1,923) (1-9,615)

BI-WEEKLY 03 (1-4,166) (1-20,833)

TWICE A MONTH 04 (1-4,166) (1-20,833)

MONTHLY 05 (1-8,333) (1-41,666)

ANNUALLY 06 (1-100,000) (1-500,000)

DON’T KNOW d

REFUSED r

PROGRAMMER, CALCULATE MONTHLY PRE-TAX PAY BASED ON D20AMT AND D20HOP FOR EACH JOB:

If D18=1, and D19 and D16≠d or r, C_Job2009MnthPay(1)=D19*D16*4.35.

If D18=1 and D19 or D16=d, C_Job2009MnthPay(1)=d.

If D18=1 and D19 or D16=r and neither are d, C_Job2009MnthPay(1)=r.

If D18=0, d, OR r AND D20AMT OR D20HOP=d, C_Job2009MnthPay(1)=d.

If D18=0, d, OR r AND D20AMT OR D20HOP=r AND NEITHER ARE d, C_Job2009MnthPay(1)=r.

If D18=0, d, or r and D20hop=1, C_Job2009MnthPay(1)=D20amt*21.74.

If D18=0, d, or r and D20hop=2, C_Job2009MnthPay(1)=D20amt*4.35.

If D18=0, d, or r and D20hop=3, C_Job2009MnthPay(1)=D20amt*2.17.

If D18=0, d, or r and D20hop=4, C_Job2009MnthPay(1)=D20amt*2.

If D18=0, d, or r and D20hop=5, C_Job2009MnthPay(1)=D20amt.

If D18=0, d, or r and D20hop=6, C_Job2009MnthPay(1)=D20amt/12.

If D18=0, d, or r and D20hop or D20amt=d, then C_Job2009MnthPay(1)=d.

If D18=0, d, or r and D20hop or D20amt=r and none=d, then C_Job2009MnthPay(1)=r.

((D12=00 or D2=01) and D13=00 and D18=00,d,r)

D21amt. For this job, about how much was left as take-home pay after taxes and other deductions?

PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ROUND TO NEAREST DOLLAR

$|___|___|___| , |___|___|___|. 00

DON’T KNOW d

REFUSED r

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00,d,r)

D21hop. For this job, about how much was left as take-home pay after taxes and other deductions?

PROBE: {Were you/Was NAME} paid daily, weekly, bi-weekly, twice a month, monthly, or annually?

INTERVIEWER: ENTER HOW OFTEN PAID.

DAILY 01 (1-346) (1-1,730)

WEEKLY 02 (1-1,730) (1-8,653)

BI-WEEKLY 03 (1-3,750) (1-18,750)

TWICE A MONTH 04 (1-3,750) (1-18,750)

MONTHLY 05 (1-7,500) (1-37,500)

ANNUALLY 06 (1-90,000) (1-450,000)

DON’T KNOW d

REFUSED r

PROGRAMMER, CALCULATE MONTHLY TAKE HOME PAY FOR EACH JOB BASED ON D21AMT AND D21HOP:

If D18=1 and D19 and D16≠d or r, C_Job2009MnthPayTH(1)=D19*D16*4.35.

If D18=1 and D19 or D16=d, C_Job2009MnthPayTH(1)=d.

If D18=1 and D19 or D16=r and neither are d, C_Job2009MnthPayTH(1)=r.

If D18_1=0, d, or r and D21amt or D21hop=d, C_Job2009MnthPayTH(1)=d.

If D18_1=0, d, or r and D21amt or D21hop=r, and neither are d, C_Job2009MnthPayTH(1)=r.

If D18=0, d, or r and D21hop=1, C_Job2009MnthPayTH(1)=D21amt*21.74.

If D18=0, d, or r and D21hop=2, C_Job2009MnthPayTH(1) =D21amt*4.35.

If D18=0, d, or r and D21hop=3, C_Job2009MnthPayTH(1)=D21amt*2.17.

If D18=0, d, or r and D21hop=4, C_Job2009MnthPayTH(1)=D21amt*2.

If D18=0, d, or r and D21hop=5, C_Job2009MnthPayTH(1)=D21amt.

If D18=0, d, or r and D21hop=6, C_Job2009MnthPayTH(1)=D21amt/12.

If D18=0, d, or r and D21hop or D21amt=d, then C_Job2009MnthPayTH(1)=d.

If D18=0, d, or r and D21hop or D21amt=r and none=d, then C_Job2009MnthPayTH(1)=r.

((D1=01 or D2=01) and D12=00 and D13=00 and D18=00,d,r) and (D20hop= 01, 02, 03, 04, 05, or 06) and (D21hop= 01, 02, 03, 04, 05, or 06)

D22. SOFT EDIT: AMOUNT OF CALCULATED MONTHLY TAKE-HOME PAY MUST BE LESS THAN OR EQUAL T0 CALCULATED MONTHLY PRE-TAX PAY. IF AMOUNT OF MONTHLY TAKE HOME PAY (C_Job2009MnthPayTH(1)) NE D OR R, AND AMOUNT OF PRE-TAX MONTHLY PAY (C_Job2009MnthPay(1)) NE D OR R, AND C_Job2009MnthPayTH(1) > C_Job2009MnthPay(1), TRIGGER EDIT AND DISPLAY FOLLOWING TEXT:. INTERVIEWER, AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY IS GREATER THAN AMOUNT OF CALCULATED MONTHLY PRE-TAX PAY. CHECK ENTRY. IF NECESSARY READ: I must have recorded an incorrect answer. You said that {you were/NAME was} paid (D20) per (D20 AMOUNT), which would be about (C_Job2009MnthPay(1) before taxes and other deductions and that (D21) per (D21 AMOUNT), or about (C_Job2009MnthPayTH(1) was left as take-home pay after taxes and other deductions. Based on what I recorded, your take home pay was more than your pre-tax pay. Should I change the amount {you were/NAME was} paid before taxes and other deductions or the amount {you took/NAME took} home after taxes and other deductions?

CHANGE AMOUNT PAID BEFORE TAXES AND OTHER DEDUCTIONS 01 (CHANGE D20amt)

CHANGE AMOUNT OF TAKE-HOME PAY 02 (CHANGE D21amt)

SUPPRESS 03

((D1=01 or D2=01) andD12=00 and D13=00 and D18=00,d,r) and (D20hop= 01, 02, 03, 04, 05, or 06) and (D21hop= 01, 02, 03, 04, 05, or 06)

D22a. SOFT EDIT: DIFFERENCE IN AMOUNT OF CALCULATED MONTHLY TAKE HOME PAY AND CALCULATED MONTHLY PRE-TAX PAY IS GREATER THAN 30%. IF AMOUNT OF MONTHLY TAKE HOME PAY (C_Job2009MnthPayTH(1)) NE D OR R, AND AMOUNT OF MONTHLY PRE-TAX PAY (C_Job2009MnthPay(1)) NE D OR R, AND (C_Job2009MnthPay(1) - C_Job2009MnthPayTH(1) / C_Job2009MnthPayTH(1) > .30, TRIGGER EDIT AND DISPLAY FOLLOWING TEXT: INTERVIEWER, DIFFERENCE IN AMOUNT OF TAKE HOME PAY AND PRE-TAX PAY IS GREATER THAN 30%. CHECK ENTRY. IF NECESSARY READ: I may have recorded an incorrect answer. You said that {you were/NAME was} paid (D20) per (D20 AMOUNT), which would be about (C_Job2009MnthPay(1) before taxes and other deductions and that (D21) per (D21 AMOUNT) , or about (C_Job2009MnthPayTH(1) was left as take-home pay after taxes and other deductions. Is this correct or should I change the amount {you were/NAME was} paid before taxes and other deductions or the amount {you took/NAME took} home after taxes and other deductions?

CHANGE AMOUNT PAID BEFORE TAXES AND OTHER DEDUCTIONS 01 (CHANGE D20amt)

CHANGE AMOUNT OF TAKE-HOME PAY 02 (CHANGE D21amt)

SUPPRESS 03

(D1=01 or D2=01)

D23. Why did {you/NAME} stop working at this job?

INTERVIEWER: ASK ‘Any other reason?’ UNTIL RESPONDENT INDICATES NO OTHER REASONS. IF RESPONDENT SAYS QUIT, ASK FOR THE REASON.

INTERVIEWER: CODE ALL THAT APPLY.

LAYOFF, FIRED, RETIRED:

LAYOFF, PLANT CLOSED 01 (D24)

FIRED 02 (D24)

RETIRED/OLD AGE 03 (D24)

JOB WAS TEMPORARY AND ENDED 04 (D24)

PROBLEMS WITH JOB:

DID NOT LIKE SUPERVISOR OR CO-WORKERS 05 (D24)

DID NOT LIKE JOB DUTIES 06 (D24)

DID NOT LIKE JOB EARNINGS 07 (D24)

DID NOT LIKE BENEFITS 08 (D24)

DID NOT LIKE OPPORTUNITIES FOR ADVANCEMENT 09 (D24)

DID NOT LIKE LOCATION 10 (D24)

DID NOT GET ACCOMMODATIONS THAT WERE NEEDED 11 (D24)

OTHER PROBLEMS:

TRANSPORTATION PROBLEMS 12 (D24)

DECIDED TO GO TO SCHOOL 13 (D24)

CHILD CARE RESPONSIBILITIES (PREGNANT) 14 (D24)

OTHER FAMILY OR PERSONAL REASONS 15 (D24)

DISABILITY:

DISABILITY GOT WORSE 16 (D24)

BECAME DISABLED 17 (D24)

OTHER 18 (D23_other)

DON’T KNOW d (D24)

REFUSED r (D24)

((D1=01 or D2=01) and D23=18)

D23_Other. What is the other reason?

<OPEN>

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D24. CHECK: DID {NAME} HOLD MORE THAN ONE JOB DURING 2009 (D3 > 01)?

YES 01

(REPEAT D4 THROUGH D23 FOR EACH JOB)

NO 00

(D1=01 or D2=01)

D25. Sometimes people work fewer hours or earn less money than they could in order to care for family members, keep the cash benefits they need, or just to have more free time. In 2009, did (you/NAME) work fewer hours or earn less money than (you/he/she) could have for any reason?

YES 01

NO 00 (D26)

DON’T KNOW d (D26)

REFUSED r (D26)

((D1=01 or D2=01) and D25=01)

D25a. Did (you/NAME) work fewer hours or earn less money than (you/he/she) could have because (you/he/she)…

PROBE: I need to ask everyone in our study the same questions, even if they don’t seem to apply to (you/NAME).

DON’T

YES NO KNOW REF

a. {Were/Was} taking care of children or others? 01 00 d r

b. {Were/Was} enrolled in school or a training program? 01 00 d r

c. Wanted to keep Medicare or Medicaid coverage? 01 00 d r

d. Wanted to keep cash benefits (you/he/she) needed such as disability or

workers compensation? 01 00 d r

e. Just did not want to work more? 01 00 d r

f. Are there any reasons I didn’t mention why {you/NAME} might

have worked or earned less than {you/he/she} could have during 2009? 01 00 d r

PROGRAMMER: IF D25f=01 GO TO D25f_Other, ELSE SKIP TO D25_1

((D1=01 or D2=01) and D25=01 and D25f=01)

D25f_Other What other reason?

<OPEN>

DON’T KNOW d

REFUSED r

NEW ITEM

((D1=01 or D2=01) and D25=01)

D25_1. Were any of (your/NAME’s) disability-related benefits reduced or ended as a result of {your/his/her} working in 2009?

YES 01

NO 00 (D26)

DON’T KNOW d (D26)

REFUSED r (D26)

NEW ITEM

(D25_1=01)

D25_2. What benefits were reduced or ended as a result of {your/NAME’s} job in 2009?

INTERVIEWER MARK ALL THAT APPLY.

PRIVATE DISABILITY INSURANCE 01

WORKERS’ COMPENSATION 02

VETERANS’ BENEFITS 03

MEDICARE 04

MEDICAID 05

SSA DISABILITY BENEFITS 06

PUBLIC ASSISTANCE OR WELFARE 07

FOOD STAMPS 08

PERSONAL ASSISTANCE SERVICES (PAS) 09

UNEMPLOYMENT BENEFITS 10

OTHER STATE DISABILITY BENEFITS 11

OTHER GOVERNMENT PROGRAMS 12

OTHER 13

(D25_2=13)

D25_2_Other: What other benefits?

<OPEN>

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D26. Now, I am going to read you a list of things that sometimes help people to work more hours or earn more money. If any of these do not apply to {you/NAME}, please just say so.

In 2009, do you think {you/NAME} could have worked or earned more if {you/he/she} had…

YES NO NA DK REF

a. Help caring for {your/his/her} children or others in the household? 01 00 02 d r

b. Help with {your/his/her} own personal care such as bathing, dressing, preparing meals, and doing housework? 01 00 02 d r

c. Reliable transportation to and from work? 01 00 02 d r

d. Better job skills? 01 00 02 d r

e. A job with a flexible work schedule? 01 00 02 d r

f. Help with finding and getting a better job? 01 00 02 d r

g. Any special equipment or medical devices? 01 00 02 d r

PROGRAMMER: IF D26g=01, GO TO D26g_Other, ELSE GO TO D26h.

h. Is there anything else that I didn’t mention that would have helped {you/NAME} to work or earn more during 2009? 01 00 02 d r

PROGRAMMER: IF D26h=01, GO TO D26h_Other, ELSE GO TO D27.

((D1=01 or D2=01) and D26g=01)

D26g_Other What other special equipment or medical devices?

<OPEN> (D26h)

DON’T KNOW d (D26h)

REFUSED r (D26h)

((D1=01 or D2=01) and D26h=01)

D26h_Other What else?

<OPEN>

DON’T KNOW d

REFUSED r

(D1=01 or D2=01)

D27. One last question about when {you were/NAME was} working in 2009. Because of {your/his/her} work, did Social Security need to make any changes to the amount of {your/his/her} disability benefits?

PROBE: Did {your/NAME’s} benefit amount decrease or did {you/he/she} lose benefits altogether?

YES 01

NO 00 (D29)

DON’T KNOW d (D29)

REFUSED r (D29)

((D1=01 or D2=01) and D27=01)

D28. Because of these changes did the Social Security Administration pay {you/NAME} the wrong benefit amount at any time during 2009?

YES 01

NO 00

DON’T KNOW d

REFUSED r

(D1=01 or D2=02=1)

D29. In 2009, {were you/was NAME} ever asked to re-pay benefits because the Social Security Administration overpaid {you/him/her}?

YES 01

NO 00 (E1)

DON’T KNOW d (E1)

REFUSED r (E1)

((D1=01 or D2=01) and D29=01)

D30. {Were you/Was NAME} asked to re-pay the Social Security Administration because {you were/(he/she) was} working while receiving benefits?

YES 01

NO 00

DON’T KNOW d

REFUSED r

SECTION E: AWARENESS OF SSA WORK INCENTIVE PROGRAMS AND TICKET TO WORK AWARENESS OF SSA WORK INCENTIVES

(All)

E1. PROGRAMMER: ONLY USE “HEARD OF THESE INCENTIVES OR SUPPORTS” IF {NAME} HAS NOT COMPLETED ANY PRIOR ROUNDS (S2=01). I’m going to read you a list of incentives and supports that Social Security offers to people getting disability benefits, to encourage them to work. Please tell me if {you have/NAME has} ever {heard of these incentives or supports or} used any of them.

PRESS 1 TO CONTINUE 01

(All)

E2. CHECK: IS {NAME} AN SSI BENEFICIARY (BSTATUS = 01,03)?

YES 01

NO 00 (E14)

(S2=04 and E2=01 and FIXE2=01) or (S2=01 and E2=01)

E3. {Have you/Has NAME} ever heard of a Plan for Achieving Self-Support or a PASS Plan? This is a Social Security incentive that lets {you/beneficiaries} set aside money to be used to help {you/them} reach a work goal. The money set aside does not affect {your/their} benefits.

PROBE 1: {Have you/Has NAME} ever heard of this plan?

PROBE 2: If you’re not sure, please just say so.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (PROGRAMMER NOTE

BEFORE E5)

DON’T KNOW d (PROGRAMMER NOTE

BEFORE E5)

REFUSED r (PROGRAMMER NOTE

BEFORE E5)

(S2=04 and FIXE2=01 and E3=01) or ((S2=02 or S2=04) and E2=01 and FIXE2=00) or (S2=01and E2=01 and E3=01)

E4. {Have you/Has NAME} ever used a Plan for Achieving Self-Support or a PASS Plan?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

((S2=04) and E2=01 and FIXE2=01) or (S2=01 and E2=01)

E5. {Have you/Has NAME} ever heard of the earned income exclusion or the 1 for 2 earnings exclusion? This is a Social Security incentive where one-half of {your/a beneficiary’s} earnings over $85 are not counted when Social Security figures {your/the} benefit.

PROBE 1: {Have you/Has NAME} ever heard of this exclusion?

PROBE 2: If you’re not sure, please just say so.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (PROGRAMMER NOTE

BEFORE E7)

DON’T KNOW d (PROGRAMMER NOTE

BEFORE E7)

REFUSED r (PROGRAMMER NOTE

BEFORE E7)

(S2=04 and FIXE2=01 and E5=01) or (S2=02 or S2=04 and E2=01 and FIXE2=00) or (S2=01 and E2=01 and E5=01)

E6. {Have you/Has NAME} ever used the earned income exclusion or the 1 for 2 earnings exclusion?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(S2=04) and E2=01 and FIXE2=01) or (S2=01 and E2=01)

E7. {Have you/Has NAME} ever heard of Property Essential to Self-Support, or PESS? This is a Social Security incentive where the dollar value of tools, equipment, or other property needed for {your/a beneficiary’s} work is excluded when Social Security figures {your/the} benefit.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (PROGRAMMER NOTE

BEFORE E9)

DON’T KNOW d (PROGRAMMER NOTE

BEFORE E9)

REFUSED r (PROGRAMMER NOTE

BEFORE E9)

(S2=04 and FIXE2=01 and E7=01) or ((S2=02 or S2=04) and E2=01 and FIXE2=00) or (S2=01and E2=01 and E7=01)

E8. {Have you/Has NAME} ever used Property Essential to Self-Support or PESS?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(S2=04 and E2=01 and FIXE2=01) or (S2=01 and E2=01)

E9. {Have you/Has NAME} ever heard of Continued Medicaid Eligibility or 1619(b) coverage? This is a Social Security incentive that lets {you/beneficiaries} keep {your/their} Medicaid insurance after {you/they} go to work, even if {your/their} benefits have stopped.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (E11)

DON’T KNOW d (E11)

REFUSED r (E11)

(S2=04 and FIXE2=01 and E9=01) or ((S2=02 or S2=04) and E2=01 and FIXE2=00) or (S2=01 and E2=01 and E9=01)

E10. {Have you/Has NAME} ever used Continued Medicaid Eligibility or 1619(b) coverage?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(E2=01)

E11. CHECK: IS {NAME} 25 OR YOUNGER {C_Intage < or = 25} AND DID {NAME} RECEIVE SSI BENEFITS BEFORE AGE 22 {SSIAGE < 22}?

YES 01

NO 00 (E14)

((S2=04) and FIXE2=01 and FIXE11=01) or (S2=01 and E2=01 and E11=01)

E12. {Have you/Has NAME} ever heard of the student earned-income exclusion? This is a Social Security incentive where if {you are/a beneficiary is} in school, up to $1,340 of earnings per month are not counted when Social Security figures {your/the} benefit.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (E14)

DON’T KNOW d (E14)

REFUSED r (E14)

E13. {Have you/Has NAME} ever used the student earned-income exclusion?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(All)

E14. CHECK: IS {NAME} A SSDI BENEFICIARY (BSTATUS=02,03)?

YES 01

NO 00 (PROGRAMMER NOTE

BEFORE E19)

(S2=04) and E14=01 and FIXE14=01) or (S2=01 and E14=01)

E15. {Have you/Has NAME} ever heard of a Trial Work Period? This is a Social Security incentive that lets {you/beneficiaries} Learn above $800 per month for nine months without losing {your/their} benefits.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (PROGRAMMER NOTE

BEFORE E17)

DON’T KNOW d (PROGRAMMER NOTE

BEFORE E17)

REFUSED r (PROGRAMMER NOTE

BEFORE E17)

(S2=02) or (S2=04 and E14=01 and FIXE14=01 and E15=01) or ((S2=04 and FIXE14=00) or (S2=01 and E14=01 and E15=01)

E16. {Have you/Has NAME} ever used a Trial Work Period?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

E17. {Have you/Has NAME} ever heard of an Extended Period of Eligibility for Medicare? This is a Social Security incentive that lets {you/beneficiaries} keep Medicare coverage when {you/they} go to work, even if {your/their} benefits have stopped.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (PROGRAMMER NOTE

BEFORE E19)

DON’T KNOW d (PROGRAMMER NOTE

BEFORE E19)

REFUSED r (PROGRAMMER NOTE

BEFORE E19)

(S2=02) or (S2=04 and E14=01 and FIXE14=01 and E17=01) or ((S2=04 and FIXE14=00) or (S2=01and E14=01 and E17=01)

E18. {Have you/Has NAME} ever used an Extended Period of Eligibility for Medicare?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(S2=01)

E19. {Have you/Has NAME} ever heard of exclusions for Impairment-Related Work Expenses or Blind Work Expenses? This is a Social Security incentive where the value of certain impairment-related items is not counted when figuring {your/a person’s} benefits and eligibility.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (PROGRAMMER NOTE BEFORE E20a)

DON’T KNOW d (PROGRAMMER NOTE BEFORE E20a)

REFUSED r (PROGRAMMER NOTE BEFORE E20a)

(S2=02 or S2=04) or (S2=01 and E19=01)

E20. {Have you/Has NAME} ever used exclusions for Impairment-Related Work Expenses or Blind Work Expenses?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(S2=01)

E20a. {Have you/Has NAME} ever heard of Expedited Reinstatement? This is a Social Security incentive that lets beneficiaries restart their benefits without having to complete a new application if their attempts at work are not successful.

INTERVIEWER: IF ‘NOT SURE’ ANSWER ‘DON’T KNOW’.

YES 01

NO 00 (PROGRAMMER NOTE BEFORE E20c)

DON’T KNOW d (PROGRAMMER NOTE BEFORE E20c)

REFUSED r (PROGRAMMER NOTE BEFORE E20c)

(S2=02 or S2=04) or (S2=01 and E20a=01)

E20b. {Have you/Has NAME} ever used Expedited Reinstatement?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

(S2=01)

E20c. {Have you/Has NAME} ever heard of Work Incentive and Planning Assistance programs? These are local organizations which give beneficiaries information about programs and help them understand how their Social Security benefits are affected by work.

INTERVIEWER: IF ‘NOT SURE’, ANSWER ‘DON’T KNOW’

PROBE: These are sometimes called WIPAs.

YES 01

NO 00 (E21)

DON’T KNOW d (E21)

REFUSED r (E21)

(S2=02 or S2=04) or (S2=01 and E20c=01)

E20d. {Have you/Has NAME} ever used a Work Incentive and Planning Assistance program?

INTERVIEWER: IF ‘NOT SURE’ OR ‘NEVER HEARD OF’ CODE AS DON’T KNOW

YES 01

NO 00

DON’T KNOW d

REFUSED r

E20e_1. {Have you/Has NAME} ever heard of Work Incentive Seminar Events or WISE? These are community events held by local organizations for beneficiaries to learn more about available work incentives.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (E20e)

DON’T KNOW d (E20e)

REFUSED r (E20e

E20f_1. {Have you/Has NAME} ever attended a Work Incentive Seminar Event?

YES 01

NO 00

DON’T KNOW d

REFUSED r

E20e. {Have you/Has NAME} ever heard of Protection and Advocacy for Beneficiaries of Social Security or PABSS? This program is focused on protecting beneficiaries’ rights to obtain services.

INTERVIEWER: IF ‘NOT SURE’, CODE AS DON’T KNOW

YES 01

NO 00 (E21)

DON’T KNOW d (E21)

REFUSED r (E21)

E20f. {Have you/Has NAME} ever used Protection and Advocacy for Beneficiaries of Social Security or PABSS?

YES 01

NO 00

DON’T KNOW d

REFUSED r

AWARENESS OF TICKET TO WORK

(All)

E21. {Have you/Has NAME} ever heard of the Ticket to Work program?

PROBE: The Ticket to Work program provides services to help disability beneficiaries achieve

steady, long-term employment by providing them greater choices and opportunities to go to work if they want to.

YES 01 (E26)

NO 00

DON’T KNOW d

REFUSED r

(E21=00,d,r)

E22. {Have you/Has NAME} heard of any Social Security programs in the last few years that allow disability beneficiaries to get services to help them go to work or earn more?

YES 01 (E25)

NO 00

DON’T KNOW d

REFUSED r

(E21=00,d,r and E22=00,d,r)

E23. CHECK: DID {NAME} HAVE A TICKET ASSIGNED AT THE TIME OF SAMPLE SELECTION (TSTATUS=01)? NOTE: VR IN-USE IS TSTATUS=0.

YES 01

NO 00 (E24b)

(E21=00,d,r and E22=00,d,r and Tstatus=01)

E24. {Are you/Is NAME} aware that, according to Social Security, {you are/(he/she) is} participating in the Ticket to Work program and {your/his/her} Ticket is assigned to {ENSAMPLE} as of {SDATE}?

YES 01 (E26)

NO 00 (E36bDON’T KNOW d (; E36b)

REFUSED r ( E36b)

E24b. CHECK: DID {NAME} HAVE AN IN-USE TICKET WITH AN SVRA AT THE TIME OF SAMPLE SELECTION (VRINUSE =01)?

YES 01 (E36b)

NO 00 (G1)

(E22=01)

E25. Does the program {you’ve/NAME’s} heard of include a certificate or Ticket that {you/NAME} would give to a service provider in exchange for services?

YES 01

NO 00 (EN2009=1, go to F; EN2009=0, go to G)

DON’T KNOW d (EN2009=1, go to F; EN2009=0, go to G)

REFUSED r (EN2009=1, go to F; EN2009=0, go to G)

(S2=01 and (E21=01 or E24=01 or E25=01))

E26. PROGRAMMER: IF {NAME} HEARD OF TICKET TO WORK PROGRAM (E21=01) ASK:

In what year did {you/NAME or his/her representative} first hear about the Ticket to Work program? Was it.

PROGRAMMER: OTHERWISE (E21=00,d,r) ASK:

The program is usually called the Ticket to Work program. I’m going to call it the Ticket to Work program in the next few questions. In what year did {you/NAME or his/her representative} first hear about the Ticket to Work program? Was it.

In 2010 01

In 2009 02

BEFORE 2009 03 (E34)

DON’T KNOW d (E34)

REFUSED r (E34)

(S2=01) and (E21=01 or E24=01 or E25=01 and E26=02)

E27. How did {you/NAME or his/her representative} first learn about the Ticket to Work program.

PROBE: For example, did you get the information through the mail, by phone, via the Internet, in-person, or in some other way?

INTERVIEW NOTE: CODE ALL THAT APPLY.

MAIL 01 (E28)

PHONE 02 (E28)

INTERNET 03 (E28)

IN-PERSON MEETING 04 (E28)

OTHER (specify) 05

DK D (E28)

R R (E28)

E27_otherspec. Other specify:

(S2=01 and (E21=01 or E24=01 or E25=01) and E26=02 and E27=01)

E28. Who did {you/NAME or his/her representative} get information from about the Ticket to Work program?

INTERVIEWER: CODE ALL THAT APPLY.

SOCIAL SECURITY ADMINISTRATION 01 (E29)

MAXIMUS 02 (E29)

STATE VOCATIONAL REHABILITATION AGENCY, OR {VRNAME} 03 (E29)

CURRENT/FORMER EMPLOYER 04 (E29)

FRIEND/FAMILY MEMBER 05 (E29)

INDEPENDENT LIVING CENTE 06 (E29)

EMPLOYMENT NETWORK 07 (E28g_other)

OTHER AGENCY/ORGANIZATION 08 (E28h_Other)

HEALTH CARE PROVIDER 09 (E28i_Other)

OTHER 10 (E28j_Other)

DON’T KNOW d (E29)

REFUSED r (E29)

(S2=01 and (E21=01 or E24=01 or E25=01) and E26=02 and E27=01 and E28=07)

E28g_Other. What Employment Network sent {you/NAME} the information?

<OPEN>

DON’T KNOW d

REFUSED r

(S2=01, and (E21=01 or E24=01 or E25=01) and E26=02 and E27=01 and E28=08))

E28h_Other. What other Agency/Organization sent {you/NAME} the information?

<OPEN>

DON’T KNOW d

REFUSED r

((S2=01) and (E21=01 or E24=01 or E25=01) and E26=02 and E27=01 and E28=09))

E28i_Other. What Health Care Provider sent {you/NAME} the information?

<OPEN>

DON’T KNOW d

REFUSED r

((S2=01) and (E21=01 or E24=01 or E25=01) and E26=02 and E27=01 and E28=10))

E28j_Other. Who sent {you/NAME} the information?

<OPEN>

DON’T KNOW d

REFUSED r

(S2=01) and (E21=01 or E24=01 or E25=01)

E34. PROGRAMMER: IF PROXY RESPONDENT, USE {NAME}

Do you recall {NAME} getting a Ticket in the mail from Social Security? It looks like a certificate with blue and red writing and the title says ‘Ticket to Work and Self-Sufficiency’.

YES 01 (E36)

NO 00

DON’T KNOW d

REFUSED r

((S2=01) and (E21=01 or E24=01 or E25=01) and E34=00,d,r))

E35. Did {you/NAME} ever try to get a Ticket from Social Security or anywhere else?

YES 01

NO 00 (F31)

DON’T KNOW d (F31)

REFUSED r (F31)

EVER USED TICKET/STATE VR AGENCY

((S2=01,) and (E21=01 or E24=01 or E25=01) and (E34=01 or E35=01))

E36. {Have you/Has NAME} ever used {your/his/her} Ticket to sign up with an Employment Network? Employment Networks are organizations or businesses that offer services to help people with disabilities work or earn more money as part of the Ticket to Work Program.

PROBE: Employment Networks can be public or private and can include the State Vocational Rehabilitation Agency.

YES 01 (E37)

NO 00 (E36check)

DON’T KNOW d (E36check)

REFUSED r (E36check)

E36CHECK.

CHECK: DID {NAME} HAVE A TICKET ASSIGNED AT THE TIME OF SAMPLE SELECTION (TSTATUS=01)? NOTE: VR IN-USE IS TSTATUS=0.

YES 01

NO 00 (E51)

E36b. {Have you/Has NAME} ever received any services from a State Vocational Rehabilitation agency? In your state, this agency is known as {VRNAME}.

YES 01 (E37b)

NO 00 (E36bcheck)

DON’T KNOW d (E36bcheck)

REFUSED r (E36bcheck)

E36bCHECK: DID {NAME} HAVE AN IN-USE TICKET WITH AN SVRA AT THE TIME OF SAMPLE SELECTION ( =01)?

YES 01

NO 00 (E51)

E36c. {Are you/Is NAME} aware that, according to Social Security, {you are/(he/she) is} signed up with the State Vocational Rehabilitation Agency {VRNAME} and have been since {VRDATE}?

YES 01 (E37b)

NO 00 (E51)

DON’T KNOW d (E51)

REFUSED r ( E51)

TICKET/SVRA USE IN 2009

((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01)) or (S2=01 and (E34=01 and E36=01) or (E34=00,d,r and E35=01 and E36=01)

(S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=01)

E37a.

((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01)) and CHECK37=00)) or ((S2=01 and (E21=01 or E24=01 or E25=01) and E36=01 and CHECK37=00))

E37

PROGRAMMER:

ASK: {Were you/Was NAME} signed up with any Employment Networks or a State Vocational Rehabilitation Agency at any time in 2009?

PROBE: Employment Networks are organizations or businesses that offer services to help people with disabilities work or earn more money as part of the Ticket to Work Program. Employment Networks can be public or private and can include the State Vocational Rehabilitation Agency.

YES 01 (E38)NO 00 (E44)

DON’T KNOW d (E44)

REFUSED r (E44)

E37b. {Were you/Was NAME} signed up with a State Vocational Rehabilitation Agency at any time in 2009?

YES 01 (E39)

NO 00 (E51)

DON’T KNOW d (E51)

REFUSED r (E51)

((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01) and CHECK37=00 and E37=01) or ((S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=01 and E37b=01)) or ((S2=01 and (E21=01 or E24=01 or E25=01) and E36=01 and CHECK37=00 and E37=01)

E38. PROGRAMMER:

How many Employment Networks {were you/was NAME} signed up with in 2009?

|__|__|

EMPLOYMENT NETWORKS IN 2009

(1-2) (1-5)

DON’T KNOW d

REFUSED r

E39. PROGRAMMER: (IF E37=1 AND IF MORE THAN ONE EMPLOYMENT NETWORK IN 2009

((IF S2=01,04 and E38>1) OR (IF S2=02 and E37a=01 and E37b=01) OR (IF S2=02 and E38>1)),

USE {FIRST, SECOND, THIRD, ETC.}

(IF E37=1) What was the name of the {first, second, third, fourth, fifth} Employment Network {you were/ NAME was} signed up with in 2009?

(IF E37b=1) What was the name of the Vocational Rehabilitation Agency {you were/NAME was} signed up with in 2009?

INTERVIEWER: IF NAME OF VR IS NOT KNOW, ENTER “STATE VR AGENCY”.

INTERVIEWER: ENTER VERBATIM RESPONSE

E39a (EN#1 2009) <STRING=240 > ______________________________________________

E39b (EN#2 2009) <STRING=240 > ______________________________________________

E39c (EN#3 2009) <STRING=240 > ______________________________________________

E39d (EN#4 2009) <STRING=240 > ______________________________________________

E39e (EN#5 2009) <STRING=240 > ______________________________________________

DON’T KNOW d

REFUSED r

PROGRAMMER: IN-USE VR (E37b=1) SKIP TO E51.

PROGRAMMER: ASK E40- E43 FOR EACH EMPLOYMENT NETWORK LISTED IN E39 (WHERE E37=1).

E40mth. The Ticket to Work program started in 2001. In what month and year did {you/NAME} first use {your/his/her} ticket with {EN IN 2009 FROM E39}?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN

|__|__| (1-12)

DON’T KNOW d

REFUSED r

E40yr. PROBE: The Ticket to Work program started in 2001. In what month and year did {you/NAME} first use your ticket with {EN IN 2009 FROM E39}?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER YEAR

|__|__|__|__| (2001-2009)

YEAR

DON’T KNOW d

REFUSED r

E41. {Are you/Is NAME} currently signed up with {EN IN 2009 FROM E39}?

YES 01 (NEXT EN OR E44)

NO 00

DON’T KNOW d

REFUSED r

((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01) and CHECK37=00 and E37=01 and E41=00,d,r) or ((S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=01 and E37b=01 and E41=00,d,r) or (E37a=01 and E37b=01)) or (S2=01 and (E21=01 or E24=01 or E25=01) and E36=01 and (CHECK37=00 and E37=01) and E41=00,d,r)

E42mth.In what month and year did {you/NAME} stop receiving services from {EN IN 2009 FROM E39}?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER MONTH HERE AN YEAR ON NEXT SCREEN

|__|__| (1-12)

DON’T KNOW d

REFUSED r

(S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=00 and E37=01 and E41=00,d,r) or ((S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=01 and E37b=01 and E41=00,d,r) or (E37a=01 and E37b=01)) or (S2=01 and (E21=01 or E24=01 or E25=01) and E36=01 and (CHECK37=00 and E37=01) and E41=00,d,r)

E42yr. PROBE 1: In what month and year did {you/NAME} stop receiving services from {EN IN 2009 FROM E39}?

PROBE 2: Your best estimate is fine.

INTERVIEWER: ENTER YEAR

|__|__|__|__| (2001-2006)

(2004 - 2006)

YEAR

DON’T KNOW d

REFUSED r

(S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=00 and E37=01 and E41=00,d,r) or ((S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=01 and E37b=01 and E41=00,d,r) or (E37a=01 and E37b=01)) or (S2=01and (E21=01 or E24=01 or E25=01) and E36=01 and (CHECK37=00 and E37=01) and E41=00,d,r) and (E42yr<2004 or E42yr>2009)

E42yr1. SOFT EDIT: [YEAR STOPPED RECEIVING SERVICES (E42yr) SHOULD BE 2009 OR 2006.} IF {NAME} FAILS EDIT, INTERVIEWER READ: Earlier you reported {you were/NAME was} signed up with {EN IN 2009 FROM E39} in 2009. I recorded {you/NAME} stopped receiving services in (E42yr).

Is this correct?

YES 01

NO 02 (CHANGE E42yr)

SUPPRESS 03

(S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=00 and E37=01 and E41=00,d,r) or ((S2=02 and (E21=01 or E24=01 or E25=01) and CHECK37=01 and E37b=01 and E41=00,d,r) or (E37a=01 and E37b=01))) or (S2=01, and (E21=01 or E24=01 or E25=01) and E36=01 and (CHECK37=00 and E37=01) and E41=00,d,r)

E43. Why {are you/is NAME} no longer receiving services from {EN IN 2009 FROM E39}?

INTERVIEWER: ENTER VERBATIM RESPONSE

<OPEN>_______________________________________________ __

DON’T KNOW d

REFUSED r

CURRENT TICKET USE

((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01)) or (S1=01 and (E21=01 or E24=01 or E25=01) and E36=01)

E44. CHECK: IS {NAME} CURRENTLY SIGNED UP WITH AN EMPLOYMENT NETWORK FROM 2009

{ E41=01 FOR ANY EN}?

YES 01 (E48)

NO 00

(((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01) and E44=00)) or ((S1=01 and (E21=01 or E24=01 or E25=01) and E36=01 and E44=00))

E45. {Are you/Is NAME} currently signed up with an Employment Network?

YES 01 (E46)

NO 00 (E48)

DON’T KNOW d (E48)

REFUSED r (E48)

(((S2=02 or S2=04)and (E21=01 or E24=01 or E25=01) and E44=00 and E45=01)) or ((S1=01and (E21=01 or E24=01 or E25=01) and E36=01 and E44=00 and E45=01))

E46. What is the name of the Employment Network {you are/NAME is} currently signed up with?

INTERVIEWER: ENTER VERBATIM RESPONSE CURRENT EN #1 <STRING=240>

DON’T KNOW d

REFUSED r

(((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01) and E44=00 and E45=01)) or ((S1=01and (E21=01 or E24=01 or E25=01) and E36=01 and E44=00 and E45=01))

E47mth. The Ticket to Work program started in 2001. In what month and year did {you/NAME} first use {your/his/her} ticket with {CURRENT EN FROM E46}?

(PROBE: Your best estimate is fine.

INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN

|__|__| (1-12)

DON’T KNOW d

REFUSED r

(((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01) and E44=00 and E45=01)) or ((S1=01and (E21=01 or E24=01 or E25=01) and E36=01 and E44=00 and E45=01))

E47yr. PROBE 1: The Ticket to Work program started in 2001. In what month and year did {you/NAME} first use {your/his/her} ticket with {CURRENT EN FROM E46}?

PROBE 2: Your best estimate is fine.

INTERVIEWER: ENTER YEAR

|__|__|__|__| (2001-2006)

YEAR

DON’T KNOW d

REFUSED r

OTHER EMPLOYMENT NETWORKS NOT PREVIOUSLY DISCUSSED

(S2=01 and (E21=01 or E24=01 or E25=01) and E36=01) or (S2=04 and (E21=01 or E24=01 or E25=01))

E48. {Have you/Has NAME} ever used {your/his/her} Ticket to sign up with any other Employment Networks that we haven’t yet talked about?

YES 01

NO 00 (E51)

DON’T KNOW d (E51)

REFUSED r (E51)

(S2=01,04) and (E21=01 or E24=01 or E25=01) and E36=01 and E48=01)

E49. How many other Employment Networks {have you/has NAME} been signed up with?

|__|__|

OTHER EMPLOYMENT NETWORKS

(1-2)

(1-5)

DON’T KNOW d

REFUSED r

(S2=01,04) and (E21=01 or E24=01 or E25=01) and E36=01 and E48=01)

E50mth. The Ticket to Work program started in 2001. In what month and year did {you/NAME} first use {your/his/her} Ticket to sign up with an Employment Network?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER MONTH HERE AND YEAR ON NEXT SCREEN

|__|__| (1-12)

DON’T KNOW d

REFUSED r

(S2=01,04) and (E21=01 or E24=01 or E25=01) and E36=01 and E48=01)

E50yr. PROBE: The Ticket to Work program started in 2001. In what month and year did {you/NAME} first use {your/his/her} Ticket to sign up with an Employment Network?

PROBE: Your best estimate is fine.

INTERVIEWER: ENTER YEAR

|__|__|__|__| (2001-2006)

YEAR

DON’T KNOW d

REFUSED r

((S2=02 or S2=04) and (E21=01 or E24=01 or E25=01)) or (E36=01 or E36b=1 or E36c=1))

E51. CHECK: DID NAME USE SVRA SERVICES IN 2009 (E37b=1)

WAS NAME AWARE OF TICKET [(E21=01 or E24=01 or E25=01)

AND:

NEVER USED TICKET (E36=00, d, r) OR DID NOT USE AN SVRA (E36b=0,d,r)

OR WAS A TICKET NON-PARTICIPANT IN 2009 (E37=00, d,r)

(

YES 01 (F1)

NO 00 (G1)

SECTION f: TICKET NON-PARTICIPANTS IN 2009

TRIED TO GET INFORMATION OR PARTICIPATE IN 2009

(E51=01)

F1. During 2009, did {you/NAME or his/her representative} contact, or try to contact, anyone to find out more about the Ticket to Work program or to participate in the program?

YES 01

NO 00 (F31)

DON’T KNOW d (F31)

REFUSED r (F31)

(E51=01 and F1=01)

F2. Thinking only about 2009, who did {you/NAME or his/her representative} contact to get information about the Ticket to Work program?

Did {you/NAME or his/her representative} contact….

	YES	NO	DON’T KNOW	REFUSED
a. The Social Security Administration?	01	00	d	r
b. Maximus?	01	00	d	r
c. The State Vocational Rehabilitation Agency or{VRNAME}?	01	00	d	r
d. A Work Incentive and Planning Assistance program or benefit specialist	01	00	d	r
e. A caseworker?	01	00	d	r
f. A friend or family member?	01	00	d	r
g. An Independent Living Center?	01	00	d	r
h. An Employment Network PROBE: Employment Networks are organizations or businesses that offer services to help people with disabilities work or earn more money as part of the Ticket to Work program. Employment Networks can be public or private and can include the State Vocational Rehabilitation Agency.	01	00	d	r
PROGRAMMER: IF F2h=01 GO TO F2h_OTHER, ELSE GO TO F2i
i. Another Agency or Organization	01	00	d	R
PROGRAMMER: IF F2I=01 GO TO F2i_OTHER, ELSE GO TO F3

(E51=01, F1=01 and F2h=01)

F2h_Other. What other Employment Network?

<OPEN> (F2i)

DON’T KNOW d (F2i)

REFUSED r (F2i)

(E51=01, F1=01 and F2i=01)

F2i_Other. What other Agency or Organization?

<OPEN>

DON’T KNOW d

REFUSED r

(E51=01 and F1=01)

F3. In general, how easy was it for {you/NAME or his/her representative} to get the information {you/they} wanted about the Ticket to Work program? Was it:

Very easy, 01

Somewhat easy, 02

Not very easy, or 03

Not at all easy? 04

DON’T KNOW d

REFUSED r

INFORMATION ABOUT EMPLOYMENT NETWORKS

(E51=01 and F1=01)

F4. Now I’d like to ask you about Employment Networks. During 2009, did {you/NAME or his/her representative} get any information about the Employment Networks that serve {your/NAME’s} area?

YES 01

NO 00 (F12)

DON’T KNOW d (F12)

REFUSED r (F12)

(E51=01 and F1=01 and F4=01)

F5. How did {you/NAME} receive this information about Employment Networks?

PROBE: For example, did you get information through the mail, by phone, via the Internet, in-person, or in some other way?

MAIL 01 (F6)

PHONE 02 (F6)

INTERNET 03 (F6)

IN-PERSON MEETING 04 (F6)

OTHER (specify) 05

DK D (F6)

R R (F6)

F5_otherspec. Other specify:

(E51=01 and F1=01 and F4=01 and F5=01)

F6. Who did {you/NAME or his/her representative} get information from about Employment Networks?

INTERVIEWER: CODE ALL THAT APPLY.

SOCIAL SECURITY ADMINISTRATION 01 (F7)

MAXIMUS 02 (F7)

STATE VOCATIONAL REHABILITATION AGENCY or {VRNAME} 03 (F7)

A WORK INCENTIVES PLANNING AND ASSISTANCE PROGRAM OR BENEFITS SPECIALIST 04 (F7)

A CASEWORKER 05 (F7)

FRIEND/FAMILY MEMBER 06 (F7)

INDEPENDENT LIVING CENTER 07 (F7)

EMPLOYMENT NETWORK 08 (F7)

OTHER AGENCY/ORGANIZATION 09 (F7)

10 (F6j_Other)

DON’T KNOW d (F7)

REFUSED r (F7)

(E51=01 and F1=01 and F4=01 and F5=01 and F6=10)

F6j_Other. What Other place?

<OPEN>

DON’T KNOW d

REFUSED r

CONTACT WITH STATE VR AGENCIES

PROGRAMMER: SKIP F12-F19 IF E37b=1)

(E51=01 and F1=01 and E37b ≠ 1)

F12. The next questions are about trying to use a Ticket with the vocational rehabilitation agency in {your/NAME’s} state. In {your/NAME’s} state the vocational rehabilitation agency is called {STATE NAME FOR VR AGENCY}. I’m going to refer to this as {your/NAME’s} State VR agency. In 2009, did {you/NAME or his/her representative} contact {your/his/her} State VR agency to use {your/his/her} Ticket or to talk about getting services from them?

YES 01

NO 00 (F20)

DON’T KNOW d (F20)

REFUSED r (F20)

(E51=01 and F1=01 and F12=01)

F13. In 2009, did {you/NAME or his/her representative} try to use {your/NAME’s} Ticket to sign up with {your/NAME’s} State VR agency?

YES 01 (F15)

NO 00

DON’T KNOW d (F20)

REFUSED r (F20)

(E51=01 and F1=01 and F12=01 and F13=01)

F15. In 2009, did {your/NAME’s} State VR agency accept {your/his/her} Ticket?

YES 01 (F17)

NO 00

DON’T KNOW d (F20)

REFUSED r (F20)

(E51=01 and F1=01 and F12=01 and F13=01and F15=00)

F16. Why didn’t the State VR agency accept {your/NAME’s} Ticket in 2009?

INTERVIEWER: CODE ALL THAT APPLY.

NOT TAKING TICKETS WHEN CONTACTED 01 (F17)

DID NOT OFFER SERVICES {NAME} NEEDED 02 (F17)

DID NOT SERVE PEOPLE WITH {NAME’S} DISABILITY/NEEDS 03 (F17)

{NAME} NOT WILLING/ABLE TO WORK FULL-TIME/ENOUGH HOURS 04 (F17)

{NAME} NOT WILLING TO GO OFF OF DISABILITY BENEFITS 05 (F17)

OTHER 06

DON’T KNOW d (F17)

REFUSED r (F17)

(E51=01 and F1=01 and F12=01 and F13=01 and F15=00 and F16=06)

F16_Other. What other reason?

<OPEN> (F20)

DON’T KNOW d

REFUSED r

(E51=01 and F1=01 and F12=01 and F13=01 and F15=01, 00)

F17. CHECK: WAS TICKET ASSIGNED TO STATE VR AGENCY IN 2009 (F15=01)?

YES 01

NO 00 (F20)

(E51=01 and F1=01 and F12=01 and F13=01 and F15=01,00 and F17=01)

F18. SOFT EDIT: You said that {your/NAME’s} State VR agency accepted {your/his/her} Ticket some time in 2009 (F15=01), but I show that you told me earlier {you/NAME} had not assigned {your/his/her} Ticket in 2009 (E51=01). Is it correct that {you/NAME} participated in the Ticket to Work program in 2009 through {your/his/her} State VR agency?

YES, DID PARTICIPATE IN 2009 01

NO, DID NOT PARTICIPATE IN 2009 02 (F20)

DON’T KNOW d (F20)

REFUSED r (F20)

(E51=01 and F1=01 and F12=01 and F13=01and F15=01,00 and F17=01 and F18=01)

F19. I have encountered a problem with the interview and need to speak with my supervisor. I will call you back shortly. Thank you for your time.

INTERVIEWER: GO TO PARALLEL BREAKOFF BLOCK, END INTERVIEW AND STATUS SUPERVISOR REVIEW 380.

CONTACT WITH EMPLOYMENT NETWORKS OTHER THAN THE STATE VR AGENCY

(E51=01 and F1=01)

F20. The next questions are about {your/NAME’s} contact with Employment Networks, other than {your/his/her} state vocational rehabilitation agency, {VRNAME}. In 2009, did {you/NAME} contact any Employment Networks other than {your/NAME’s} state VR Agency to use {your/his/her} Ticket or to talk about getting services from them?

YES 01

NO 00 (F28)

DON’T KNOW d (F28)

REFUSED r (F28)

(E51=01 and F1=01 and F20=01)

F21. How many other Employment Networks did {you/NAME} contact in 2009?

PROBE: Your best guess is fine.

|__|__| NUMBER (1-2)

(1-15)

DON’T KNOW d

REFUSED r

(E51=01 and F1=01 and F20=01)

F22. PROGRAMMER: IF MORE THAN ONE EMPLOYMENT NETWORK IN F21, READ THIS STATEMENT BEFORE F22:

{In the next few questions, I am going to ask about {your/NAME’s} overall experience with the Employment Networks that {you/ (he/she)} contacted.}

PROGRAMMER: USE “ANY OF” AND “NETWORKS” IF {NAME} CONTACTED MORE THAN ONE EN (F21>1).

Did {you/NAME or his/her representative} try to use {your/NAME’s} Ticket to sign up with {any of} the Employment Network(s) {you/he/she} contacted?

YES 01 (F24)

NO 00

DON’T KNOW d (F24)

REFUSED r (F24)

(E51=01 and F1=01 and F20=01 and F22=01,d,r)

F24. PROGRAMMER: USE ”ANY OF” AND “NETWORKS” IF {NAME} CONTACTED MORE THAN ONE EN (F21>1).

In 2009, did {any of} the Employment Network(s) {you/NAME} tried to use {your/his/her} Ticket with accept {your/NAME’s} Ticket?

YES 01 (F26)

NO 00

DON’T KNOW d (F30)

REFUSED r (F30)

(E51=01 and F1=01 and F20=01 and F22= 01,d,r and F24=00)

F25. PROGRAMMER: USE “NETWORKS” IF {NAME} CONTACTED MORE THAN ONE EN (F21>1).

Overall, why didn’t the Employment Network(s) {you/NAME} tried to use {your/his/her} Ticket with accept {your/NAME’s} Ticket in 2009?

PROGRAMMER: USE “THESE” AND “NETWORKS” IF {NAME} CONTACTED MORE THAN ONE EN (F21>1)

PROBE: Were there any other reasons why {these/this} Employment Network(s) would not accept {your/NAME’S} Ticket in 2009?

INTERVIEWER: CODE ALL THAT APPLY.

NOT TAKING TICKETS WHEN CONTACTED 01 (F30)

DID NOT OFFER SERVICES {NAME} NEEDED 02 (F30)

EMPLOYMENT NETWORK DID NOT SERVE PEOPLE WITH {NAME’S} DISABILITY/NEEDS 03 (F30)

{NAME} NOT WILLING/ABLE TO WORK FULL-TIME/ENOUGH HOURS 04 (F30)

{NAME} NOT WILLING TO GO OFF OF DISABILITY BENEFITS 05 (F30)

OTHER 06

DON’T KNOW d (F30)

REFUSED r (F30)

(E51=01 and F1=01 and F20=01 and F22= 01,d,r and F24=00 and F25=06)

F25_Other. What Other reason?

<OPEN>

DON’T KNOW d

REFUSED r

GO TO F30

(E51=01 and F1=01 and F20=01 and F22= 01,d,r and F24=01)

F26. PROGRAMMER: USE “ONE OF” AND “NETWORKS” IF {NAME} CONTACTED MORE THAN ONE EN (F21>1).

You said that {one of} the Employment Network{s} {you/NAME} tried to use {your/his/her} Ticket with accepted {your/his/her} Ticket some time during 2009 (F24=01), but I show that you told me earlier {you/NAME} had not assigned {your/his/her} Ticket in 2009 (E51=01). Is it correct that {you/NAME} participated in the Ticket program in 2009?

YES, DID PARTICIPATE IN 2009 01

NO, DID NOT PARTICIPATE IN 2009 02 (F30)

DON’T KNOW d (F30)

REFUSED r (F30)

(E51=01 and F1=01 and F20=01 and F22= 01,d,r and F24=01 and F26=01)

F27. I have encountered a problem with the interview and need to speak with my supervisor. I will call you back shortly. Thank you for your time.

INTERVIEWER: GO TO PARALLEL BREAKOFF BLOCK, END INTERVIEW AND STATUS SUPERVISOR REVIEW 380.

RECEIVED INFORMATION BUT DID NOT CONTACT ENs IN 2009

(E51=01 and F1=01 and F20=00,d,r)

F28. CHECK: DID {NAME} RECEIVE INFORMATION ABOUT EMPLOYMENT NETWORKS (F4=01) BUT DID NOT CONTACT THEM (F12=00 AND F20=00)?

YES 01

NO 00 (F30)

(E51=01 and F1=01 and F20=00,d,r and F28=01)

F29. After receiving information about the Employment Networks in {your/NAME’s} area (IF E37b≠1){ including the State Vocational Rehabilitation agency or {VRNAME}}, why didn’t {you/NAME or his/her representative} contact any of them?

INTERVIEWER: CODE ALL THAT APPLY.

PHYSICAL/MENTAL CONDITION 01 (F30)

CHANGED MIND 02 (F30)

FAMILY RESPONSIBILITIES 03 (F30)

FAMILY WOULD NOT SUPPORT 04 (F30)

COULD NOT GET RELIABLE TRANSPORTATION 05 (F30)

ECONOMIC CONDITIONS CHANGED – NO LONGER THINK JOB OPPORTUNITIES EXIST 06 (F30)

FEARED SERVICES WOULD ENDANGER BENEFITS 07 (F30)

INFORMATION TOO CONFUSING – DID NOT KNOW WHERE TO START 08 (F30)

EMPLOYMENT NETWORK {NAME} WANTED WAS NOT PARTICIPATING 09 (F30)

ENs TOO FAR AWAY 10 (F30)

COULD NOT GET IN CONTACT WITH ENs 11 (F30)

NO ENs PROVIDED SERVICES {NAME} NEEDS 12 (F30)

NO ENs SERVE MY KIND OF DISABILITY 13 (F30)

OTHER 14

DON’T KNOW d (F30)

REFUSED r (F30)

(E51=01 and F1=01 and F20=00,d,r and F28=01 and F29=14)

F29_OTHER. What other reason?

<OPEN>

DON’T KNOW d

REFUSED r

FUTURE PLANS ABOUT TICKET TO WORK PARTICIPATION

(E51=01 and F1=01)

F30. Do you think {you/NAME} will try to participate in the Ticket to Work program at any time in the future?

YES 01

NO 00

DON’T KNOW d

REFUSED r

GO TO F33

AWARE OF TICKET PROGRAM BUT DID NOT TRY TO GET INFORMATION OR PARTICIPATE DURING 2009

(E35=00,d,r) OR (E51=01 and F1=00,d,r)

F31. What are the main reasons {you did/NAME did} not try to participate in the Ticket to Work program in 2009?

INTERVIEWER: CODE ALL THAT APPLY:

PHYSICAL/MENTAL CONDITION 01 (F32)

DIDN’T WANT TO 02 (F32)

FAMILY RESPONSIBILITIES 03 (F32)

FAMILY WOULD NOT SUPPORT 04 (F32)

COULD NOT GET RELIABLE TRANSPORTATION 05 (F32)

ALREADY HAD A JOB 06 (F32)

FEARED SERVICES WOULD ENDANGER BENEFITS 07 (F32)

INFORMATION TOO CONFUSING – DID NOT KNOW WHERE TO START 08 (F32)

EMPLOYMENT NETWORK {YOU/NAME} WANTED WAS NOT PARTICIPATING 09 (F32)

ENs TOO FAR AWAY 10 (F32)

COULD NOT GET IN CONTACT WITH ENs 11 (F32)

NO ENs PROVIDED SERVICES {NAME} NEEDS 12 (F32)

NO ENs SERVE MY KIND OF DISABILITY 13 (F32)

IN SCHOOL 14 (F32)

OTHER 15 (F31_oth)

DECIDED TO GO TO STATE VOCATIONAL REHABILITATION AGENCY (VR) 16 (F32)

DON’T KNOW d (F32)

REFUSED r (F32)

(F31=15)

F31_oth. INTERVIEWER: ENTER VERBATIM RESPONSE

<OPEN>

DON’T KNOW d

REFUSED r

(E35=00,d,r) OR (E51=01 and F1=00,d,r)

F32. Do you think {you/NAME} will try to participate in the Ticket to Work program at any time in the future?

YES 01

NO 00

DON’T KNOW d

REFUSED r

KNOWLEDGE OF TICKET TO WORK PROGRAM

(E35=00,d,r or E51=01)

F33. Now I’m going to read you some statements about the Ticket to Work program. For each statement, please tell me if it is something {you/NAME or his/her representative} knew before today or not.

PROGRAMMER: INSERT STATEMENT BELOW HERE

Is this something {you/NAME or his/her representative} knew before today or not?

INTERVIEWER: REPEAT AS NECESSARY

	KNEW BEFORE TODAY	DID NOT KNOW BEFORE TODAY	DON’T KNOW	REFUSED
a. Ticket to Work is a program to help people with disabilities get training or other employment services to improve their ability to work. These employment services are paid for by Social Security	01	00	d	r
b. Ticket to Work participants are free to choose an employment service provider from among a network of employment service providers in the program	01	00	d	r
c. {Your/NAME’s} employment service provider in the Ticket to Work program is not paid by Social Security unless {you go/(he/she) goes} back to work	01	00	d	r
d. While participating in the Ticket to Work program, Social Security will not conduct a review of {your/NAME’s} medical eligibility for disability benefits	01	00	d	r
e. {You/NAME} can get services from your State Vocational Rehabilitation Agency without giving them your Ticket	01	00	d	r
f. {You/NAME} can use your Ticket to get follow-up services somewhere else after you finish getting services from the State Vocational Rehabilitation Agency	01	00	d	r

SECTION G: EMPLOYMENT-RELATED SERVICES AND SUPPORTS USED IN 2009

SERVICE PROVIDERS

(All)

G1. PROGRAMMER: USE LANGUAGE BELOW IF {NAME} HAS NOT COMPLETED ANY PRIOR ROUND (S2=01)

Next, I will ask about different types of services that people with disabilities sometimes get in order to improve their ability to work or live independently.

First, I will ask about employment services {you/NAME} may have received.

(IF DISABLED BEFORE AGE 16 (B18_AGE < 16 OR IF BIRTHYEAR – B18_YEAR <16)) Since age 16, {have you/has NAME} received any employment services to help {you/him/her} get a job?

(IF DISABLED AT AGE 16 OR LATER (B18_AGE ≥ 16 OR IF BIRTHYEAR - B18_YEAR ≥ 16)) Since becoming disabled, {have you/has NAME} received any employment services to help {you/him/her} get a job?

YES 01

NO 00 (G10)

DON’T KNOW d (G10)

REFUSED r (G10)

(G1=01)

G2. What was the name of the place {you/NAME} went to for those employment services?

PROGRAMMER: DISPLAY Anyplace else? ON SCREEN FOR PROVIDERS 2 THROUGH 8

INTERVIEWER: PRESS ‘ENTER’ FOR NO OTHER PLACE

PROBE 1: IF RESPONDENT DOESN'T KNOW NAME: I need to enter something that will help identify the place {you/NAME} received these services from in later questions. What could I enter to help us identify this place later? Street name, address, person spoken with there, even the color of the building would help identify it.

PROBE 2: (IF (S2=01 AND E36=01) OR (IF S2=02 and E37a=01 or E37b=01) or (S2=02 or S2=04 and E37=01)):

This includes services {you/NAME} received from an Employment Network.

PROVIDER 1 <STRING=240>___________________________________________

PROVIDER 2 < STRING=240>___________________________________________

PROVIDER 3 < STRING=240>___________________________________________ PROVIDER 4 < STRING=240>___________________________________________

PROVIDER 5 < STRING=240>___________________________________________

PROVIDER 6 < STRING=240>___________________________________________

PROVIDER 7 < STRING=240>___________________________________________

PROVIDER 8 < STRING=240>___________________________________________

REFUSED r

(G1=01)

G3. CHECK: WAS {NAME} A TICKET PARTICIPANT IN 2009(E37=01) OR (IF S2=02 AND EN2009=01)?

YES 01

NO 00 (G7)

PROGRAMMER: REPEAT G4 THROUGH G6 ONLY FOR THE FIRST AND SECOND 2009 EMPLOYMENT NETWORKS

LISTED IN E39 OR ROUND2 EN FROM R2 E39 OR ROUND2 EN FROM R2 E46

(G1=01 and G3=01)

G4. INTERVIEWER: IS {EMPLOYMENT NETWORK IN 2009 (DISPLAY FIRST/SECOND NAME FROM E39 OR ROUND2 EN FROM R2 E39 OR ROUND2 EN FROM R2 E46)} ON

THIS LIST {DISPLAY LIST FROM G2}?

YES 01 (DISPLAY SECOND EN FROM E39) OR (ROUND2 EN FROM R2 E39) OR (ROUND2 EN FROM R2 E46) THEN SKIP TO G7

NO 00

(G1=01 and G3=01 and G4=00)

G5. In 2009, did {you/NAME} receive employment services from {FIRST/SECOND EMPLOYMENT NETWORK IN 2009 (E39 OR ROUND2 EN FROM R2 E39 OR ROUND2 EN FROM R2 E46)}?

YES 01

NO 00 (G7)

DON’T KNOW d (G7)

REFUSED r (G7)

(G1=01 and G3=01 and G4=00 and G5=01)

G6. Then let me add {FIRST/SECOND EMPLOYMENT NETWORK FROM 2009 (E39 OR ROUND2 EN FROM R2 E39 OR ROUND2 EN FROM R2 E46)} to this list.

INTERVIEWER: ENTER ‘1’ TO ADD NAME OF EMPLOYMENT NETWORK TO LIST

PRESS 1 TO CONTINUE 01

(G1=01)

G7. PROGRAMMER: ASK G7 THROUGH G9 FOR EACH PLACE LISTED IN G2 INCLUDING EMPLOYMENT NETWORKS THAT WERE ADDED IN G6.

Thinking about {PROVIDER FROM G2}, was this place:

A state agency, 01 (G8)

A private business, or 02 (NEXT PROVIDER OR G10)

Some other type of place? 03 (G7_oth)

DON’T KNOW d (NEXT PROVIDER OR G10)

REFUSED r (NEXT PROVIDER OR G10)

(G1=01 and G7=03)

G7_oth. INTERVIEWER: PLEASE SPECIFY

<OPEN>__________________________________________________ (NEXT PROVIDER OR G10)

DON’T KNOW d (NEXT PROVIDER OR G10)

REFUSED r (NEXT PROVIDER OR G10)

(G1=01 and G7=01)

G8. CHECK: WAS {PROVIDER FROM G2} A STATE AGENCY (G7 = 01)?

YES 01

NO 02 (NEXT PROVIDER OR G10)

(G1=01 and G7=01 and G8=01)

G9. Was this place a:

A vocational rehabilitation agency, 01 (NEXT PROVIDER OR G10)

A welfare agency, 02 (NEXT PROVIDER OR G10)

A mental health agency, 03 (NEXT PROVIDER OR G10)

Some other state agency, 04 (G9_oth1)

Workforce center or employment/unemployment office, 06 (NEXT PROVIDER OR G10)*

Some other type of place 05 (G9_oth2)

DON’T KNOW d (NEXT PROVIDER OR G10)

REFUSED r (NEXT PROVIDER OR G10)

*Note: G9=6 is a category added at R2 and R3; value of “other” category (G9=5) maintained for comparability across rounds.

(G1=01 G7=01 and G8=01 and G9=04)

G9_oth1. INTERVIEWER: PLEASE SPECIFY

<OPEN>_________________________________________________(NEXT PROVIDER OR G10)

DON’T KNOW d (NEXT PROVIDER OR G10)

REFUSED r (NEXT PROVIDER OR G10)

(G1=01 G7=01 and G8=01 and G9=05)

G9_oth2. INTERVIEWER: PLEASE SPECIFY

<OPEN>_________________________________________________(NEXT PROVIDER OR G10)

DON’T KNOW d (NEXT PROVIDER OR G10)

REFUSED r (NEXT PROVIDER OR G10)

(All)

G10. PROGRAMMER: USE LANGUAGE BELOW IF {NAME} HAS NOT COMPLETED ANY PRIOR ROUNDS (S2=01)

Sometimes people get training to help them learn new skills so they can get a new job or change careers.

(IF DISABLED BEFORE AGE 16 (B18_AGE < 16 OR IF BIRTHYEAR – B18_YEAR <16)) Since age 16, {have you/has NAME} received any training to help {you/him/her} get a new job or change careers?

(IF DISABLED AT AGE 16 OR LATER (B18_AGE ≥ 16 OR IF BIRTHYEAR - B18_YEAR ≥ 16)) Since becoming disabled, {have you/has NAME} received any training to help {you/him/her} get a new job or change careers?

PROBE: Please do not include places you already told me about.

PROGRAMMER: USE LANGUAGE BELOW IF {NAME} HAS COMPLETED ONE OR MORE PRIOR ROUNDS (S2=02 or S2=04)

Sometimes people get training to help them learn new skills so they can get a new job or change careers.

In 2009, did {you/NAME} receive any training to help {you/him/her} get a new job or change careers?

PROBE: Please do not include places you already told me about.

YES 01

NO 00 (G15)

DON’T KNOW d (G15)

REFUSED r (G15)

(G10=01)

G11. What was the name of the place {you/NAME} went to for that training?

PROBE: Please do not include any places you already told me about.

PROGRAMMER: DISPLAY Anyplace else? ON SCREEN FOR PROVIDERS 2 THROUGH 8

INTERVIEWER: PRESS ‘ENTER’ FOR NO OTHER PLACE

PROBE 2: (IF (S2=01AND E36=01) OR (IF S2=02 and E37a=01 or E37b=01) or (S2=02 or S2=04 and E37=01)):

This includes services {you/NAME} received from an Employment Network.

PROVIDER 1 <STRING=240>____________________________________________________

PROVIDER 2 < STRING=240>____________________________________________________

PROVIDER 3 < STRING=240>____________________________________________________

PROVIDER 4 < STRING=240>____________________________________________________

PROVIDER 5 < STRING=240>____________________________________________________

PROVIDER 6 < STRING=240>____________________________________________________

PROVIDER 7 < STRING=240>____________________________________________________

PROVIDER 8 < STRING=240>____________________________________________________

REFUSED r

PROGRAMMER: FOR EACH PROVIDER LISTED IN G11 DISPLAY G12

(G10=01)

G12. INTERVIEWER: DID THE RESPONDENT MENTION {PROVIDER LISTED IN G11} AT G2?

INTERVIEWER: IF THE LIST OF PROVIDERS ALREADY MENTIONED IS BLANK, NO PROVIDERS HAVE BEEN MENTIONED YET.

INTERVIEWER: PROVIDERS MENTIONED AT G2 INCLUDE {DISPLAY PROVIDERS FROM G2}:

YES 01 (PROGRAMMER: DELETE ONE MENTION)

NO 00 (NEXT PROVIDER OR G13)

PROGRAMMER: ASK G13 THROUGH G14 FOR EACH NEW PROVIDER LISTED IN G11.

(G10=01)

G13. Thinking about {NEW PROVIDER FROM G11}, was this place:

A state agency, 01 (G14)

A private business, 02 (NEXT PROVIDER OR G15)

A school or college 04 (NEXT PROVIDER OR G15)*

Some other type of place 03 (G13_oth)

DON’T KNOW d (NEXT PROVIDER OR G15)

REFUSED r (NEXT PROVIDER OR G15)

*Note: G13=4 is a category added at R2 and R3; value of “other” category (G13=3) maintained for comparability across rounds.

(G10=01 and G13=03)

G13_oth. INTERVIEWER: PLEASE SPECIFY

<OPEN>____________________________________________________ (NEXT PROVIDER OR G15)

DON’T KNOW d (NEXT PROVIDER OR G15)

REFUSED r (NEXT PROVIDER OR G15)

(G10=01 and G13=01)

G14. Was this place a:

A vocational rehabilitation agency, 01 (NEXT PROVIDER OR G15)

A welfare agency, 02 (NEXT PROVIDER OR G15)

A mental health agency 03 (NEXT PROVIDER OR G15)

Some other state agency, or 04 (G14_oth)

None of these 05 (NEXT PROVIDER OR G15)

DON’T KNOW d (NEXT PROVIDER OR G15)

REFUSED r (NEXT PROVIDER OR G15)

(G10=01 and G13=01 and G14=04)

G14_oth. INTERVIEWER: PLEASE SPECIFY

<OPEN>____________________________________________________ (NEXT PROVIDER OR G15)

DON’T KNOW d (NEXT PROVIDER OR G15)

REFUSED r (NEXT PROVIDER OR G15)

(All)

G15. PROGRAMMER: USE LANGUAGE BELOW IF {NAME} HAS NOT COMPLETED ANY PRIOR ROUNDS (S2=01)

Sometimes people with disabilities receive medical services to improve their ability to work or help them live independently. Some examples of these services are physical therapy, surgery, and help getting special equipment or devices.

(IF DISABLED BEFORE AGE 16 (B18_AGE < 16 OR IF BIRTHYEAR – B18_YEAR <16)) Since age 16, {have you/has NAME} received any medical services to improve {your /his/her} ability to work or live independently?

(IF DISABLED AT AGE 16 OR LATER (B18_AGE ≥ 16 OR IF BIRTHYEAR - B18_YEAR ≥ 16)) Since becoming disabled, {have you/has NAME} received any medical services to improve {your/his/her} ability to work or live independently?

PROBE: Please do not include places you already told me about.

PROGRAMMER: USE LANGUAGE BELOW IF {NAME} HAS COMPLETED ONE OR MORE PRIOR ROUNDS (S2=02 or S2=04)

In 2009, did {you/NAME} receive any medical services to improve {your/his/her} ability to work or live independently?

PROBE: Please do not include places you already told me about.

YES 01

NO 00 (G19)

DON’T KNOW d (G19)

REFUSED r (G19)

(G15=01)

G16. What was the name of the place {you/NAME} went to for those medical services?

PROBE: Please do not include any places you already told me about.

PROGRAMMER: DISPLAY Anyplace else? ON SCREEN FOR PROVIDERS 2 THROUGH 8

INTERVIEWER: PRESS ‘ENTER’ FOR NO OTHER PLACE

PROBE 2: (IF (S2=01 AND E36=01) OR (IF S2=02 and E37a=01 or E37b=01) or (S2=02 OR S2=04 AND E37=01)): This includes services {you/NAME} received from an Employment Network.