FMLA employee survey2000 v 2011 Question Crosswalk

FMLA Employee Survey-2000 vs 2011 Question Crosswalk_Final to OMB.xls

Family and Medical Leave Act Employer and Employee Surveys, 2011

FMLA employee survey2000 v 2011 Question Crosswalk

OMB: 1235-0026

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2000 QUESTION NUMBER, IN ORIGINAL ORDER Question Text Response Categories DISPOSITION 2011 VARIABLE NAME NOTES
SINTRO_1 RESIDENTIAL Are you a member of this household and at least 18 years old?
BUSINESS Is this phone number used for…
Residential
YES .............................................. 1 (BUSINESS COL.)
NO................................................ 2 (S3A)
PROBABLE BUSINESS ............. 3 (BUSINESS COL.)
ANSWERING MACHINE ......AM (READMSG)
RETRY AUTODIALER ........... RT (AUTODIALER)
NONWORKING, DISCONNECTED
CHANGED............................NW
GO TO RESULT.......................GT
Business
Home use................................. 4 (S5)
Home and business use, or ...... 5 (S5)
Business use only?................... 6 (THANK01)
GO TO RESULT..................GT
KEPT BUT CHANGED S1, S3 S3 for cell phones
S3a May I speak to a household member who is at least 18 years old? AVAILABLE .................................... 1 (S4)
NOT AVAILABLE........................... 2 (RESULTS)
THERE ARE NONE ......................... 3
GO TO RESULT............................... GT
KEPT S2
S3OV [IF RESPONDENT IS A CHILD, ASK FOR AN OLDER HOUSEHOLD MEMBER] NO ONE LIVING IN HH IS 18 OR OLDER 1 (P20)
THERE ARE HH MEMBERS 18 OR OLDER 2
GO TO RESULT................................................ GT
KEPT S2
S5 We are conducting this study for the U.S. Department of Labor to find out about people's use of and attitudes about workplace family and medical leave. Study results will be used to assess the impact of family and medical leave policies on employees. Your participation is voluntary and all information you provide will be kept confidential. If we should come to any question that you don't want to answer, just let me know and we'll go on to the next question. I now have a few questions that, altogether, should take between 3 and 5 minutes to answer.
KEPT BUT CHANGED INTRO1, INTRO2, S4 Text has been split up between INTROs and S4; revised wording
WU1 Does anyone in your household have more than one job? YES.................................................... 1
NO ..................................................... 2
REFUSED ......................................... -7
DON'T KNOW.................................. -8
DROPPED

WU2 Does anyone in your household ever take public transportation to work? YES.................................................... 1
NO ..................................................... 2
REFUSED ......................................... -7
DON'T KNOW.................................. -8
DROPPED

S6 We're interested in talking to someone in the household in more depth about workplace family
and medical leave. In order to do that, I need to list all the first names of members of your
household, their ages, and genders. Let's start with you. May I have your name?
free text KEPT BUT CHANGED S4, S6, S7, S8 Questions now in a matrix (name, age, gender). Revised question wording.
S6VERF1. [VERIFY THE NUMBER OF HOUSEHOLD MEMBERS LISTED ABOVE] NUMBER OF HH MEMBERS IN MATRIX CORRECT ...... 1
RETURN TO MATRIX ........................................................... 2 [RETURN TO MATRIX]
GO TO RESULT......................................................................GT
KEPT S13 Revised question wording
P30 {Are you/Is this person} 18 years old or older? YES.................................................... 1
NO ..................................................... 2
REFUSED ......................................... -7
DON'T KNOW.................................. -8
KEPT BUT CHANGED S7, S14 S7: asks age rather than if 18 years or older
P31 What is {PERSON FROM MATRIX}’s month and year of birth? MONTH |__|__| [HR: 00-12]
YEAR |__|__|__|__| [HR: 1997-2000]
REFUSED ......................................... -7
DON’T KNOW ................................. -8
KEPT BUT CHANGED S7 Ask age rather than month and year of birth
P31b {Have you/Has this person} been employed at all since January 1, 1999? YES.................................................... 1
NO ..................................................... 2
REFUSED ......................................... -7
DON'T KNOW.................................. -8
KEPT BUT CHANGED S9 Revised language and incorporated into matrix of houshold member questions
P32 Since January 1, 1999, {have you/has this person} taken leave from work
· to care for a newborn, newly adopted, or new foster child;
· for reasons related to your or a family member’s pregnancy; or
· for {your/their} own serious health condition or the serious health condition of {your/their} child,
spouse, or parent? A serious health condition is one that lasted more than 3 days or required an
overnight hospital stay.
YES.................................................... 1
NO ..................................................... 2
REFUSED ......................................... -7
DON'T KNOW.................................. -8
KEPT BUT CHANGED S11 Reference period changed to the last 18 months; revised question wording.
P33 Since January 1, 1999, {have you/has this person} needed to take leave from work but did
not
· to care for a newborn, newly adopted, or new foster child;
· for reasons related to your or a family member’s pregnancy; or
· for {your/their} own serious health condition or the serious health condition of {your/their} child,
spouse, or parent? [A serious health condition is one that lasted more than 3 days or required
an overnight hospital stay.]
YES.................................................... 1
NO ..................................................... 2
REFUSED ......................................... -7
DON'T KNOW.................................. -8
KEPT BUT CHANGED S12 Reference period changed to the last 18 months; revised question wording.
S15AD In addition to {THIS TELEPHONE NUMBER}, are there any other telephone numbers in
your household?
YES.................................................... 1
NO ..................................................... 2 (BOX A)
NOT MY PHONE NUMBER........... 91
KEPT BUT CHANGED T1-T6 New telephone usage questions
S16 {Is this/Are these} number(s) for... Home use, .......................................... 1
Business and home use or.................. 2
Business use only?............................. 3
KEPT BUT CHANGED T1-T6 New telephone usage questions
READMSG [PLEASE READ THE FOLLOWING MESSAGE INTO THE ANSWERING MACHINE]
This is {INTERVIEWER} calling on behalf of the U.S. Department of Labor. We are
conducting a survey to ask you about workplace family and medical leave. Results will be
used by the U.S. Department of Labor and others in assessing the impact of family and
medical leave policies on employees, so your opinions are important. Your phone number
was randomly selected and your answers will be kept confidential. We will call back within
the next day or two. Thank you.
n/a KEPT READMSG
P20 Thank you very much, we are only interviewing in households with members who are 18
and over.
n/a KEPT THANK01
THANK 02 Thank you very much for the information. These are all the questions I have at this time. n/a KEPT THANK02
INTRO2 [Hello] May I speak to {SELECTED RESPONDENT}?
[I'm calling on behalf of the U.S. Department of Labor. We're conducting a study about workplace
family and medical leave.]
SUBJECT SPEAKING/COMING TO PHONE............................... 1
SUBJECT LIVES HERE - NEEDS APPOINTMENT .................... 2
SUBJECT KNOWN LIVES AT ANOTHER NUMBER ................ 3
NEVER HEARD OF SUBJECT.................................................................... 4
TELEPHONE COMPANY RECORDING...................................... 5
ANSWERING MACHINE............................................................... AM
GO TO RESULT CODES................................................................ GT
RETRY AUTODIALER .................................................................. RT
KEPT BUT CHANGED HANDOFF1, HANDOFF2, HANDOFF3 Revised question wording and response categories
NAME1 We are conducting this study for the U.S. Department of Labor to find out about people's use of and
attitudes about workplace family and medical leave. Results will be used to study the impact of
family and medical leave policies on employees. Your participation is voluntary and all information
you provide will be kept confidential. If we should come to any question that you don't want to
answer, just let me know and we'll go on to the next question.
n/a KEPT INTRO3, INTRO4, INTRO5 Revised wording
A1a I want to confirm with you that since January 1, 1999, you have taken leave from work:
· for the care of a newborn, newly adopted or new foster child;
· for reasons related to your or a family member’s pregnancy; or
· for yourself, your child, spouse, or parent because of a serious health condition. A serious health condition is one that lasted more than 3 days or required an overnight hospital stay.
Is this correct? [Have you taken leave from work for one or more of these reasons?]
YES=1
NO=2
KEPT BUT CHANGED A1 Changed reference period (last 18 months) and revised language for reasons for leave. Also added care for military member reason.
A1b Since January 1, 1999, did you need but not take leave from work:
• for the care of a new child;
• for reasons related to your or a family member’s pregnancy; or
• for yourself, your child, spouse, or parent because of a serious health condition? [A serious health condition is one that lasted more than 3 days or required an overnight hospital stay.]
YES 1 [GO TO QB1b]
NO 2 [GO TO QC0]
KEPT BUT CHANGED B1 Moved to section B (Leave Needers). Changed reference period (last 18 months) and revised language for reasons for leave. Also added care for military member reason.
A1d Are you currently on this type of leave from work? YES 1
NO 2
KEPT A3
A2 How many leaves of this type have you taken since January 1, 1999? |__|__| [SR: 00-08]
[HR: 00-20]
KEPT BUT CHANGED A4 Revised language and reference period (last 18 months)
A2a How about just since January 1, 2000, through today? |__|__| [SR: 00-04]
[HR: 00-10]
DROPPED

A3 Now I'm going to ask you some questions about the {leave/leaves} you have taken since January 1, 1999. What was the reason for the {leave/longest leave}? OWN HEALTH CONDITION, EXCEPT MATERNITY-RELATED ILLNESS 1
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY, OR OTHER PREGNANCY-RELATED AILMENT PRIOR TO DELIVERY 2
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY AND TO CARE FOR A NEWBORN 3
[WOMEN ONLY] MISCARRIAGE 4
TO CARE FOR NEWBORN 5
TO CARE FOR NEWLY ADOPTED CHILD 6
TO CARE FOR NEWLY PLACED FOSTER CHILD 7
CHILD’S HEALTH CONDITION 8
SPOUSE’S HEALTH CONDITION 9
PARENT’S HEALTH CONDITION 10
OTHER RELATIVE’S HEALTH CONDITION 11
OTHER NON-RELATIVE’S HEALTH CONDITION 12
KEPT BUT CHANGED A5 Revised language and reference period (last 18 months); added new response categories; first loop asks about longest leave and second loop asks about most recent leave
A3a/1 OVERLAY. [SPECIFY R'S HEALTH CONDITION OR ASK] What health condition did you have? [RECORD RESPONSE VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A3a/8 OVERLAY. [SPECIFY CHILD'S HEALTH CONDITION OR ASK] What health condition did your child have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A3a/9 OVERLAY. [SPECIFY SPOUSE'S HEALTH CONDITION OR ASK] What health condition did your spouse have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A3a/10 OVERLAY. [SPECIFY PARENT'S HEALTH CONDITION OR ASK] What health condition did your parent have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A3a/11 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? GRANDCHILD 1
GRANDPARENT 2
SIBLING 3
OTHER (SPECIFY)__(35 CHAR)___ 91
KEPT A6 Added a response category (Aunt/Uncle)
A3a/12 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? DOMESTIC PARTNER 1
OTHER (SPECIFY)__(35 CHAR)__ 91
KEPT A7 Revised/added response categories
A3b Did {you/your child/your spouse/your parent} require a doctor's care?
KEPT BUT CHANGED A11 Revised language
A3c {Were/Was} {you/your childyour spouse/your parent} in the hospital overnight? YES 1
NO 2
KEPT BUT CHANGED A12 Revised language
A3d Over how long a period of time did this leave last? [IF STILL ON THIS LEAVE, STATE “so far.”] |__|__|__|
DAYS 1
WEEKS 2
MONTHS 3
DROPPED
Incorporated into new A13, A16, and A17
A3e Were you off work that entire time? YES 1 [SKIP TO NEXT PROGRAMMING NOTE]
NO 2
KEPT BUT CHANGED A14 Revised language
A3f How much time were you actually away from work? [ENTRY SHOULD BE LESS THAN {ANSWER FROM QA3d}. IF RESPONSE IS GREATER, PLEASE VERIFY.] |__|__|__|
DAYS 1
WEEKS 2
MONTHS 3
KEPT BUT CHANGED A19 Revised language; added response category for Hours
A3g How much time were you away from work after the birth of your child? |__|__|__|
DAYS 1
WEEKS 2
MONTHS 3
REFUSED -7
DON’T KNOW -8
DROPPED

A4 Now I'm going to briefly ask you about your other leave{s}. What was the reason for the second longest leave you have taken since January 1, 1999? OWN HEALTH CONDITION, EXCEPT MATERNITY-RELATED ILLNESS 1
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY, OR OTHER PREGNANCY-RELATED AILMENT PRIOR TO DELIVERY 2
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY AND TO CARE FOR A NEWBORN 3
[WOMEN ONLY] MISCARRIAGE 4
TO CARE FOR NEWBORN 5
TO CARE FOR NEWLY ADOPTED CHILD 6
TO CARE FOR NEWLY PLACED FOSTER CHILD 7
CHILD’S HEALTH CONDITION 8
SPOUSE’S HEALTH CONDITION 9
PARENT’S HEALTH CONDITION 10
OTHER RELATIVE’S HEALTH CONDITION 11
OTHER NON-RELATIVE’S HEALTH CONDITION 12
KEPT BUT CHANGED A20, A5 Revised into A5- loop for most recent leave.
A4a/1 OVERLAY. [SPECIFY R'S HEALTH CONDITION OR ASK] What health condition did you have? [RECORD RESPONSE VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A4a/8 OVERLAY. [SPECIFY CHILD'S HEALTH CONDITION OR ASK] What health condition did your child have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A4a/9 OVERLAY. [SPECIFY SPOUSE'S HEALTH CONDITION OR ASK] What health condition did your spouse have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A4a/10 OVERLAY. [SPECIFY PARENT'S HEALTH CONDITION OR ASK] What health condition did your parent have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new A10
A4a/11 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? GRANDCHILD 1
GRANDPARENT 2
SIBLING 3
OTHER (SPECIFY)__(35 CHAR)___ 91
KEPT A6 Added a response category (Aunt/Uncle)
A4a/12 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? DOMESTIC PARTNER 1
OTHER (SPECIFY)__(35 CHAR)__ 91
KEPT A7 Revised/added response categories
A4b Did {you/your child/your spouse/your parent} require a doctor's care? YES 1
NO 2 [SKIP TO QA4d]
KEPT BUT CHANGED A11 Revised language
A4c {Were/Was} {you/your child/your spouse/your parent} in the hospital overnight? YES 1
NO 2
KEPT BUT CHANGED A12 Revised language
A4d Over how long a period of time did this leave last? [IF STILL ON THIS LEAVE, STATE “so far.”] |__|__|__|
DAYS 1
WEEKS 2
MONTHS 3
DROPPED
Incorporated into new A13, A16, and A17
A4e Were you off work that entire time? YES 1 [SKIP TO NEXT PROGRAMMING NOTE]
NO 2
KEPT BUT CHANGED A14 Revised language
A4f How much time were you actually away from work? [ANSWER SHOULD BE LESS THAN {ANSWER FROM QA4d}. IF GREATER, PLEASE VERIFY.] |__|__|__|
DAYS 1
WEEKS 2
MONTHS 3
KEPT BUT CHANGED A19 Revised language; added response category for Hours
A4g How much time were you away from work after the birth of your child? |__|__|__|
DAYS 1
WEEKS 2
MONTHS 3
DROPPED

A5 You said before that you took {NUMBER FROM QA2} leaves since January 1, 1999. We just
asked you about your two longest leaves. What {was/were} the reason{s} for the {other/other {NUMBER FROM QA2 MINUS 2}} leave{s} you took since January 1, 1999? [CODE UP TO 4 RESPONSES.]
OWN HEALTH CONDITION, EXCEPT MATERNITY-RELATED ILLNESS 1
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY, OR OTHER PREGNANCY-RELATED AILMENT PRIOR TO DELIVERY 2
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY AND TO CARE FOR A NEWBORN 3
[WOMEN ONLY] MISCARRIAGE 4
TO CARE FOR NEWBORN 5
TO CARE FOR NEWLY ADOPTED CHILD 6
TO CARE FOR NEWLY PLACED FOSTER CHILD 7
CHILD’S HEALTH CONDITION 8
SPOUSE’S HEALTH CONDITION 9
PARENT’S HEALTH CONDITION 10
OTHER RELATIVE’S HEALTH CONDITION 11
OTHER NON-RELATIVE’S HEALTH CONDITION 12
DROPPED

A5b Sometimes people alternate between work and leave. That is, they repeatedly take leave for a few hours or days at a time because of ongoing family or medical reasons. Have you taken this kind of leave since January 1, 1999? YES 1
NO 2 [GO TO PROGRAMMING NOTE]
KEPT BUT CHANGED A14 Revised language
A5c Was this kind of leave less than half, about half, or more than half of all the time you spent on family or medical leave since January 1, 1999? LESS THAN HALF 1
ABOUT HALF 2
MORE THAN HALF 3
DROPPED

A6 Is your current leave the longest leave you have taken since January 1, 1999? YES 1
NO 2
KEPT BUT CHANGED A20 Revised question wording

Was the leave you just told me about taken under the federal Family and Medical Leave Act? YES 1
NO 2 [GO TO QC8]
KEPT BUT CHANGED A21 Revised language so question doesn't specifically mention FMLA; new response categories

{Please think about the most recent time you needed leave}. At the time you {took/took your longest/needed/most recently needed} leave, {do you think you were/Do you think you are} eligible to take advantage of the federal Family and Medical Leave Act? YES 1
NO 2 [GO TO QC7]
DROPPED
FMLA leave designation/eligibility determined by responses to S11 and S12
A7 I’m going to read you some reasons why some people might be worried about taking family or medical leave. For each of these, please tell me if you were worried. Were you worried about taking family or medical leave.
KEPT BUT CHANGED A22 Revised language and added new categories

a. Because you thought you might lose your job if you took leave?
b. Because you thought taking leave might hurt your job advancement?
c. Because you would lose your seniority?
d. Because you worried about not having enough money to pay bills
YES 1
NO 2



A8 Please think about the leave that lasted the longest when you answer the rest of the questions during this interview. Did you take the leave all at once or did you alternate between work and leave? ALL AT ONCE 1 [GO TO QA9]
ALTERNATED 2
BOTH 3
DROPPED
Covered in A14
A8a Did you take leave on a regular routine or as needed? REGULAR ROUTINE 1
AS NEEDED 2
DROPPED

A9 Did you lose any of your benefits during your leave or didn’t you have any? YES 1
NO 2
DIDN’T HAVE ANY 3 [GO TO QA10]
COMBINED A44 Combined A9 and A9a. Revised question so it only asks about health insurance. Added new response categories
A9a What benefits did you lose? [PROBE: Anything else?] [CODE ALL THAT APPLY.] HEALTH INSURANCE 1
LIFE INSURANCE 2
DISABILITY INSURANCE 3
PENSION CONTRIBUTIONS 4
OTHER (SPECIFY)__(35 CHAR)_____ 91
COMBINED A44 Combined A9 and A9a. Revised question so it only asks about health insurance. Added new response categories
A10 Did you receive pay for any part of your {longest} leave? YES 1
NO 2 [GO TO QA11]
KEPT BUT CHANGED A45 Refers to most recent leave instead of longest
A10a Was the pay you received part of…
KEPT BUT CHANGED A46, A48 Added benefit categories; e. temporary disability insurance removed and asked in new A48 with other types of paid leave

a. Your sick leave?
b. Your vacation leave?
c. Personal leave?
d. Parental leave?
e. Temporary disability insurance?
f. Some other benefit?
YES 1
NO 2



A10b OVERLAY What benefit is that? [RECORD BENEFIT VERBATIM; 135 CHARACTERS/3 LINES]
DROPPED

A10c Did you receive your full pay for the entire time you were on {[your longest]} leave? YES 1 [GO TO QA12]
NO 2
DROPPED

A10d Did you receive at least some pay for each pay period that you were on {[your longest]} leave? YES 1 [GO TO QA10f]
NO 2
DROPPED

A10e When you received this pay, was it for your full salary or only for part of your salary? FULL 1
PART 2
KEPT BUT CHANGED A49 Revised language
A10f Over the entire time you were on {[your longest]} leave, about how much of your usual pay did you receive in total? Would you say… Less than half, 1
About half, or 2
More than half? 3
KEPT BUT CHANGED A50 Revised language; refers to most recent leave instead of longest; added response categories
A11 In order to cover lost wages or salary during the leave, did you…
KEPT BUT CHANGED A53 Slightly revised wording in item c

a. Use savings that you had earmarked for this situation?
b. Use savings earmarked for something else?
c. Borrow money to cover lost wages?
d. Go on public assistance?
e. Limit extras?
f. Put off paying your bills?
g. Cut your leave time short?
h. Do anything else? (SPECIFY)____(35 CHAR)____
YES 1
NO 2



A11b How easy or difficult was it for you to make ends meet during your {[longest]} leave? Would you say… Very easy, 1
Somewhat easy, 2
Neither easy nor difficult, 3
Somewhat difficult, or 4
Very difficult? 5
KEPT BUT CHANGED A54 Refers to most recent leave instead of longest
A11c If you had received {some/additional} pay, would you have taken leave for a longer period of time? YES 1
NO 2
KEPT A55
A12 Would you say using family and medical leave had a positive effect or no effect at all on…
KEPT BUT CHANGED A56 Added language based on new response category. Added response category; revised wording in items c-e

a. Your ability to care for family members?
b. Your ability to select a satisfactory childcare provider?
c. Your ability to select a satisfactory caretaker for a sick family member?
d. Your or your family member's physical health?
e. Your or your family member's emotional well-being?
POSITIVE 1
NO EFFECT 2



A13 Which effects did your family and medical leave have on your or your family member's physical health? Would you say…
KEPT A57, A58 Revised question wording. Revised wording in all items. Added new item

a. A quicker recovery time
b. It was easier to comply with doctor's instructions
c. It delayed or avoided need to enter nursing home or other
long-term care facility, or
d. Was there another effect (SPECIFY)?__(35 CHAR)
YES 1
NO 2



A14 Now I’m going to ask you some questions about how your work was covered while you were away on your leave. By cover your work, we mean what your employer did while you were away on leave to make sure that the work you usually did was completed. Did your employer:
KEPT BUT CHANGED A52 Revised language for response categories

a. Cover your work by assigning it to other employees?
b. Hire a permanent employee?
c. Hire an outside temporary worker?
d. Leave your work for you when you returned?
YES 1
NO 2



A14a Which method was used most often? WORK ASSIGNED TO OTHER EMPLOYEES 1
PERMANENT EMPLOYEE HIRED 2
OUTSIDE TEMPORARY WORKER HIRED 3
EMPLOYER LEFT WORK FOR LEAVE WORK FOR YOUR RETURN 4
DROPPED

A15 After your leave ended, did you go back to work for the same employer, a new employer, or did you not return to work at all? SAME EMPLOYER 1 [GO TO QA16]
NEW EMPLOYER 2 [GO TO QA16]
NOT RETURN TO WORK 3
KEPT A59
A15a Why didn’t you return to work? OBTAINED OTHER INCOME SOURCE (SELF-EMPLOYED) 1
HEALTH CONDITION CONTINUED (ILLNESS CONTINUES) 2
LAID OFF / FIRED / REPLACED 3 [GO TO QA19]
DIDN’T WANT TO RETURN TO WORK 4
COULDN'T FIND CHILD CARE 5
Other (SPECIFY)__(35 CHAR)________ 91
KEPT BUT CHANGED A61 Added new categories
A16 Was a reason you returned to work because you no longer needed to be on leave YES 1
NO 2
REFUSED -7
DON’T KNOW -8
COMBINED A62 Combined with old A17
A17 Was a reason you returned to work because…
KEPT and COMBINED A62 Combined with old A16. Revised wording in item f; added new items

a. You could not afford financially to take more time off?
b. You just wanted to get back to work?
c. You used up all the leave time you were allowed?
d. You felt pressured by your boss or co-workers to return?
e. You had too much work to do to stay away longer?
f. Someone else took over care?
YES 1
NO 2



A18 After your leave, did you return to the same or an equal position, a higher position, or a lower position than you had before the leave? SAME OR EQUAL POSITION 1 [GO TO QA19]
HIGHER POSITION 2 [GO TO QA19]
LOWER POSITION 3
KEPT BUT CHANGED A63 Revised language and response categories
A18a Did you choose to take a lower position or did your employer ask you to take a lower position? CHOSE LOWER POSITION 1
EMPLOYER ASKED 2
KEPT BUT CHANGED A64 Revised language and response categories
A19 Now I’m going to ask you some questions about your feelings regarding your leave. How easy or difficult was it to get your employer to let you take time off? Would you say it was… Very easy, 1
Somewhat easy, 2
Neither easy nor difficult, 3
Somewhat difficult, or 4
Very difficult? 5
KEPT BUT CHANGED A24 Revised language
A20 How satisfied were you with the amount of time you took off? Would you say you were… Very satisfied, 1
Somewhat satisfied, 2
Neither satisfied nor dissatisfied, 3
Somewhat dissatisfied, or 4
Very dissatisfied? 5
DROPPED

A21 Since January 1, 1999, have you ever been denied leave to take care of family or medical problems? YES 1
NO 2 [GO TO QC1]
KEPT BUT CHANGED, COMBINED B15d Incorporated into old B3 loop
A22 Were you denied leave…
KEPT BUT CHANGED B19 Added new categories; revised wording in item d

a. Because your employer does not offer family or medical leave?
b. Because you hadn’t worked for your employer long enough to be eligible for family or medical leave?
c. Because you had worked too few hours in the previous year?
d. Because you had no leave left?
e. For other reasons? (SPECIFY)____(90 CHAR)_____
YES 1
NO 2



B1 I want to confirm with you that since January 1, 1999 you wanted to take leave from work but did not for an event in your family such as:
• the arrival of a newborn, newly adopted or new foster child;
• reasons related to your or a family member’s pregnancy; or
• the serious health condition of yourself, your child, spouse, or parent. A serious health condition is one that lasted more than 3 days or required an overnight hospital stay.
Is that correct? [Have you wanted but not taken leave from work for one or more of these reasons?]
YES 1 [GO TO QB1b]
NO 2
KEPT BUT CHANGED B2 Added new reason for care of military member; reference period changed to last 18 months
B1a Did you actually take leave since January 1, 1999 for any of the events I just described? YES 1 [GO TO QA1d]
NO 2 [GO TO QC0]
DROPPED

B1b Was there an event like this since January 1, 2000? YES 1
NO 2
KEPT BUT CHANGED B3 Reference period changed to last 12 months
B2 {Thinking of the times you needed leave since January 1, 1999, what/What} were the reasons you needed to take leave from work? [CODE UP TO 4 RESPONSES] OWN HEALTH CONDITION, EXCEPT MATERNITY-RELATED ILLNESS 1
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY, OR OTHER PREGNANCY-RELATED AILMENT PRIOR TO DELIVERY 2
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY AND TO CARE FOR A NEWBORN 3
[WOMEN ONLY] MISCARRIAGE 4
TO CARE FOR NEWBORN 5
TO CARE FOR NEWLY ADOPTED CHILD 6
TO CARE FOR NEWLY PLACED FOSTER CHILD 7
CHILD’S HEALTH CONDITION 8
SPOUSE’S HEALTH CONDITION 9
PARENT’S HEALTH CONDITION 10
OTHER RELATIVE’S HEALTH CONDITION 11
OTHER NON-RELATIVE’S HEALTH CONDITION 12
KEPT BUT CHANGED B6 Added new response options; asked for up to 3 reasons
B2a/1 [SPECIFY R'S HEALTH CONDITION OR ASK] What health condition did you have? [RECORD RESPONSE VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new B11.
B2a/8 OVERLAY. [SPECIFY CHILD'S HEALTH CONDITION OR ASK] What health condition did your child have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new B11.
B2a/9 OVERLAY. [SPECIFY SPOUSE'S HEALTH CONDITION OR ASK] What health condition did your spouse have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new B11.
B2a/810 OVERLAY. [SPECIFY PARENT'S HEALTH CONDITION OR ASK] What health condition did your parent have? [RECORD VERBATIM; 90 CHARACTERS/2 LINES]
DROPPED
Nature of health condition asked in new B11.
B2a/11 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? GRANDCHILD 1
GRANDPARENT 2
SIBLING 3
OTHER (SPECIFY)__(35 CHAR)___ 91
KEPT BUT CHANGED B7 Added new response option (Aunt/Uncle)
B2a/12 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? DOMESTIC PARTNER 1
OTHER (SPECIFY)__(35 CHAR)__ 91
KEPT BUT CHANGED B8 Revised/added response options
B2a How many different times did you need leave but not take it, since January 1, 1999? |__|__| KEPT BUT CHANGED B4 Changed reference period to last 18 months
B2b What was the most recent reason you needed to take leave from work? [CODE ONLY ONE] OWN HEALTH CONDITION, EXCEPT MATERNITY-RELATED ILLNESS 1
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY, OR OTHER PREGNANCY-RELATED AILMENT PRIOR TO DELIVERY 2
[WOMEN ONLY] FOR MATERNITY-RELATED DISABILITY AND TO CARE FOR A NEWBORN 3
[WOMEN ONLY] MISCARRIAGE 4
TO CARE FOR NEWBORN 5
TO CARE FOR NEWLY ADOPTED CHILD 6
TO CARE FOR NEWLY PLACED FOSTER CHILD 7
CHILD’S HEALTH CONDITION 8
SPOUSE’S HEALTH CONDITION 9
PARENT’S HEALTH CONDITION 10
OTHER RELATIVE’S HEALTH CONDITION 11
OTHER NON-RELATIVE’S HEALTH CONDITION 12
COMBINED B6 Combined with old B2
B2c How many different times did you need leave for the {first/second/third/fourth} reason you mentioned? [REASON FROM QB2] |__|__| KEPT BUT CHANGED B14 Revised language
B2d Did {you/your child/your spouse/your parent} require a doctor's care? YES 1
NO 2 [GO TO QB2c FOR THE NEXT REASON OR SKIP TO QB3]
KEPT BUT CHANGED B12 Revised language
B2e {Were/Was} {you/your child/your spouse/your parent} in the hospital overnight? YES 1
NO 2
KEPT BUT CHANGED B13 Revised language
B3 I’m going to read some reasons people don’t take leave from work. Please answer yes or no to all that apply. Was a reason you didn't take {a leave/the leaves you needed} because…
KEPT BUT CHANGED B15 Added new categories and removed d and e ineligible categories to new separate questions (B16-B17).

a. You thought you might lose your job?
b. You thought you might hurt your job advancement?
c. You didn’t want to lose your seniority?
d. You weren't eligible because you only worked part-time?
e. You hadn’t worked for your employer long enough to be eligible?
f. Your employer denied your request?
g. You couldn’t afford to?
h. You wanted to save your leave time?
i. Your work is too important? or
j. Was there some other reason you didn’t take leave (SPECIFY/35)
YES 1
NO 2



B3a If you had received some or additional pay, would you have taken leave? YES 1
NO 2
DROPPED

B4 Since you did not take leave, what did you do to take care of your situation? [RECORD RESPONSE VERBATIM; 135 CHARACTERS/3 LINES]
KEPT BUT CHANGED B20 Revised question from free text to ask specific categories
C0a I want to confirm with you that since January 1, 1999, you have not taken or needed to take a leave from work:
• for the care of a newborn, newly adopted or new foster child;
• for reasons related to your or a family member’s pregnancy; or
• for yourself, your child, spouse, or parent because of a serious health condition. A serious health condition is one that lasted more than 3 days or required an overnight hospital stay.
Is this correct? [You have not needed or taken leave from work for any of these reasons?]
YES 1
NO 2 [GO TO QA1a]
KEPT BUT CHANGED C1 Added new reason for care of military member; reference period changed to last 18 months
C0 Have you been employed at all since January 1, 1999? YES 1
NO 2
DROPPED S9, E1 Ask about employment status in S9 and E1
C1 Do you currently take care of a newborn, newly adopted or new foster child, or a relative with a serious health condition on a daily basis? YES 1
NO 2 [GO TO QC1d]
DROPPED

C1a Whom do you care for? [CODE UP TO 3 RESPONSES] NEWBORN 1
NEWLY ADOPTED 2
NEW FOSTER CHILD 3 [GO TO QC1d]
CHILD 4
SPOUSE 5
PARENT 6
OTHER RELATIVE 7
OTHER NON-RELATIVE 8
DROPPED

C1a/7 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? GRANDCHILD 1
GRANDPARENT 2
SIBLING 3
OTHER (SPECIFY)__(35 CHAR)____ 91
DROPPED

C1a/8 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? DOMESTIC PARTNER 1
OTHER (SPECIFY)__(35 CHAR)__ 91
DROPPED

C1d For the next question, please think about time you took off from work since January 1, 1999, because you were sick. What was the largest number of sick days in a row that you took off from work in this time period? |__|__|__| DROPPED

C1e Earlier we discussed whether you had taken leave from work for a family or medical reason since January 1, 1999. Now think about the period from 1995 through 1998. During that time, did you take leave from work:
• for the care of a newborn, newly adopted or new foster child;
• for reasons related to your or a family member’s pregnancy; or
• for yourself, your child, spouse, or parent because of a serious health condition? A serious health condition is one that lasted more than 3 days or required an overnight hospital stay.
YES 1
NO 2
DROPPED

C2 Over the next 5 years, how likely do you think it is that you will need to take a leave from work for your own serious health condition, the serious health condition of your child, spouse, or parent, or for the arrival of a newborn, newly adopted, or new foster child. Would you say it was… ery likely, 1
Somewhat likely, 2
Somewhat unlikely, or 3
Very unlikely? 4 [GO TO QC3]
DROPPED

C2a Who do you think that person or persons will be? [CODE UP TO 4 RESPONSES] YOURSELF 1
NEWBORN 2
NEWLY ADOPTED 3
NEW FOSTER CHILD 4 [GO TO QC3]
CHILD 5
SPOUSE 6
PARENT 7
OTHER RELATIVE 8
OTHER NON-RELATIVE 9
DROPPED

C2a/8 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? GRANDCHILD 1
GRANDPARENT 2
SIBLING 3
OTHER (SPECIFY)_____(35 CHAR)_______ 91
DROPPED

C2a/9 OVERLAY. [SPECIFY RELATION TO R OR ASK] What is that person’s relationship to you? DOMESTIC PARTNER 1
OTHER (SPECIFY)__(35 CHAR)__ 91
DROPPED

C3 Have you ever heard about the federal Family and Medical Leave Act? YES 1
NO 2 [GO TO QC8]
KEPT E2 Moved to Employment Section
C4 How did you first learn about the federal Family and Medical Leave Act? MEDIA (TV, NEWSPAPERS, ETC.) 1
CO-WORKERS 2
EMPLOYER GAVE OUT INFORMATION 3
POSTERS 4
INTERNET 5
FAMILY MEMBER 6
UNION GAVE OUT INFORMATION 7
OTHER (SPECIFY)_____(35 CHAR)______ 91
KEPT BUT CHANGED E3 Revised question language, dropped internet category, revised item 3 and added an item
C5 {Please think about the most recent time you needed leave}. At the time you {took/took your longest/needed/most recently needed} leave, {do you think you were/Do you think you are} eligible to take advantage of the federal Family and Medical Leave Act? YES 1
NO 2 [GO TO QC7]
DROPPED

C6 Was the leave you just told me about taken under the federal Family and Medical Leave Act? YES 1
NO 2 [GO TO QC8]
DROPPED

C7 Prior to January 1, 1999, had you ever taken leave from a job under the federal Family and Medical Leave Act? YES 1
NO 2
DROPPED

C8 Are you currently employed? YES 1
NO 2
KEPT E1
C9 At your place of employment, {is/was} there a notice posted that explains the federal Family and Medical Leave Act? YES 1
NO 2
KEPT BUT CHANGED E4 Refers to current place of employment only
C10 You told me earlier that you had been denied leave. Were you denied leave because you reached the FMLA limit of 12 weeks? YES 1
NO 2
KEPT BUT CHANGED B19 Question does not specify FMLA limit of 12 weeks. Changed to: Denied because you used up all the leave time you were allowed
C11 Please tell me whether you agree or disagree with the following statements:
DROPPED


a. Every employee should be able to have up to 12 weeks of unpaid leave in a year from work for family and medical problems
b. Having to provide employees with up to 12 weeks of unpaid leave in a year for family and medical problems is an unfair burden to employees’ co-workers
AGREE 1
DISAGREE 2



C11c Since January 1, 1999, have any co-workers where you work{ed} taken leave for family or medical reasons? YES 1
NO 2
KEPT BUT CHANGED E5 Changed reference period to last 18 months
C11d As a result of these co-workers taking leave, did you…
KEPT BUT CHANGED E6 Added new item

a. Work more hours than you usually do?
b. Work a shift that you do not normally work?
c. Take on additional duties?
YES 1
NO 2



C11e Would you say that your co-workers taking leave had a positive impact on you, a negative impact on you, or neither? POSITIVE 1
NEGATIVE 2
NEITHER 3
DROPPED

C12 I’m going to read a list of benefits that some employers offer to their employees. For each, please tell me if it {USE DISPLAY FROM PROGRAMMING NOTE}.
KEPT BUT CHANGED E7 Revised question language. Dropped D-I and added new items

a. Flextime
b. Flexplace or telecommuting
c. Job sharing
d. Referral services for child care
e. Vouchers for child care
f. Onsite child care
g. Referral services for elder care
h. Adoption assistance
i. Employee Assistance Program
j. Paid parental leave
k. Workplace provision for lactation
YES 1
N0 2
DEPENDS ON CIRCUMSTANCES 3



C12a Of those offered, which two are the most important to you? FLEXTIME 1
FLEXPLACE/TELECOMMUTING 2
JOB SHARING 3
REFERRAL SERVICES FOR CHILD CARE 4
VOUCHERS FOR CHILD CARE 5
ONSITE CHILD CARE 6
REFERRAL SERVICES FOR ELDER CARE 7
ADOPTION ASSISTANCE 8
EMPLOYEE ASSISTANCE PROGRAM 9
PAID PARENTAL LEAVE 10
WORKPLACE PROVISION FOR LACTATION 11
REFUSED -7
DON'T KNOW -8
DROPPED

C13 {Does/Did} your employer allow you to take leave for the following reasons?
DROPPED


a. To take part in children’s school and early childhood educational activities?
b. To attend to routine family medical needs?
c. To help with elderly relatives’ health care needs?
YES 1
N0 2
DEPENDS 3



C13a Since January 1, 1999, have you taken this type of leave? YES 1
NO 2
DROPPED

C13b Have you needed to take this kind of leave? YES 1
NO 2
DROPPED

C14 {Were/Are} you salaried on {that/this} job, paid by the hour, or what? [CODE ALL THAT APPLY] SALARIED 1
HOURLY 2
PIECEWORK/COMMISSION 3
OTHER/COMBINATION 4
KEPT BUT CHANGED E9 Revised question language; refers to current place of employment only
C14a {Were/Are} you a contract worker? YES 1
NO 2
KEPT BUT CHANGED E10 Read in present tense only
C15 At the place where you work{ed}, (for example the site – store, building) would you say there {were/are} 50 or more employees? YES 1 [GO TO QC16]
NO 2
KEPT BUT CHANGED E11 Refers to current place of employment only
C15a Counting all of the sites in your organization, would you say there {were/are} 50 or more employees within 75 miles of where you work{ed}? YES 1 [GO TO QC16]
NO 2
KEPT BUT CHANGED E12 Old C15a and C15b combined into new question with numeric response ranges
C15b Counting all of the sites in your organization, would you say there {were/are} 25 or more employees within 75 miles of where you work{ed}? YES 1
NO 2
KEPT BUT CHANGED E12 Old C15a and C15b combined into new question with numeric response ranges
C16 {Since/During the time you were employed between} January 1, 1999 and the present, {have/had} you worked continuously for the same employer {except for the leave you just told me about}? YES 1
NO 2 [GO TO QC19]
KEPT BUT CHANGED E13 Changed reference period to last 12 months
C17 ({Since/During the time you were employed between} January 1, 1999 and the present, {have/had} you always been a full-time employee {except for the leave you just told me about}? YES 1 [GO TO SECTION D]
NO 2
KEPT BUT CHANGED E14 Changed reference period to last 12 months
C18 {Since/During the time you were employed between} January 1, 1999 and the present, how many hours per week did you work on average? |__|__| KEPT BUT CHANGED E15 Changed reference period to last 12 months
C19 {DISPLAY FILL FROM PROGRAMMING NOTE}, for how many months from January 1, 1999 to the present did you work for that employer? |__|__| DROPPED

C19a On average, how many hours a week did you work for that employer? |__|__| DROPPED

D1 Are you currently… Married; 1
Living with a partner; 2
Separated; 3
Divorced; 4
Widowed; or 5
Never married? 6
KEPT D10
D2 Are you Spanish, Hispanic or Latino? YES 1
NO 2
KEPT BUT CHANGED D5 Revised language
D2b Please tell me which of the following best describes your race. Would you say… White, 1
Black or African American, 2
American Indian or Alaska Native, 3
Asian 4
Native Hawaiian or Pacific Islander? 5
SOMETHING ELSE (SPECIFY)__(35 CHAR)___ 91
KEPT BUT CHANGED D6 Revised language; changed order of response categories
D3 How many of your own children under 18 years old do you have living with you? |__|__| KEPT BUT CHANGED D7 Revised language
D4 What is the highest level of education you have completed? LESS THAN HIGH SCHOOL 1
SOME HIGH SCHOOL 2
HIGH SCHOOL GRADUATE OR GED 3
SOME COLLEGE 4
COLLEGE GRADUATE 5
GRADUATE SCHOOL 6
KEPT D1 Split #3 into 2 response categories
D5 {Were/Are} you employed by government, by a private company, a non-profit organization or {were/are} you self-employed? GOVERNMENT 1
PRIVATE FOR PROFIT 2
NON-PROFIT ORGANIZATION INCLUDING
TAX EXEMPT AND CHARITABLE ORGANIZATIONS 3
SELF EMPLOYED 4 [GO TO QD6]
WORKING IN FAMILY BUSINESS 5
KEPT BUT CHANGED S10 Revised language and incorporated into matrix of houshold member questions
D5a Would that be the federal, state or local government? FEDERAL 1
STATE 2
LOCAL (COUNTY, CITY, TOWNSHIP) 3
REFUSED -7
DON’T KNOW -8
KEPT D2 Added transition statement
D6 To get a picture of people’s financial situation we need to know the general range of income of all people we interview. Now, thinking about your total family income before taxes from all sources including your job {and your spouse’s job}, how much did you receive in 1999? |__|__|__|__|__|__|__| [GO TO END] [HR: 00- 9999999] KEPT BUT CHANGED D4 Revised language and reference period
D6a Was your family income $35,000 or more in 1999? YES 1
NO 2 [GO TO QD6f]
KEPT D4a
D6b Was it $40,000 or above? YES 1
NO 2
KEPT D4b
D6c Was it $50,000 or above? YES 1
NO 2
KEPT D4c
D6d Was it $75,000 or above? YES 1
NO 2
KEPT D4d
D6e Was it $100,000 or above? YES 1 [GO TO END]
NO 2
KEPT D4e
D6f Was it $30,000 or above? YES 1 [GO TO END]
NO 2
KEPT D4f
D6g Was it $20,000 or above? YES 1 [GO TO END]
NO 2
KEPT D4g
D6h Was it $10,000 or above? YES 1 [GO TO END]
NO 2
KEPT D4h
D6j Was it $5,000 or above? YES 1 [GO TO END]
NO 2
KEPT D4j

How many adults age 18 or over live in your household? Let's start with you. [RANGE 1-11, 99 DK/REF SOFT REFUSAL] NEW S5

Now thinking about your telephone use, do you have a working cell phone? YES, HAVE CELL PHONE 1
NO, DO NOT HAVE A CELL PHONE 2
DK/REF 9
NEW T1

How many working cell phones do YOU personally have? RECORD NUMBER (1-6)
DK/REF 9
NEW T2

Thinking about the other adults in your household, how many working cell phones in total do THEY have? RECORD NUMBER (1-6)
DK/REF 9
NEW T3

Is a cell phone your ONLY phone, or do you also have a regular landline telephone at home? CELL PHONE IS ONLY PHONE 1
HAVE LANDLINE TELEPHONE AT HOME 2
DK/REF 9
NEW T4

How many different residential phone NUMBERS do you have coming into your household, not including lines dedicated to a fax machine, modem, or used strictly for business purposes? Do not include cellular phones RECORD NUMBER (1-6)
DK/REF 9
NEW T5

Of all the telephone calls that you [or your family] receive, are: All or almost all calls received on cell phones 1
Some received on cell phones and some on regular phones 2
Very few or none on cell phones? 3
DK/REF 9
NEW T6

[FILL QS6 AX] has been selected as the respondent for this survey. May I please speak to [FILL QS6 AX] for the rest of the interview? YES/PHONE HANDED OFF 1
NOT AVAILABLE 2
ALTERNATE NUMBER PROVIDED 3
DK/REF 9
NEW HANDOFF1

Was there an event like this IN THE LAST YEAR [12 MONTHS, INSERT DATE]? YES 1
NO 2
DK 8
REF 9
NEW A2

For how many TOTAL reasons or conditions did you take leave from work IN THE PAST YEAR, that is since [INSERT 12 MONTH PERIOD]? RANGE: 0-100
DK 888
REF 999
NEW A4a

[IF QS8=9 FOR SELECTED RESPONDENT:] MALE 1
FEMALE 2
DK 9
NEW GUESSGENDER1

What type of deployment-related issue did you need to address for this leave? Events or activities sponsored by the miltiary before deployment 1
Childcare or school activities 2
Financial or legal arrangements 3
Non-medical counseling 4
Short-notice deployment 5
Events or activities sponsored by the military after the military member returned 6
Issues arising from the death of a military member 7
OTHER 8
DK 98
REF 99
NEW A5a

What was the age of your care recipient? 0-1 YEARS 1
2-17 YEARS 2
18-40 YEARS 3
41-59 YEARS 4
60-69 YEARS 5
70-79 YEARS 6
80-89 YEARS 7
90 OR OLDER 8
DK (VOL) 98
REF (VOL) 00
NEW A8

Was this leave taken in order to care for a member of the military for a service-related health condition or injury? YES 1
NO 2
NEW A9

What is that person's relationship to you? SPOUSE 1
PARENT 2
SON OR DAUGHTER 3
NEXT OF KIN 4
OTHER 5
DK 8
REF 9
NEW A9a military member’s relationship to the respondent

What was the nature of this health condition? Was it… A one-time health matter, such as appendicitis or injury; 1
The treatment of an injury or illness that now requires routine scheduled care, such as chemotherapy or physical therapy; or 2
An ongoing health condition that affects one’s ability to work from time to time, such as diabetes, migraines, depression, or Multiple Sclerosis? 3
OTHER (SPECIFY): 4
DK 8
REF 9
NEW A10

For this leave, in what month and year did you start taking time off? ENTER MONTH [RANGE: 1-12]
ENTER YEAR [RANGE 2009-2011]
NEW A13

How many separate blocks of time did you take off from work during your [longest/most recent] leave? [RANGE: 1-100] NEW A15

In what month and year did the last block of time for this leave begin? ENTER MONTH [RANGE: 1-12]
ENTER YEAR [RANGE 2009-2011]
NEW A16

In what month and year did this leave end? ENTER MONTH [RANGE: 1-12]
ENTER YEAR [RANGE 2009-2011]
NEW A17

To review: You've taken leave for [[FILL QA5]; IF QA5=DK/REF DISPLAY "and you are not able to tell us the reason"], [and you began taking leave in QA13 MONTH QA13 YEAR - IF MONTH OR YEAR IS DK/REF LEAVE OUT, IF BOTH ARE MISSING DISPLAY "and you are not able to tell us when it began"], [and you are currently on this leave/and it ended in QA17 MONTH QA17 YEAR - IF MONTH OR YEAR IS DK/REF LEAVE OUT, IF BOTH ARE MISSING DISPLAY "and you are not able to tell us when it ended"]. Is that correct? YES 1
NO 2
DK 3
REF 9
NEW A18

How much time was needed for the care for the military member? HOURS [RANGE: 1-500]
DAYS [RANGE: 1-500]
WEEKS [RANGE: 1-100]
MONTHS [RANGE: 1-24]
DK/REF 9
NEW A19a

In the last 18 months, did anyone else in your household take leave for the same reason you mentioned? YES 1
NO 2
DK 3
REF 9
NEW A19b

What is this person's relationship to you? Spouse 1
Unmarried partner 2
Parent 3
Child 4
Sibling 5
Aunt or Uncle 6
Son- or Daughter-in-law 7
Father- or Mother-in-law 8
Grandchild 9
Grandparent 10
NEW A19c

How much time in total did this person take off from work for the same reason you mentioned? HOURS [RANGE: 1-500]
DAYS [RANGE: 1-500]
WEEKS [RANGE: 1-100]
MONTHS [RANGE: 1-24]
DK/REF 9
NEW A19d

Regardless of whether or not you were concerned about any of the reasons I just mentioned, as a result of taking leave:
NEW A23

a. Did you lose your job?
b. Did you lose your seniority or potential for job advancement?
c. Were you unable to afford an unpaid leave?
d. Did you reveal personal information about yourself, your care recipient, or family relationships?
e. Were you treated differently because of the reason you took leave?
f. Were you able to maintain or pay for health insurance?
g. Did you [FILL SPECIFY FROM QA22g]?
YES 1
NO 2
DOES NOT APPLY 3
DK 8REF 9




If your leave involved taking time off work multiple times for short periods, how important was this degree of flexibility to you and your family? Would you say…. Very important 1
Important 2
Somewhat important 3
Not important 4
DK (VOL) 8
REF (VOL) 9
NEW A25

Did your employer require medical certification for this leave? YES 1
NO 2
DK 8
REF 9
NEW A26

Did you obtain medical certification for this leave? YES 1
NO 2
DK 8
REF 9
NEW A27

Was your medical certification accepted on the first submission for this leave? YES 1
NO 2
DK 8
REF 9
NEW A28

Why wasn’t your medical certification accepted on the first submission? [SELECT ALL THAT APPLY] 1. Insufficient information
2. Physician not accepted
3. Condition not accepted
4. Submission not considered timely
5. OTHER (SPECIFY)
8. DK (VOL)
9. REF (VOL)
NEW A29

Did your employer require multiple doctors visits - that is, a second or third opinion - to obtain your INITIAL medical certification? YES 1
NO 2
DK 8
REF 9
NEW A30

How many physicians in TOTAL did you consult? Range: 2-5 NEW A31

Did your insurance cover the cost of your medical certifications? YES 1
NO 2
DK 8
REF 9
NEW A32

Did you pay out of your own pocket for your medical certification (for example, a co-pay or a portion of the cost)? YES 1
NO 2
DK 8
REF 9
NEW A33

How much did you, personally, pay for your medical certification? RANGE: 0-10,000
DK - 88888
REF = 99999
NEW A34

Did your employer require medical RE-CERTIFICATION? YES 1
NO 2
DK 8
REF 9
NEW A35

Did you obtain medical re-certification for this leave? YES 1
NO 2
DK 8
REF 9
NEW A35a

Did your employer require multiple doctor visits - that is, a second or third opinion, to obtain your medical RE-certification? YES 1
NO 2
DK 8
REF 9
NEW A36

How many physicians in TOTAL did you consult? Range: 2-5 NEW A37

Did your insurance cover the cost of your medical RE-certification? YES 1
NO 2
THERE WAS NO COST 3
DK 8
REF 9
NEW A38

Did you pay out of your own pocket for your medical RE-certifications (for example, a co-pay or portion of the cost)? YES 1
NO 2
DK 8
REF 9
NEW A39

How much did you, personally, pay for your medical RE-certification? RANGE: 0-10,000
DK - 88888
REF = 99999
NEW A40

How much time did you need to take off from work in order to obtain medical certification? HOURS [RANGE: 1-100]
DAYS [RANGE: 1-100]
WEEKS [RANGE: 1-50]
DID NOT TAKE EXTRA TIME OFF 4
DK 8
REF 9
NEW A41

How long before you took your [leave/most recent block of time off from work] did you provide notice to your employer? HOURS [RANGE: 1-100]
DAYS [RANGE: 1-100]
WEEKS [RANGE: 1-50]
MONTHS [RANGE: 1-24]
DID NOT PROVIDE NOTICE BEFORE LEAVE 5
DK 8
REF 9
NEW A42

Did you satisfy your employer’s standard rules about taking time off? YES 1
NO 2
DK 8
REF 9
NEW A43

Was receiving some of the pay as part of [FILL ITEMS FROM QA46 THAT EQUAL 1] your choice, did your employer require it, or both?
NEW A47

a. Paid time off, or PTO
b. Your sick days or sick leave
c. Your vacation days or vacation leave
d. Personal leave
e. Maternity leave
f. Paternity leave
EMPLOYEE'S CHOICE 1
REQUIRED BY EMPLOYER 2
BOTH 3
DK 8
REF 9




Was the pay you received part of…
NEW A48

a. Temporary disability insurance?
b. State-paid family leave?
c. State-paid disability leave?
d. Some other benefit I haven't already mentioned?
YES 1
NO 2
DK 8
REF 9




Did your employer require you to take paid leave first, before taking any unpaid leave? YES 1
NO 2
DK 8
REF 9
NEW A51

Did your employer require you to obtain fitness for duty certification before you returned to work? YES 1
NO 2
DK 8
REF 9
NEW A60

[FILL QS6 AX] has been selected as the respondent for this survey. May I please speak to [FILL QS6 AX] for the rest of the interview? YES/PHONE HANDED OFF 1
NOT AVAILABLE 2
ALTERNATE NUMBER PROVIDED 3
DK/REF 9
NEW HANDOFF2

How many different times did you need leave but not take it, IN THE LAST YEAR [12 MONTHS, INSERT DATE]? RANGE: 1-100
DK (VOL) 888
REF (VOL) 999
NEW B5

Were all the times you needed leave but did not take it since [INSERT 18 MONTH PERIOD] for the SAME reason or condition, or were they for DIFFERENT reasons or conditions? SAME 1
DIFFERENT 2
DK 8
REF 9
NEW B5a

For how many TOTAL reasons or conditions did you need leave from work, but not take it, since [INSERT 18 MONTH PERIOD]? RANGE: 1-100
DK (VOL) 888
REF (VOL) 999
NEW B5b

What type of deployment-related issue did you need to address for this leave? Events or activities sponsored by the miltiary before deployment 1
Childcare or school activities 2
Financial or legal arrangements 3
Non-medical counseling 4
Short-notice deployment 5
Events or activities sponsored by the military after the military member returned 6
Issues arising from the death of hte military member 7
OTHER 8
DK 98
REF 99
NEW B6a

[IF QS8=9 FOR SELECTED RESPONDENT:] MALE 1
FEMALE 2
DK 9
NEW GUESSGENDER2

What was the age of your care recipient? 0-1 YEARS 1
2-17 YEARS 2
18-40 YEARS 3
41-59 YEARS 4
60-69 YEARS 5
70-79 YEARS 6
80-89 YEARS 7
90 OR OLDER 8
DK (VOL) 98
REF (VOL) 00
NEW B9

Was this leave taken in order to care for a member of the military for a service-related health condition or injury? YES 1
NO 2
NEW B10

What is that person's relationship to you? SPOUSE 1
PARENT 2
SON OR DAUGHTER 3
NEXT OF KIN 4
OTHER 5
DK 8
REF 9
NEW B10a military member’s relationship to the respondent

How much time was needed to care for the military member? HOURS [RANGE: 1-500]
DAYS [RANGE: 1-500]
WEEKS [RANGE: 1-100]
MONTHS [RANGE: 1-24]
DK/REF 9
NEW B10b

What was the nature of this health condition for which you need to take this leave? Was it: A one-time health matter, such as appendicitis or injury; 1
The treatment of an injury or illness that now requires routine scheduled care, such as chemotherapy or physical therapy; or 2
An ongoing health condition that affects one’s ability to work from time to time, such as diabetes, migraines, depression, or Multiple Sclerosis? 3
OTHER (SPECIFY): 4
DK 8
REF 9
NEW B11

And how many different times did you need leave for this reason or condition, IN THE LAST YEAR [12 MONTHS, INSERT DATE]? [RANGE: 1-100]
DK 888
REF 999
NEW B14a

Were you ineligible because you only worked part-time? YES 1
NO 2
DK 8
REF 9
NEW B16 From original B3

Were you ineligible because you hadn’t worked long enough for your employer? YES 1
NO 2
DK 8
REF 9
NEW B17 From original B3

When was the last time you were denied leave? 1. In the last month,
2. In the last year, or
3. In the last 18 months
8 DK (VOL) [NOTE: TRAINING NOTE, RECALL]
9 REFUSED (VOL)
NEW B18

[FILL QS6 AX] has been selected as the respondent for this survey. May I please speak to [FILL QS6 AX] for the rest of the interview? YES/PHONE HANDED OFF 1
NOT AVAILABLE 2
ALTERNATE NUMBER PROVIDED 3
DK/REF 9
NEW HANDOFF3

[IF QS8=9 FOR SELECTED RESPONDENT:] MALE 1
FEMALE 2
DK 9
NEW GUESSGENDER3

To the best of your knowledge, are employees who are covered by the federal FMLA law entitled to take leave for the following reasons?
NEW E4a

a. For the care of a newborn
b. For an employee's own serious health condition
c. For the care of a child with a serious health condition
d. For the care of a spouse with a serious health condition
e. For the care of a parent with a serious health condition
f. For the care of a grandparent with a serious health condition
g. For the care of a grandchild with a serious health condition
h. For the care of a sibling with a serious health condition
i. For the care of an adopted child with a serious health condition
j. For the care of a military service member
k. For reasons related to the deployment of a military srevice member
YES 1
NO 2
DK 8
REF 9


rather than asking each respondent all 11 items, 4 items will be subsampled per respondent (one of which will come from the “false” items and one of which will come from the military-related items)

Does your employer have an attendance policy that includes penalties for absences? YES 1
NO 2
DK 8
REF 9
NEW E8

[Were/Are] you a member of a labor union? YES 1
NO 2
DK 8
REF 9
NEW D3

How many people over the age of 65 are in your care? ENTER RANGE 0-7; 7=7 OR MORE]
DK 8
REF 9
NEW D8

Do you consider yourself to be: 1. Heterosexual or straight
2. Gay or lesbian
3. Bisexual
4. SOMETHING ELSE
8. DK
9. REF
NEW D9

[Is your/Do you have a] [spouse/partner/spouse or partner] living outside of the household? YES 1
NO 2
DK 8
REF 9
NEW D11

What is the age of your [spouse/partner/spouse or partner]? ENTER AGE [RANGE 8-100]
DK 888
REF 999
NEW D12

Those are all the questions we have for you at this time. Can I please have your name and address so I can send you your check? YES 1
NO 2
NEW END1

So that we can group households geographically, may I have your zip code? RANGE: 00000-99999
DK 999998
REF 999999
NEW ZIP
File Typeapplication/vnd.ms-excel
AuthorNicole DellaRocco
Last Modified ByU.S. Department of Labor
File Modified2011-07-28
File Created2011-05-09

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