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Enter Line Number of the person you wish to interview
If no one else is available, Enter 99 to exit.
Name
Rel
Mem
(name of person talking about)
Age
^RRP_FILL
1. ^NAME[1]
2. ^NAME[2]
3. ^NAME[3]
4. ^NAME[4]
5. ^NAME[5]
6. ^NAME[6]
7. ^NAME[7]
8. ^NAME[8]
9. ^NAME[9]
10. ^NAME[10]
11. ^NAME[11]
12. ^NAME[12]
13. ^NAME[13]
14. ^NAME[14]
15. ^NAME[15]
16. ^NAME[16]
99. Exit
SET_ELIG_FLAGS
*NON-SCREEN ITEM
Pr_incom
?[F1] Importance of responding
Wording of introduction is optional.
The questions you just answered were about your job and
economic status last week. The next set of questions ask
about your job and economic status last year.
Page 1 of 206
^MEM age
1. Enter 1 to Continue
LINENO
*NON-SCREEN ITEM
LINENO
*NON-SCREEN ITEM
Q29a
Did (name/you) work at a job or business
at any time during set date-1?
1. Yes
2. No
Q29b
Did ( you/he/she) do any temporary, part-time, or seasonal
work even for a few days during set date-1?
1. Yes
2. No
Q30
Even though (name/you) did not work in set date-1,
did ( you/he/she) spend any time trying to find a job or on layoff?
1. Yes
2. No
Page 2 of 206
Q31
How many different weeks (was/were) (name/you)
looking for work or on layoff from a job?
(01-52) Number of weeks
Q32
What was the main reason ( you/he/she)
did not work in set date-1?
Read categories if necessary
1. Ill, or disabled and unable to work
2. Retired
3. Taking care of home or family
4. Going to school
5. Could not find work
6. Doing something else
Q33
During set date-1 in how many weeks did (name/you)
work even for a few hours?
Include paid vacation and sick leave as work.
(01-52) Number of weeks
Enter 97 if respondent can only answer in months
Q33mon
Enter number of months worked
(1-12)
Q33OUT
**NON-DISPLAY ITEM**
Page 3 of 206
Q33ver
Then (name/you) worked about (number) weeks.
Is that correct?
1. Yes
2. No - - back to Q33 and obtain estimate
Q35
Did (name/you) lose any full weeks
of work in set date-1 because ( you/he/she) (was/were)
on layoff from a job or lost a job?
Number of weeks worked in set date-1: (number)
1. Yes
2. No
7. Mistake made in number of weeks worked last year - Specify in Q35SP
Q35SP
Specify mistake made in number of weeks worked last year
Q36
You said (name/you) worked about (number) (week/weeks).
How many OF THE REMAINING (number) WEEKS (was/were)
( you/he/she) looking for work or on layoff from a job?
Enter 0 for none
Q37
Were the (number) weeks (name/you) (was/were) looking for
work or on layoff all in one stretch?
Page 4 of 206
1. Yes - one stretch
2. No - two stretches
3. No - 3 or more stretches
Q38
What was the main reason (name/you) (was/were) not working or looking for work in the
remaining weeks of set date-1?
Read list only if respondent is having
difficulty answering the question
1. Ill, or disabled and unable to work
2. Taking care of home or family
3. Going to school
4. Retired
5. No work available
6. Other (Specify - Q38sp)
Q38sp
Enter verbatim response
Q39
For how many employers did (name/you) work in set date-1?
If more than one at the same time, only count it as one employer.
1. One
2. Two
3. Three or more
Q41
In the (one week/weeks) that (name/you) worked,
how many hours did ( you/he/she) (work that week?/usually work per week?)
Enter number of hours
Page 5 of 206
Q43
During set date-1, were there one or more weeks in which
(name/you) worked less than 35 hours?
Exclude time off with pay because of holidays,
vacation, days off, or sickness.
1. Yes
2. No
Q44
In the weeks that (name/you) worked,
how many weeks did (name/you) work
less than 35 hours in set date-1?
Number of weeks worked in set date-1: (number)
(Number of weeks was reported in item Q33)
(1-52)
Q45
What was the main reason (name/you) worked
less than 35 hours per week?
Read list only if respondent is having difficulty
answering the question
1. Could not find a full time job
2. Wanted to work part time or only able to work part time
3. Slack work or material shortage
4. Other reason
Q46
What was (name's/your) longest job during set date-1?
Page 6 of 206
Was it:
(IO1NAM:)
(IO1IND:)
(IO1OCC:)
(IO1DT:)
(name of employer)
(kind of business or industry)
(occupation)
(duties)
(duties)
CLASS OF WORKER: (PRIVATE/FEDERAL GOVERNMENT/STATE GOVERNMENT/LOCAL
GOVERNMENT/WORKING WITHOUT PAY IN FAMILY BUS./SEL
1. Same as listed
2. Different job
Q46_STORE
**NON-DISPLAY ITEM**
Q47a
For whom did (name/you) work (?/at) (blank/(your/his/her) (blank/longest job last year)
Name of Company, business, organization or other employer
^TABLE47A
Q47b
What kind of business or industry is this?
For example: TV and radio manufacturing, retail shoe store, farm
^TABLE47b
Q47b1
Is this business or organization mainly manufacturing,
retail trade, wholesale trade, or something else?
^TABLE47b1
1. Manufacturing
2. Retail trade
3. Wholesale trade
Page 7 of 206
4. Something else
Q47c
What kind of work (was/were) ( you/he/she) doing?
For example: Electrical Engineer, Stock Clerk, Typist
^TABLE47c
Q47d1
What were (your/his/her) most important activities or duties?
For example: Types, keeps account books, files, sells cars,
operates printing press, finishes concrete.
^TABLE47d
Q47d2
What were (your/his/her) most important activities or duties?
For example: Types, keeps account books, files, sells cars,
operates printing press, finishes concrete.
^TABLE47d
Q47E1
Ask Only If Necessary
(were/was) ( you/he/she) employed by government, by a PRIVATE company,
a nonprofit organization, or (was/were) ( you/he/she) self-employed
or working in a family business?
Page 8 of 206
1. Government
2. Private for profit company
3. Non profit organization including tax exempt and charitable organizations
4. Self employed
5. Working in family business
Q47E1a
Would that be the federal, state, or
local government?
1. Federal
2. State
3. Local (county, city, township)
Q47E1c
(were/was) (name/you) the owner of the business?
1. Yes
2. No
Q47E1b
Was this business incorporated?
1. Yes
2. No
PRE_Q4788
**Non-Display Item**
Q4788
Counting all locations where (this employer/(name/you)) (operates/operate), what is
the total number of persons who work for ((name's/your) employer)/name/you))?
Read categories if necessary
Page 9 of 206
^Q4788_fill
1. under 10
2. 10-49
3. 50-99
4. 100-499
5. 500-999
6. 1,000+
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q48aa
How much did (name/you) earn from this employer before taxes
and other deductions during set date-1?
Enter dollar amount
Enter 0 for none
Q48aarn1
Could you please tell me if (name/you) earned less than $45,000, between $45,000 and $60,000, or
over $60,000 for the TOTAL yearly amount from this employer before taxes and other deductions
during set date-1?
1. Less than $45,000
2. Between $45,000 and $60,000
3. $60,000 or more
Q48aarn2
Did (name/you) earn less than $15,000, between $15,000 and $30,000, or over $30,000 from this
Page 10 of 206
employer during set date-1?
1. Less than $15,000
2. Between $15,000 and $30,000
3. Over $30,000
Q48aap
Read if necessary
Is this a weekly, every other week, twice a month,
monthly, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q48a1
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn
(fill from Q48a)
from this employer in set date-1?
Earnings payment (1-12; 1-24; 1-26; 1-52)
Q48aV
According to my calculations (name/you) earned $(total) altogether
from this employer in set date-1 before deductions.
Does that sound about right?
1. Yes
2. No
Q48a2
Page 11 of 206
What is your best estimate of (name's/your) correct total amount of earnings
from this employer during set date-1 before deductions?
PREVIOUS ENTRIES: (amount)
Q48aap: (periodicity)
Q48a1: (number of pay periods)
Enter dollar amount
Q48a3
Does this amount include all tips, bonuses, overtime pay,
or commissions (name/you) may have received from
this employer in set date-1?
1. Yes
2. No
Q48aad
How much did (name/you) earn in tips, bonuses, overtime pay,
or commissions from this employer in set date-1?
Enter dollar amount
Q48aadrn1
Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over
$3,000 in tips, bonuses, overtime pay, or commissions from this employer during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q48aadrn2
Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses,
overtime pay, or commissions from this employer during set date-1?
Page 12 of 206
1. Less than $100
2. Between $100 and $500
3. More than $500
Q48aT
*NON-DISPLAY ITEM
LINENO
*NON-SCREEN ITEM
Q48b
What were (name's/your) net earnings from this business/farm
after expenses during set date-1?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48brn1
Could you please tell me if (name/you) earned less than $45,000, between $45,000 and $60,000,
or over $60,000 for the TOTAL yearly amount from this business/farm after expenses during set
date-1?
1. Less than $45,000
2. Between $45,000 and $60,000
3. $60,000 or more
Q48brn2
Did (name/you) earn less than $15,000, between $15,000 and $30,000, or over $30,000 from this
business/farm after expenses during set date-1?
Page 13 of 206
1. Less than $15,000
2. Between $15,000 and $30,000
3. Over $30,000
Q48b_char
Enter "L" for Lost Money
Q48BL
Enter amount of money lost in set date-1
Enter annual amount only
Q48bp
Is this a weekly, every other week, twice a month,
monthly, quarterly, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
7. Yearly
Q48b2
What is your best estimate of (name's/your) ANNUAL net earnings
from this business/farm after expenses in set date-1?
PREVIOUS ENTRIES: Q48b: $^Q48b_fill
Q48bp: ^Q48bp_fill
Enter dollar amount
Page 14 of 206
Q48b2L
What is your best estimate of (name's/your) ANNUAL net LOSS
from this business/farm after expenses in set date-1?
PREVIOUS ENTRIES: Q48bL: $^Q48bL_fill
Q48bp: ^Q48bp_fill
Enter dollar amount
LINENO
*NON-SCREEN ITEM
Q48b3
What were (name's/your) net earnings from this business/farm
during the FIRST quarter of set date-1?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b3_char
Enter "L" for Lost Money
Q48B3L
Enter amount of money lost in the first quarter of set date-1.
Q48b4
What were (name's/your) net earnings from this business/farm
during the SECOND quarter of set date-1?
If response is "Broke Even" then enter 1
Page 15 of 206
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b4_char
Enter "L" for Lost Money
Q48B4L
Enter amount of money lost in the second quarter of set date-1.
Q48b5
What were (name's/your) net earnings from this business/farm
during the THIRD quarter of set date-1?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b5_char
Enter "L" for Lost Money
Q48B5L
Enter amount of money lost in the third quarter of set date-1.
Q48b6
What were (name's/your) net earnings from this business/farm
Page 16 of 206
during the FOURTH quarter of set date-1?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter dollar amount
Q48b6_char
Enter "L" for Lost Money
Q48B6L
Enter amount of money lost in the fourth quarter of set date-1.
CTRLNUM
**Non-Displayed Item**
Q48b7
Does this amount include all tips, bonuses, overtime pay,
or commissions (name/you) may have received from
this business in set date-1?
1. Yes
2. No
Q48bad
How much did (name/you) earn in tips, bonuses, overtime pay,
or commissions in set date-1?
Enter dollar amount
Q48badrn1
Page 17 of 206
Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over
$3,000 in tips, bonuses, overtime pay, or commissions from this business during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q48badrn2
Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses,
overtime pay, or commissions during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q48bT
*NON-DISPLAY ITEM
Q48BLO
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q49a
Did (name/you) earn money from any other work
( you/he/she) did during set date-1?
1. Yes
2. No
Page 18 of 206
Q49b1d
How much did (name/you) earn from all other employers
before taxes and other deductions during set date-1?
Enter dollar amount
Enter "0" for None
Q49b1drn1
Could you please tell me if (name/you) earned less than $10,000, between $10,000 and $20,000,
or over $20,000 from all other employers before taxes and other deductions during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q49b1drn2
Did (name/you) earn less than $1,000, between $1,000 and $5,000, or over $5,000 from all other
employers before taxes and other deductions during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q49b1p
Read if necessary
Is this a weekly, every other week, twice a month,
monthly, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q49B11
Page 19 of 206
For how many (weekly/every other week/twice a month/monthly) pay periods did (name/you) earn
$^Q49b1d_fill
from all other employers in set date-1?
Other earnings(1-12; 1-52)
Q49B1V
According to my calculations (name/you) earned $(total) altogether
from all other employers in set date-1.
Does that sound about right?
1. Yes
2. No
Q49B12
What is your best estimate of (name's/your) correct total amount of earnings
from all other employers during set date-1?
PREVIOUS ENTRIES: Q49b1d: $^Q49b1d_fill
Q49b1p: ^Q49b1p_fill
Q49b11: ^Q49b11_fill
Enter dollar amount
Q49b13
Does this amount include all tips, bonuses, overtime pay,
or commissions (name/you) may have received from
all other employers in set date-1?
1. Yes
2. No
Q49B1A
How much did (name/you) earn in tips, bonuses, overtime pay,
or commissions from all other employers in set date-1?
Page 20 of 206
Enter dollar amount
Q49B1ARN1
Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000, or over
$3,000 in tips, bonuses, overtime pay, or commissions from all other employers during set
date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q49B1ARN2
Did (name/you) earn less than $100, between $100 and $500, or over $500 in tips, bonuses,
overtime pay, or commissions from all other employers during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q49B1T
*NON-DISPLAY ITEM
CTRLNUM
**Non-Displayed Item**
Q49b2
How much did (name/you) earn from
(blank/any other businesses of) (your/his/her) (own/own business) after expenses?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost Money" press enter
Enter annual amount only
Page 21 of 206
Q49b2rn1
Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over
$20,000 from from (blank/any other businesses of) (your/his/her) (own/own business) after
expenses?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q49b2rn2
Could you tell me if (name/you) earned less than $1,000, between $1,000 and $5,000, or over
$5,000 from from (blank/any other businesses of) (your/his/her) (own/own business) after
expenses?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q49b2_char
Enter "L" for Lost Money
Q49b3
Enter annual amount lost only
Q49b4
How much did (name/you) earn from
(your/his/her) farm after expenses?
If response is "Broke Even" then enter 1
Enter "0" for None
If response is "Lost money" press enter
Enter annual amount only
Page 22 of 206
Q49b4rn1
Could you tell me if (name/you) earned less than $10,000, between $10,000 and $20,000, or over
$20,000 from (your/his/her) farm after expenses?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q49b4rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 from
(your/his/her) farm after expenses?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q49b4_char
Enter "L" for Lost Money
Q49b5
Enter annual amount lost only
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q51A1
At any time during set date-1 did (name/you) receive any
State or Federal unemployment compensation?
Page 23 of 206
1. Yes
2. No
Q51A1p
What is the easiest way for you to tell us (name's/your)
State or Federal unemployment compensation;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q51A11
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/
in State or Federal unemployment compensation
during set date-1?
)
Enter dollar amount
Q51A11r1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in State or Federal unemployment compensation during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q51A11r2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in State or
Federal unemploymeny compensation during set date-1?
Page 24 of 206
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q51A12
How many (weekly/every other week/ twice a month/monthly/
receive
from State or Federal unemployment compensation
during set date-1?
) payments did (name/you)
Unemployment compensation (1-2; 1-52)
Q51A13
According to my calculations (name/you) received $(total) altogether
from State or Federal unemployment compensation
during set date-1.
Does that sound about right?
1. Yes
2. No
Q51A14
What is your best estimate of the correct total amount (name/you)
received from State or Federal unemployment compensation
during set date-1?
PREVIOUS ENTRIES: (amount)
Q51A1p: (periodicity)
Q51A12: (number of pay periods)
Enter dollar amount
Q51A1T
*NON-SCREEN ITEM*
Page 25 of 206
Q51A2
At any time during set date-1 did (name/you) receive any
Supplemental Unemployment Benefits (SUB)?
1. Yes
2. No
Q51A2p
What is the easiest way for you to tell us (name's/your)
Supplemental Unemployment Benefits;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q51A21
How much did (name/you) receive (weekly/every other week/twice a month/ monthly/
in Supplemental Unemployment Benefits
during set date-1?
)
Enter dollar amount
Q51A21r1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in Supplemental Unemployment Benefits during set date-1?
Page 26 of 206
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q51A21r2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in
Supplemental Unemployment Benefit during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q51A22
How many (weekly/every other week/twice a month/ monthly/
receive
from Supplemental Unemployment Benefits
during set date?
) payments did (name/you)
Unemployment compensation (1-2; 1-52)
Q51A23
According to my calculations (name/you) received $(total) altogether
from Supplemental Unemployment Benefits
during set date-1.
Does that sound about right?
1. Yes
2. No
Q51A24
What is your best estimate of the correct total amount (name/you)
received from Supplemental Unemployment Benefits
during set date-1?
PREVIOUS ENTRIES: (amount)
Q51A2p: (periodicity)
Page 27 of 206
Q51A22: (number of pay periods)
Enter dollar amount
Q51A2T
*NON-SCREEN ITEM*
Q51A3
At any time during set date-1 did (name/you) receive any
Union Unemployment or Strike Benefits?
1. Yes
2. No
Q51A3p
What is the easiest way for you to tell us (name's/your)
Union Unemployment or Strike Benefits;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q51A31
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/ )
in Union Unemployment or Strike Benefits
during set date-1?
Enter dollar amount
Page 28 of 206
Q51A31r1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in Union Unemployment or Strike Benefits during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q51A31r2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in
Supplemental Unemployment Benefit during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q51A32
How many (weekly/every other week/ twice a month/ monthly/ ) payments did (name/you)
receive from Union Unemployment or Strike Benefits
during set date-1?
Union Unemployment or Strike Benefits (1-2; 1-52)
Q51A33
According to my calculations (name/you) received $(total) altogether
from Union Unemployment or Strike Benefits
during set date-1.
Does that sound about right?
1. Yes
2. No
Q51A34
What is your best estimate of the correct total amount (name/you)
received from Union Unemployment or Strike Benefits
Page 29 of 206
during set date-1?
PREVIOUS ENTRIES: (amount)
Q51A3p: (periodicity)
Q51A32: (number of pay periods)
Enter dollar amount
Q51A3T
*NON-SCREEN ITEM*
Q52a
During set date-1 did (name/you) receive any
Worker’s Compensation payments or other payments
as a result of a job related injury or illness?
Exclude sick pay and disability retirement.
1. Yes
2. No
Q52b
What was the source of these payments?
1. State Worker's Compensation
2. Employer or employer's insurance
3. Own insurance
4. Other
Q52cp
What is the easiest way for you to tell us (name's/your)
Worker's Compensation;
weekly, every other week, twice a month,
monthly, or yearly?
Page 30 of 206
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q52c1
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/
in Worker's Compensation
during set date-1?
)
Enter dollar amount
Q52cr1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in Worker's Compensation during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q52cr2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Worker's
Compensation during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q52c2
How many (weekly/every other week/ twice a month/ monthly/
receive from Worker’s Compensation
during set date-1?
Worker's Comp (1-2; 1-52)
Page 31 of 206
) payments did (name/you)
Q52c3
Then (name/you) received $^TQ52C3 altogether
from Worker’s Compensation
during set date-1.
Does that sound about right?
1. Yes
2. No
Q52c4
What is your best estimate of the correct total amount (name/you)
received from Worker’s Compensation
during set date-1?
PREVIOUS ENTRIES: (amount)
Q52cp: (periodicity)
Q52c2: (number of pay periods)
Enter dollar amount
Q52CT
*NON-SCREEN ITEM*
PERSON_SUPP_COMP
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
DNPER_S
** NON-DISPLAYED ITEM **
SPELIG
Page 32 of 206
** NON-DISPLAYED ITEM **
IncsOrd
** NON-DISPLAYED ITEM **
Q59AR
At any time in set date-1 did (you/ anyone in this household) have a disability or health problem
which prevented (you/them) from working, even for a short time, or which limited the work
(you/they) could do?
1. Yes
2. No
Q59b
Read only if necessary
Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
LN
LN
NAME
Mem
Relation
(name of person talking about)
^MEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
Page 33 of 206
^RRP_FILL
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Q60a
(Did you/Is there anyone in this household who) ever (retire or leave/ retired or left) a job for
health reasons?
1. Yes
2. No
Q60b
Read only if necessary
Who is that?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
LN
LN
NAME
Mem
Relation
(name of person talking about)
^MEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
Page 34 of 206
^RRP_FILL
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q61br
Did (name/you) receive any disability income in set date-1 as a result of (your/his/her) disability
or health problem?
1. Yes
2. No
Q61cra
Was any part of this disability income from Social Security Disability Insurance, for people who
are eligible based on years of work?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
1. Yes
2. No
Q61cra1
Did (name/you) receive (your/his/her) first Social Security Disability payment in set date-1?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
Page 35 of 206
1. Yes
2. No
Q61crb
Was any part of this disability income from Supplemental Security Income, which provides
payments to low-income aged, blind and disabled persons?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
1. Yes
2. No
Q61crc
Was any part of this disability income from company or union disability payments?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
If "Yes", Probe to determine which source, company or union
Select All that apply
1. Company
2. Union
3. Neither
Q61crd
Was any part of this disability income from Federal, State, or Local government employee
disability?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
If "Yes" Probe to determine which source. Select all that apply
Page 36 of 206
1. Federal
2. State
3. Local
4. None of the above
Q61cre
Was any part of this disability income from accident or disability insurance?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
1. Yes
2. No
Q61crf
Did (name/you) receive any part of this disability income from some other source?
Asking About: ^Q61c_fill ( name/name- -CURRENT RESPONDENT)
1. Yes
2. No
Q61dr
What was the source of this disability income?
Enter all that apply.
Probe: Any other reason?
1. Worker's compensation
Page 37 of 206
2. Federal Government (Civil Service) disability
3. U.S. Military retirement disability
4. U.S. Railroad retirement disability
5. State temporary sickness
6. Black Lung mine's disability
7. Other - specify
Q61c1
*Non-Screen Item*
Q61c2
*Non-Screen Item*
Q61c3
*Non-Screen Item*
Q61c4
*Non-Screen Item*
Q61c5
*Non-Screen Item*
Q61c6
*Non-Screen Item*
Q61c7
*Non-Screen Item*
Q61c8
*Non-Screen Item*
Q61c9
*Non-Screen Item*
Page 38 of 206
Q61c10
*Non-Screen Item*
Q61c11
*Non-Screen Item*
Q61c12
*Non-Screen Item*
Q61c13
*Non-Screen Item*
Q61c14
*Non-Screen Item*
Q61c15
*Non-Screen Item*
Q61Cs1
What was the source of this disability income?
Specify other source of income from health problem or disability
Enter "Other Health Problem/Disability" if the answer is "Don't Know"
CTRLNUM
**Non-Displayed Item**
L59B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
Page 39 of 206
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L60B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q56a
During set date-1 did (you/ anyone in this household) receive any
Page 40 of 206
Social Security payments from the U.S. Government?
1. Yes
2. No
Q56b
Read only if necessary
Who received Social Security
payments either for themselves
or as combined payments with
other family members?
Enter Line Number Of Parent Or
Guardian For Payments Made To
Children Under Age 15
Enter all that apply, separate using the space bar or a comma.
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
Page 41 of 206
*NON-SCREEN ITEM
SSR
What were the reasons (name/you)
(was/were) getting Social Security in set date-1?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1. Retired
2. Disabled
3. Widowed
4. Spouse
5. Surviving child
6. Dependent child
7. On behalf of surviving, dependent, or disabled children
8. Other
SSR1
*Non-Screen Item*
SSR2
*Non-Screen Item*
SSR3
*Non-Screen Item*
SSR4
*Non-Screen Item*
SSR5
*Non-Screen Item*
Page 42 of 206
SSR6
*Non-Screen Item*
SSR7
*Non-Screen Item*
SSR8
*Non-Screen Item*
SSRs
Specify other reason
SSC
Which children under age 19
were receiving Social Security
in set date-1?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All People Enter 0 for None
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
Page 43 of 206
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
SSCR
What were the reasons (Child's name/the children) (was/were)
getting Social Security in set date-1?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1. Disabled child/children
2. Surviving child/children
3. Dependent child/children
4. Other
SSCR1
*Non-Screen Item*
SSCR2
*Non-Screen Item*
SSCR3
*Non-Screen Item*
SSCR4
*Non-Screen Item*
CTRLNUM
Page 44 of 206
**Non-Displayed Item**
L56B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q56f
Did anyone in this household receive any
Social Security income in set date-1 that we have
not already counted on behalf of children
in this household?
Includes all children under 19 years of age
Social Security Income previously reported will appear here
LN
Name
Amount reported in Q56d
amount
Page 45 of 206
1. Yes
2. No
Q56g
Read only if necessary
Who received these Social Security
payments?
Enter line number of parent or
guardian
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
CSS
Page 46 of 206
Which children under age 19
were receiving Social Security
in set date-1?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All People Enter 0 for None
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
Page 47 of 206
CRSS
What were the reasons Fill for CRSS
getting Social Security in set date-1?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1. Disabled child/children
2. Surviving child/children
3. Dependent child/children
4. Other
CRSS1
*Non-Screen Item*
CRSS2
*Non-Screen Item*
CRSS3
*Non-Screen Item*
CRSS4
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
L56G
*NON_SCREEN ITEM
1. NAME[1]
Page 48 of 206
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q57a
During set date-1 did (you/ anyone in this household) receive:
any SSI payments, that is, Supplemental Security Income?
Note: SSI are assistance payments to low-income aged,
blind and disabled persons, and come from state or local welfare
offices, the Federal government, or both.
1. Yes
2. No
Q57b
Read only if necessary
Who received SSI?
Supplemental Security Income
Page 49 of 206
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
SSIR
What were the reasons (name/you)
(was/were) getting Supplemental
Security Income in set date-1?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Reason?
1. Disabled
2. Blind
3. On behalf of a disabled child
4. On behalf of a blind child
Page 50 of 206
5. Other
SSIR1
*Non-Screen Item*
SSIR2
*Non-Screen Item*
SSIR3
*Non-Screen Item*
SSIR4
*Non-Screen Item*
SSIR5
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
L57B
*NON-SCRENN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
Page 51 of 206
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q57d
Did anyone in this household receive any
Supplemental Security Income in set date-1 that we
have not already counted on behalf of children
in this household?
Includes all children under 18 years of age
SSI previously reported will appear here
LN
Name
Amount for Q57C
amount
1. Yes
2. No
Q57e
Read only if necessary
Who received these Supplemental Security Income
payments?
Enter line number of parent or guardian
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Page 52 of 206
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
RSSI
What were the reasons (name/you)
getting Supplemental Security Income
on behalf of children in set date-1?
Enter all that apply, separate with using the space bar or a comma.
Probe: Any Other Reason?
1. On behalf of a disabled child/children
2. On behalf of a blind child/children
3. Other
RSSI1
*Non-Screen Item*
Page 53 of 206
RSSI2
*Non-Screen Item*
RSSI3
*Non-Screen Item*
CSSI
Which children under age 18
were receiving Supplemental Security
Income in set date-1?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All People
Enter 0 if None
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
CTRLNUM
Page 54 of 206
**Non-Displayed Item**
L57D
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q60A88
At any time during set date-1 did
(you/ anyone in this household) receive:
Any Veterans’ (VA) payments?
Include assistance received by children of veterans
1. Yes
2. No
Q60b_88
Page 55 of 206
Read only if necessary
Who received Veterans' (VA)
payments either for themselves
or as combined payments with
other family members?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q60C8
What type of Veterans' payment did (name/you) receive?
Read list only if respondent is having difficulty
answering the question.
Enter all that apply, separate using the space bar or a comma.
Page 56 of 206
Probe: Any other payments?
1. Service-connected disability compensation
2. Survivor Benefits
3. Veterans' pension
4. Educational assistance (including assistance received by children of veterans)
5. Other Veterans' payments
Q60C81
*Non Screen Item*
Q60C82
*Non Screen Item*
Q60C83
*Non Screen Item*
Q60C84
*Non Screen Item*
Q60C85
*Non Screen Item*
Q60D88
(Are / Is) (name/you) required to fill out
an annual income questionnaire for
the Department of Veterans' Affairs?
1. Yes
Page 57 of 206
2. No
CTRLNUM
**Non-Displayed Item**
L608
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q58A
Did (you/ anyone in this household) receive any
survivor benefits in set date-1 such as
widow’s pensions, estates, trusts,
insurance annuities, or
any other survivor benefits (other than Social Security/ other than VA benefits/ other than Social
Security or VA benefits)
^SSVA2
Page 58 of 206
1. Yes
2. No
Q58b
Read only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q58Cra
Was (name's/your) income from a company or union survivor pension including profit sharing?
Page 59 of 206
Enter all that apply, separate using the space bar or a comma.
1. Company pension
2. Union pension
3. None of the Above
Q58Crb
Was (name's/your) income from a Federal, State, or Local government survivor penion (civil
service)?
Enter all that apply, separate using the space bar or a comma.
1. Federal Government survivor pension
2. State Government survivor pension
3. Local Government survivor pension
4. none of the above
Q58Crc
Was (name's/your) income from a U.S. Military retirement survivor penion?
1. Yes
2. No
Q58Crd
Was (name's/your) income from regular payments from estates or trusts?
1. Yes
2. No
Page 60 of 206
Q58Cre
Was (name's/your) income from regular payments from annuities or paid-up insurance policies?
Enter all that apply, separate using the space bar or a comma.
1. Annuity
2. Paid-up insurance policy
3. none of the above
Q58Crf
Did (name/you) receive survivor benefits from some other source?
1. Yes
2. No
Q58Dr
What was the source of this income?
Asking About: ^Q58C_fill ( name/name- -CURRENT RESPONDENT)
Read list if respondent is having difficulty answering the question
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Source?
1. Social Security survivor payments
2. Black Lung survivor pension
3. U.S. Railroad retirement survivor pension
4. Worker's compensation survivor pension
5. Other or don't know
Q58C1
Page 61 of 206
*Non-Screen Item*
Q58C2
*Non-Screen Item*
Q58C3
*Non-Screen Item*
Q58C4
*Non-Screen Item*
Q58C5
*Non-Screen Item*
Q58C6
*Non-Screen Item*
Q58C7
*Non-Screen Item*
Q58C8
*Non-Screen Item*
Page 62 of 206
Q58C9
*Non-Screen Item*
Q58C10
*Non-Screen Item*
Q58C11
*Non-Screen Item*
Q58C12
*Non-Screen Item*
Q58C13
*Non-Screen Item*
Q58C14
*Non-Screen Item*
Q58C15
*Non-Screen Item*
Q58Cs1
What was the source of this survivor benefit?
Page 63 of 206
Specify other source of income as survivor or widow
Enter "Survivor Benefits" if the answer is "Don't Know"
CTRLNUM
**Non-Displayed Item**
L58B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q59A88
At any time during set date-1, even for one month, did
(you/ anyone in this household) receive any CASH assistance from
a state or county welfare program such as
(State Program Name)?
Include cash payments from:
Page 64 of 206
welfare or welfare-to-work programs,
(State Program Name)_note
Temporary Assistance for Needy Families program (TANF),
Aid to Families with Dependent Children (AFDC),
General Assistance/Emergency Assistance program,
Diversion Payments,
Refugee Cash and Medical Assistance program,
General Assistance from Bureau of Indian Affairs, or
Tribal Administered General Assistance.
[bold]Do not include:
food stamps/Supplemental Nutrition Assistance Program (SNAP) benefits,
SSI,
energy assistance,
WIC,
School meals, or
transportation, child care, rental, or education assistance.[n]
1. Yes
2. No
Q59A89
Just to be sure, in set date-1, did anyone receive
CASH assistance from a state or county
welfare program, on behalf of CHILDREN
in the household?
1. Yes
2. No
Q59b_88
Who received this CASH assistance?
Enter line number
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Page 65 of 206
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q59C8r
From what type of program did (name/you)
receive the CASH assistance? Was it a
welfare or welfare-to-work program such as
(State Program Name), General Assistance, Emergency
Assistance, Disversion Payments or
some other program?
Enter all that apply, separate using the space bar or a comma.
Probe: Any Other Program?
If the respondent mentions any of the following categories, note this but explain "Right now we are
interested in CASH assitance." Seek answers using the accepted categories.
Food Stamps
SSI
Energy assistance
WIC
School meals
Transportation, childcare, rental or educational assistance
Page 66 of 206
1. ^PUBASST_ST/welfare/AFDC
2. General Assistance
3. Emergency Assistance/short-term cash assistance
4. Diversion payments
5. Refugee cash and medical assistance program
6. General assistance from Bureau of Indian Affairs, or Tribal administered general assistance
7. Some other program (specify)
Q59C81
*Non Screen Item*
Q59C82
*Non Screen Item*
Q59C83
*Non Screen Item*
Q59C84
*Non Screen Item*
Q59C85
*Non Screen Item*
Q59C86
*Non Screen Item*
Page 67 of 206
Q59C87
*Non Screen Item*
Q59C8s
What was the name of that other program?
Specify other source of cash assistance
Enter "Cash" if the answer is "Don't Know"
CTRLNUM
**Non-Displayed Item**
L598
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Page 68 of 206
Q87r
Did (you/ anyone in this household) get food stamps or use a food stamp benefit card at any time
during set date-1?
Do not include WIC benefits.
1. Yes
2. No
Q87ar
At any time during set date-1, even for one month,
did (you/ anyone in this household) receive any food assistance from
(State program name)?
Do not include WIC benefits.
1. Yes
2. No
Q88
Which of the people now living here were covered by that
food assistance during set date-1?
List all household members covered by food assistance regardless of age
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
Probe: Anyone else?
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
Page 69 of 206
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
SWRWIC
At any time during set date-1, (was/were) (you/ anyone in this household)
on WIC, the Women, Infants, and Children Nutrition Program?
Help screen available for description of WIC
1. Yes
2. No
SWRW
Who received WIC for themselves
or on behalf of a child?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
Page 70 of 206
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q80
During set date-1 which of the children
ages 5 to 18 in this household usually ate a
complete lunch offered at school?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
Page 71 of 206
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
Q83
During set date-1 which of the children in this household
received free or reduced priced lunches because they qualified
for the Federal School Lunch Program?
Probe: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter 96 for All
Enter 0 for None
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
Page 72 of 206
CTRLNUM
**Non-Displayed Item**
Q85
Is this public housing, that is, is it owned by a
local housing authority or other public agency?
1. Yes
2. No
Q86
Are you paying lower rent because the Federal, State,
or local government is paying part of the cost?
1. Yes
2. No
SPHS8
Is this through Section 8 or through
some other government program?
1. Section 8
2. Some other government program
3. Not sure
CTRLNUM
**Non-Displayed Item**
PRE_Q93
*NON-SCREEN ITEM*
Page 73 of 206
Q93
The government has an energy assistance program which
helps pay heating or cooling costs. This assistance can be received
directly by the household or it can be paid directly to the
electric company, gas company, or fuel dealer.
In set date-1, (have you/has this household) receive
assistance of this type from the federal, state, or local government?
1. Yes
2. No
Q93pr1
Do you remember receiving an additional or unexpected check
that was sent during the year to help pay heating or cooling costs?
1. Yes
2. No
Q93pr2
Was it used to pay heating costs?
1. Yes
2. No
CTRLNUM
**Non-Displayed Item**
Q62AR
During set date-1 did (you/ anyone in this household) receive
any pension income from
a previous employer or union other than VA benefits?
1. Yes
2. No
Page 74 of 206
Q62b
Read only if necessary
Who received pension income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q62CRa
Was (name's/your) pension income from a company or union pension
(including profit sharing)?
Enter all that apply, separate using the space bar or a comma.
If "Yes", probe to identify which source
Page 75 of 206
1. Company Pension
2. Union Pension
3. Neither
Q62CRb
Was (name's/your) pension income from a Federal, State, or Local Government pension?
Enter all that apply, separate using the space bar or a comma.
If "Yes", probe to identify which source
1. Federal Government Pension
2. State Government Pension
3. Local Government Pension
4. Neither
Q62CRc
Was (name's/your) pension income from a U.S. Military pension?
1. Yes
2. No
Q62CRd
Did (name/you) receive pension income from some other source?
1. Yes
2. No
Q62DR
What was the source of (name's/your) pension income?
Enter <1> if the answer is "Railroad Retirement"
Enter <2> Other Source if the answer is some other source or "Don't Know"
1. U.S. Railroad Retirement
Page 76 of 206
2. Other source or "Don't know"
Q62Cs1
Enter other source of pension income
Enter "Other Pension" if the answer is "Don't Know"
Q62c1
*Non-Screen Item*
Q62c2
*Non-Screen Item*
Q62c3
*Non-Screen Item*
Q62c4
*Non-Screen Item*
Q62c5
*Non-Screen Item*
Q62c6
*Non-Screen Item*
Q62c7
*Non-Screen Item*
Q62c8
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
Page 77 of 206
L62B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q96AR
During set date-1 did (you/ anyone in this household) receive
any income from an annuity?
1. Yes
2. No
Q96BR
Read only if necessary
Who received annuity income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Page 78 of 206
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L96B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
Page 79 of 206
16. NAME[16]
Q97AR
At any time during set date-1 did (you/ anyone in this household) have any retirement
accounts such as a 401(k), 403(b), IRA, or other account designed specifically
for retirement savings?
1. Yes
2. No
Q97BR
Read only if necessary
Who had such a retirement account?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Page 80 of 206
LINENO
*NON-SCREEN ITEM
Q97CR
What type of retirement account did (name/you) have? Did ^heshe have...
Read each category
Enter all that apply, separate using the space bar or a comma.
1. a 401(k)
2. a 403(b)
3. a Roth IRA
4. a Regular IRA
5. a KEOUGH plan (
6. an SEP plan (Simplified Employee Pension)
7. another type of retirement account
Q97C1
*Non Screen Item*
Q97C2
*Non Screen Item*
Q97C3
*Non Screen Item*
Q97C4
*Non Screen Item*
Q97C5
*Non Screen Item*
Page 81 of 206
Q97C6
*Non Screen Item*
Q97C7
*Non Screen Item*
Q97C8
*Non Screen Item*
Q97DR
What was the source of (name's/your) retirement income?
Enter other source of retirement income
Q98AR1
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) 401k account in set date-1 ^Q98AR?
1. Yes
2. No
Q98AR2
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) 403(b) account in set date-1 ^Q98AR?
1. Yes
2. No
Q98AR3
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) Roth IRA account in set date-1 ^Q98AR?
1. Yes
2. No
Page 82 of 206
Q98AR4
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) regular IRA account in set date-1 ^Q98AR?
1. Yes
2. No
Q98AR5
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) KEOUGH plan in set date-1 ^Q98AR?
1. Yes
2. No
Q98AR6
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) SEP plan in set date-1 ^Q98AR?
1. Yes
2. No
Q98AR7
Did (name/you) withdraw any money or receive a distribution from
(your/his/her) ^Q97DR account in set date-1 ^Q98AR?
1. Yes
2. No
CTRLNUM
**Non-Displayed Item**
L97B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
Page 83 of 206
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Q99ARa
Now I will ask about assets that may have paid interest
or dividends in set date-1 outside of the retirement accounts.
At anytime during set date-1 did (you/ anyone in this household):
Have money in an interest-earning checking account?
1. Yes
2. No
Q99Ba
Ask only if necessary
Which members of this household ages 15 and over
had an interest-earning checking account?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Page 84 of 206
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L99Ba
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Page 85 of 206
Q99ARb
At anytime during set date-1 did (you/ anyone in this household):
Have money in a savings account?
1. Yes
2. No
Q99Bb
Ask only if necessary
Which members of this household ages 15 and over
had a savings account?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
Page 86 of 206
16. NAME[16]
L99Bb
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Q99ARc
At anytime during set date-1 did (you/ anyone in this household):
Have money in a money market fund?
1. Yes
2. No
Q99Bc
Ask only if necessary
Which members of this household ages 15 and over
had a money market fund?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Page 87 of 206
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L99Bc
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
Page 88 of 206
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Q99ARd
At anytime during set date-1 did (you/ anyone in this household):
Have money in CDs (certificates of deposit)?
1. Yes
2. No
Q99Bd
Ask only if necessary
Which members of this household ages 15 and over
had CDs (certificates of deposit)?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
Page 89 of 206
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L99Bd
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Q99ARe
At anytime during set date-1 did (you/ anyone in this household):
Have money in savings bonds?
1. Yes
2. No
Page 90 of 206
Q99Be
Ask only if necessary
Which members of this household ages 15 and over
had savings bonds?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L99Be
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
Page 91 of 206
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Q99ARf
At anytime during set date-1 did (you/ anyone in this household):
Have money in shares of stock in corporations or mutual funds?
1. Yes
2. No
Q99Bf
Ask only if necessary
Which members of this household ages 15 and over
had shares of stock in corporations or mutual funds?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Page 92 of 206
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L99Bf
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Page 93 of 206
LINENO
*NON-SCREEN ITEM
CAPGDIS
Did (name/you) receive any capital gains distributions from (your/his/her) share of stocks or
mutual funds in set date-1?
1. Yes
2. No
CTRLNUM
**Non-Displayed Item**
Q99ARg
At anytime during set date-1 did (you/ anyone in this household):
Have money in any other savings or investments that pay interest or dividends?
1. Yes
2. No
Q99Bg
Ask only if necessary
Which members of this household ages 15 and over
had any other savings or investments that paid interest or dividends?
Include each person in cases of joint accounts or ownership
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
Page 94 of 206
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L99Bg
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Page 95 of 206
LINENO
*NON-SCREEN ITEM
Q99BR
What was the source of (name's/your) savings or investments that pay interest or dividends?
Enter other source of interest or dividend income
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
Q65A1
During set date-1 did (you/ anyone in this household):
Own any land, business property, apartments, or houses
which were rented to others?
1. Yes
2. No
Q65A2
At anytime during set date-1 did (you/ anyone in this household):
Receive income from royalties or from roomers or boarders?
(exclude amounts paid by relatives)
1. Yes
2. No
Q65A3
At anytime during set date-1 did (you/ anyone in this household):
Receive income from estates or trusts?
(exclude estates or trusts already reported)
1. Yes
2. No
Page 96 of 206
Q65b
Ask only if necessary
Who received this ^RNT ?
Fill for Q65b
Include each in cases of joint ownership. For self-employed persons, determine if income was already
included
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L65B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
Page 97 of 206
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q66a
During set date-1 did (you/ anyone in this household) attend
school beyond the high school level including
a college, university, or other schools?
(include vocational, business, or trade schools)
1. Yes
2. No
Q66b
Did (you/ anyone in this household) receive any educational
assistance for tuition, fees, books, or living
expenses during set date-1?
Exclude loans, assistance from household members,
and VA educational benefits
1. Yes
2. No
Page 98 of 206
Q66c
Ask only if necessary
Which member received assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q66d
What type of assistance did (name/you) receive?
Exclude assistance from household members
Enter all that apply, separate using the space bar or a comma.
Probe: Any other assistance?
Page 99 of 206
2. Pell Grant
3. Assistance from a welfare or social service office
4. Some other government assistance
5. Scholarships, grants, etc.
6. Other assistance (employers, friends, etc.)
Q66d1
*Non-Screen Item*
Q66d2
*Non-Screen Item*
Q66d3
*Non-Screen Item*
Q66d4
*Non-Screen Item*
Q66d5
*Non-Screen Item*
Q66d6
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
L66c
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
Page 100 of 206
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q70a
During set date-1 did (you/ anyone in this household) receive:
Any child support payments?
1. Yes
2. No
Q70b
Read only if necessary
Who received these payments?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
Page 101 of 206
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L70B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Page 102 of 206
Q72a
During set date-1 did (you/ anyone in this household) receive:
(Any other/Any) regular financial assistance from friends
or relatives not living in this household?
Do not include loans
1. Yes
2. No
Q72b
Read only if necessary
Who received this assistance?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Page 103 of 206
L72B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
Q73A1
During set date-1 did (you/ anyone in this household)
receive cash income not already covered, such as:
income from foster child care, alimony, jury duty,
armed forces reserves, severnce pay, or any other source?
1. Yes
2. No
Q73A1b
Ask only if necessary
Page 104 of 206
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L73B
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
Page 105 of 206
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
Q73A1c
What was the source of this income?
Asking about: (name/you) ( name/name- -CURRENT RESPONDENT)
CTRLNUM
**Non-Displayed Item**
Q73A2
During set date-1 did (you/ anyone in this household)
receive income from:
Any severance pay, welfare, emergency assistance,
other short-term cash assistance, foster child care payments,
or any other money income not already covered?
1. Yes
2. No
Q73A2b
Ask only if necessary
Who received this income?
Enter all that apply, separate using the space bar or a comma.
Page 106 of 206
Probe: Anyone Else?
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
L73C
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
Page 107 of 206
LINENO
*NON-SCREEN ITEM
Q73A2c
What was the source of this income?
Asking about: (name/you) ( name/name- -CURRENT RESPONDENT)
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
AMTINTRO
Now I will ask you about the amount of income you ^AMTINTRO received from various sources in
set date-1.
1. Enter 1 to continue
LINENO
*NON-SCREEN ITEM
Q61E1P
What is the easiest way for you
to tell us (name's/your) (first fill from Q61c or Q61cs1) payments;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Page 108 of 206
Q61E1
How much did (name/you) receive
(weekly/ every other week/ twice a month/monthly/ ) before deductions in (first fill from Q61c or
Q61cs1)
payments in set date-1?
Enter dollar amount
Q61E12
How many (weekly/ every other week/ twice a month/monthly/ ) payments did
(name/you) receive in (first fill from Q61c or Q61cs1)
payments in set date-1?
Disability income source #1 (1-12; 1-52)
Q61e1rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in (first fill from Q61c or Q61cs1)
during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q61e1rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (first fill
from Q61c or Q61cs1) during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q61E13
According to my calculations (name/you)
received (total) dollars altogether from
(first fill from Q61c or Q61cs1) payments in set date-1.
Does that sound about right?
Page 109 of 206
1. Yes
2. No
Q61E14
What is your best estimate of the
correct amount (name/you)
received from (first fill from Q61c or Q61cs1) payments
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q61E1P: ^Q61E1P_fill
Q61E12: (number of pay periods)
Enter dollar amount
Q61E1T
*NON-SCREEN ITEM*
Q61E2P
What is the easiest way for you
to tell us (name's/your) (second fill from Q61c@2 or Q61c@s1) payments;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q61E2
How much did (name/you) receive
(weekly/every other week/ twice a month/ monthly) before deductions in (second fill from Q61c@2
or Q61c@s1)
payments in set date-1?
Enter dollar amount
Page 110 of 206
Q61E22
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in (second fill from Q61c@2 or Q61c@s1)
payments in set date-1?
Disability income payment type 2 (1-12; 1-52)
Q61e2rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in (second fill from Q61c@2 or
Q61c@s1) during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q61e2rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (second fill
from Q61c@2 or Q61c@s1) during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q61E23
According to my calculations (name/you)
received (total) dollars altogether from
(second fill from Q61c@2 or Q61c@s1) payments in set date-1.
Does that sound about right?
1. Yes
2. No
Q61E24
What is your best estimate of the
Page 111 of 206
correct amount (name/you)
received from (second fill from Q61c@2 or Q61c@s1) payments
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q61E2P: ^Q61E2P_fill
Q61E22: (number of pay periods)
Enter dollar amount
Q61E2T
*NON-SCREEN ITEM*
BACKPAY1
During set date-1, did (name/you) receive an initital Social Security Disability Insurance payment
that was larger than the usual payment that we haven't accounted for yet?
BACKPAY2
How much was that initial disability payment?
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q56dp
What is the easiest way for you
to tell us (name's/your)
Social Security payment
(excluding Social Security
Disability Insurance);
monthly, quarterly, or yearly?
4. Monthly
Page 112 of 206
5. Quarterly
7. Yearly
Q56d
How much did (name/you) receive
(monthly/quarterly/
) Social Security payments
in set date-1?
Enter dollar amount
Already included
Q56d_Char
Enter for Already included
Q56d1
What is the amount of the Social
Security payment (name/you)
received last month?
Enter dollar amount
Q56d2
For how many (months/quarters) did
(name/you) receive Social
Security in set date-1?
Social security (1-4; 1-12)
Q56drn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in Social Security Payments during
set date-1?
1. Less than $10,000
Page 113 of 206
2. Between $10,000 and $20,000
3. $20,000 or more
Q56drn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social
Security payments during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q56d3
Is this $(amount from Q56d/amount from Q56d1) before or after
the Medicare part B monthly
deduction?
1. After
2. Before
Q56d4
Was the cost of living increase the
only change which occurred in monthly
payments?
1. Yes
2. No
Q56d5
According to my calculations (name/you)
received $^TQ56D5 altogether from
Social Security in set date-1.
Does that sound about right?
1. Yes
Page 114 of 206
2. No
Q56d6
What is your best estimate of the
correct amount (name/you)
received in Social Security
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q56dp: (periodicity)
Q56d2: (number of pay periods)
Q56d3: (amount added per month)
Q56d4: (cost of living subtracted per month)
Enter dollar amount
Q56DT
**NON-DISPLAYED ITEM**
CTRLNUM
**Non-Displayed Item**
Q56r
Now we're going to ask you to report the amount of Social Security received on behalf of children
in the household. ^Q56R2
1. Separately
2. Combined
LINENO
*NON-SCREEN ITEM
Q56ipc
What is the easiest way for you
to tell us (name's/your) Social Security
payment for Fill for SSC (Separate amounts) monthly, quarterly, or yearly?
Page 115 of 206
4. Monthly
5. Quarterly
7. Yearly
Q56ic
How much did (name/you) receive
(monthly/quarterly/
) Social Security payments
for Fill for SSC (Separate amounts) in set date-1?
Enter dollar amount
Already included
Q56irn1c
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in Social Security Payments for Fill
for SSC (Separate amounts) during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q56irn2c
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social
Security payments for Fill for SSC (Separate amounts) during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q56i_CharC
Enter A for Already included
Q56i1c
What is the amount of the Social
Page 116 of 206
Security payment (name/you)
received for Fill for SSC (Separate amounts) last month?
Enter dollar amount
Q56i2c
For how many (months/quarters) did
(name/you) receive Social Security
for Fill for SSC (Separate amounts) in set date-1?
Social security (1-4; 1-12)
Q56i3c
Was the cost of living increase the
only change which occurred in monthly
payments for children in this household?
1. Yes
2. No
Q56i4c
According to my calculations (name/you)
received $^TQ56I4 altogether for children
in this household from Social Security in set date-1.
Does that sound about right?
1. Yes
2. No
Q56i5c
What is your best estimate of the
correct amount (name/you)
received in Social Security
Page 117 of 206
for Fill for SSC (Separate amounts) during set date-1?
Previous entries: $ (amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)
Enter dollar amount
Q56iTc
**NON-DISPLAYED ITEM**
Q56ip
What is the easiest way for you
to tell us (name's/your) Social Security
payment for children in this
household; monthly, quarterly, or yearly?
4. Monthly
5. Quarterly
7. Yearly
Q56i
How much did (name/you) receive
(monthly/quarterly/
) Social Security payments
for children in this household
in set date-1?
Enter dollar amount
Already included
Q56irn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in Social Security Payments for
children in this household during set date-1?
1. Less than $10,000
Page 118 of 206
2. Between $10,000 and $20,000
3. $20,000 or more
Q56irn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in Social
Security payments for children in this household during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q56i_Char
Enter A for Already included
Q56i1
What is the amount of the Social
Security payment (name/you)
received for children in this household
last month?
Enter dollar amount
Q56i2
For how many (months/quarters) did
(name/you) receive Social
Security in set date-1?
Social security (1-4; 1-12)
Q56i3
Was the cost of living increase the
only change which occurred in monthly
payments for children in this household?
Page 119 of 206
1. Yes
2. No
Q56i4
According to my calculations (name/you)
received $^TQ56I4 altogether for children
in this household from Social Security in set date-1.
Does that sound about right?
1. Yes
2. No
Q56i5
What is your best estimate of the
correct amount (name/you)
received in Social Security
for children in this household
during set date-1?
Previous entries: $ (amount)
Q56ip: (periodicity)
Q56i2: (number of pay periods)
Q56i3: (cost of living subtracted per month)
Enter dollar amount
Q56iT
**NON-DISPLAYED ITEM**
CTRLNUM
**Non-Displayed Item**
LINENO
Page 120 of 206
*NON-SCREEN ITEM
Q57cp
What is the easiest way for you
to tell us (name's/your)
Supplemental Security Income payment;
monthly, quarterly, or yearly?
4. Monthly
5. Quarterly
7. Yearly
Q57c
How much did (name/you) receive
(monthly/ quarterly/
) in Supplemental Security
Income payments in set date-1?
Enter dollar amount
Q57c1
What is the amount of the Supplemental
Security Income payment (name/you)
received last month?
Enter dollar amount
Q57c2
For how many (months/quarters) did
(name/you) receive Supplemental
Security Income in set date-1?
Social security (1-4; 1-12)
Q57crn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in Supplemental Security Income
payments in set date-1?
Page 121 of 206
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q57crn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over
$5,000 in Supplemental Security Income in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q57c3
Was the cost of living increase the
only change which occurred in monthly
payments?
1. Yes
2. No
Q57c4
According to my calculations (name/you)
received $(total) altogether from
Supplemental Security Income in set date-1.
Does that sound about right?
1. Yes
2. No
Q57c5
What is your best estimate of the
correct amount (name/you)
received in Supplemental Security
Page 122 of 206
Income during set date-1?
Previous entries: (amount)
Q57cp: (periodicity)
Q57c2: (number of pay periods)
(amount subtracted per month)
Enter Dollar Amount
Q57CT
**NON-DISPLAYED ITEM**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q57r
Now we're going to ask you to report the amount of Social Security received on behalf of children
in the household. What would be the easiest way for you to report the amount (name/you)
received for ^Q57r. Is is easiest to report for them combined or separately?
1. Separately
2. Combined
Q57ipc
What is the easiest way for you
to tell us the Supplemental Security
Income (name/you) received on behalf of children?
4. Monthly
5. Quarterly
7. Yearly
Page 123 of 206
Q57ic
How much did (name/you) receive
(monthly/ quarterly/
) in Supplemental Security
Income on behalf of children in set date-1?
Enter dollar amount
Q57i1c
What is the amount of the Supplemental
Security Income payment (name/you)
received on behalf of children
last month?
Enter dollar amount
Q57i2c
For how many (months/quarters) did
(name/you) receive Supplemental
Security Income on behalf of
children in set date-1?
Supplemental security income for children (1-4; 1-12)
Q57irn1c
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in Supplemental Security Income
payments in set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q57irn2c
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over
$5,000 in Supplemental Security Income in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Page 124 of 206
Q57i3c
Was the cost of living increase the
only change which occurred in monthly
payments?
1. Yes
2. No
Q57i4c
According to my calculations (name/you)
received $(total) altogether from
Supplemental Security Income on
behalf of children in set date-1.
Does that sound about right?
1. Yes
2. No
Q57i5c
What is your best estimate of the
correct amount (name/you)
received in Supplemental Security
Income on behalf of children
during set date-1?
PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
(amount subtracted per month)
Enter dollar amount
Q57iTc
Page 125 of 206
**NON-DISPLAYED ITEM**
Q57ip
What is the easiest way for you
to tell us the Supplemental Security
Income (name/you) received on behalf of children?
4. Monthly
5. Quarterly
7. Yearly
Q57i
How much did (name/you) receive
(monthly/ quarterly/
) in Supplemental Security
Income on behalf of children in set date-1?
Enter dollar amount
Q57i1
What is the amount of the Supplemental
Security Income payment (name/you)
received on behalf of children
last month?
Enter dollar amount
Q57i2
For how many (months/quarters) did
(name/you) receive Supplemental
Security Income on behalf of
children in set date-1?
Supplemental security income for children (1-4; 1-12)
Q57irn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in Supplemental Security Income
payments in set date-1?
Page 126 of 206
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q57irn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over
$5,000 in Supplemental Security Income in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q57i3
Was the cost of living increase the
only change which occurred in monthly
payments?
1. Yes
2. No
Q57i4
According to my calculations (name/you)
received $(total) altogether from
Supplemental Security Income on
behalf of children in set date-1.
Does that sound about right?
1. Yes
2. No
Q57i5
Page 127 of 206
What is your best estimate of the
correct amount (name/you)
received in Supplemental Security
Income on behalf of children
during set date-1?
PREVIOUS ENTRIES: (amount)
Q57ip: (periodicity)
Q57i2: (number of pay periods)
(amount subtracted per month)
Enter dollar amount
Q57iT
**NON-DISPLAYED ITEM**
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q60V1P
What is the easiest way for you
to tell us (name's/your) (fill from first answer in Q60c-88);
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Page 128 of 206
Q60V1
How much did (name/you) receive
(weekly/every other week/ twice a month/monthly ) before deductions in (fill from first answer in
Q60c-88)
in set date-1?
Enter dollar amount
Q60V12
How many (weekly/every other week/ twice a month/monthly ) payments did
(name/you) receive in (fill from first answer in Q60c-88) in set date-1?
number of VA payments
Q60v1rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in (fill from first answer in Q60c-88)
during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q60v1rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from
first answer in Q60c-88) during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q60V13
According to my calculations (name/you)
received (total) dollars altogether from
(fill from first answer in Q60c-88) in set date-1.
Does that sound about right?
1. Yes
Page 129 of 206
2. No
Q60V14
What is your best estimate of the
correct amount (name/you)
received in Veteran's benefits
during set date-1?
PREVIOUS ENTRIES: Q60V1: $ (amount)
Q60V1P: ^Q60V1P_fill
Q60V12: (number of pay periods)
Enter dollar amount
Q60V1T
*NON-DISPLAY ITEM*
Q60V2P
What is the easiest way for you
to tell us (name's/your) (fill from second answer in Q60c8);
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q60V2
How much did (name/you) receive
how often Veterans' payment (type 2) received before deductions in (fill from second answer in
Q60c8)
in set date-1?
Enter dollar amount
Page 130 of 206
Q60V22
How many how often Veterans' payment (type 2) received payments did
(name/you) receive in (fill from second answer in Q60c8) in set date-1?
Veterans' payment type 2 (1-12; 1-52)
Q60v2rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in (fill from second answer in Q60c8)
during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q60v2rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (fill from
second answer in Q60c8) during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q60V23
According to my calculations (name/you)
received (total) dollars altogether from
(fill from second answer in Q60c8) in set date-1.
Does that sound about right?
1. Yes
2. No
Q60V24
What is your best estimate of the
correct amount (name/you)
received in (fill from second answer in Q60c8)
during set date-1?
Page 131 of 206
PREVIOUS ENTRIES: Q60V2: $ (amount)
Q60V2P: ^Q60V2P_fill
Q60V22: (number of pay periods)
Enter dollar amount
C_Q60V2T
**NON-SCREEN ITEM
Q60V2T
**NON-SCREEN ITEM
Q60E8O
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q58E1P
What is the easiest way for you to
tell us (name's/your)
^SOUINCO;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
Page 132 of 206
4. Monthly
7. Yearly
Q58E1
How much did (name/you) receive (weekly/every other week/twice a month/monthly/ )
in ^SOUINCO in set date-1?
Enter dollar amount
Q58E12
How many (weekly/every other week/twice a month/monthly/ ) payments did
(name/you) receive in
^SOUINCO in set date-1?
(1-52)
Q58e1rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in ^SOUINCO during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q58e1rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in
^SOUINCO during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q58E13
Page 133 of 206
According to my calculations (name/you)
received $(total) altogether from
^SOUINCO in set date-1.
Does that sound about right?
1. Yes
2. No
Q58E14
What is your best estimate of the
correct amount (name/you) received
from ^SOUINCO during set date-1?
PREVIOUS ENTRIES: Q58E1: (amount)
Q58E1P: ^Q58E1P_fill
Q58E12: (number of pay periods)
Enter dollar amount
Q58E1T
*NON-SCREEN ITEM*
Q58E2P
What is the easiest way for you to
tell us (name's/your)
^SOUINCO2;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Page 134 of 206
Q58E2
How much did (name/you) receive (weekly/every other week/twice a month/monthly/ ) in
^SOUINCO2 in set date-1?
Enter dollar amount
Q58E22
How many (weekly/every other week/twice a month/monthly/ ) payments did
(name/you) receive in
^SOUINCO2 in set date-1?
Number of Periodicity2
Q58e2rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in ^SOUINCO2 during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q58e2rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in
^SOUINCO2 during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q58E23
According to my calculations (name/you)
received (total) altogether from
^SOUINCO2 in set date-1.
Does that sound about right?
Page 135 of 206
1. Yes
2. No
Q58E24
What is your best estimate of the
correct amount (name/you) received
from ^SOUINCO2 during set date-1?
PREVIOUS ENTRIES: Q58E2: (amount)
Q58E2P: ^Q58E2P_fill
Q58E22: (number of pay periods)
Enter dollar amount
Q58E2T
*NON-SCREEN ITEM*
Q58E3P
What is the easiest way for you to
tell us (name's/your)
^SOUINCO3;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q58E3
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly) in
^SOUINCO3 in set date-1?
Enter dollar amount
Page 136 of 206
Q58E32
How many (weekly/every other week/ twice a month/ monthly) payments did
(name/you) receive in
^SOUINCO3 in set date-1?
(1-52)
Q58e3rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in ^SOUINCO3 during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q58e3rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in
^SOUINCO3 during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q58E33
According to my calculations (name/you)
received (total) altogether from
^SOUINCO3 in set date-1.
Does that sound about right?
1. Yes
2. No
Q58E34
What is your best estimate of the
Page 137 of 206
correct amount (name/you) received
from ^SOUINCO3 during set date-1?
PREVIOUS ENTRIES: Q58E3: (amount)
Q58E3P: ^Q58E3P_fill
Q58E32: (number of pay periods)
Enter dollar amount
Q58E3T
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q59ep
What is the easiest way for you to tell us
(name's/your) CASH assistance payments from ^CASH_TYPE;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q59e
Page 138 of 206
During set date-1, how much CASH assistance
did (name/you) receive (per week/every other week/twice a month/ momthly/
^CASH_TYPE?
) in
Enter dollar amount
Q59e2
How many (weekly/every other week/ twice a month/ monthly) cash assistance payments
did (name/you) receive in set date-1?
Cash assistance (1-12; 1-52)
Q59ern1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or over
$3,000 in CASH assistance payments from ^CASH_TYPE in set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q59ern2
Did (name/you) receive less than $100, between $100 and $500, or over $500 in CASH assistance
payments from ^CASH_TYPE in set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q59e3
According to my calculations (name/you)
received $(total) altogether in cash
assistance from a state or county program
in set date-1.
Does that sound about right?
Page 139 of 206
1. Yes
2. No
Q59e4
What is your best estimate of the
correct amount of cash assistance
(name/you) received during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q59ep: (periodicity)
Q59e2: (number of pay periods)
Enter dollar amount
Q59f
Was the cash assistance for adults
AND children in the household, or JUST children?
1. Both adults AND children
2. Children only
3. Adults only
Q59g
who/which was the cash assitance for in your household was
the cash assistance for?
Probe: Anyone Else?
Enter all that apply, separate using the space bar or a comma.
Enter 0 if none listed
Enter 96 for All persons
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
Page 140 of 206
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
Q59ET
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
Q90p
What is the easiest way for you to tell us the
value of the food assistance: monthly or yearly?
1. Monthly
2. Yearly
3. Already included with TANF/AFDC payment
Q90
What is the (monthly/
received in set date-1?
) of the food assistance
Enter dollar amount
Page 141 of 206
Q902
How many months was food assistance
received in set date-1?
(1-12)
Q90rn1
Could you tell me if the value of food assistance received in set date-1 is less than $1,000,
between $1,000 and $3,000, or over $3,000?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q90rn2
Was the value of food assistance received in set date-1 less than $100, between $100 and $500,
or over $500?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q903
According to my calculations $(total) was received altogether
from food assistance in set date-1.
Does that sound about right?
1. Yes
2. No
Q904
What is your best estimate of the correct amount of food
assistance received during set date-1?
Page 142 of 206
PREVIOUS ENTRIES: (amount)
Q90p: (periodicity)
Q902: (number of pay periods)
Enter dollar amount
Q90T
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
Q94R
Earlier, you reported that you received energy assistance to pay heating or cooling costs.
Altogether, how much energy assistance was received in set date-1?
Enter annual amount only
Q94rn1
Could you tell me if you received less than $1,000, between $1,000 and $3,000, or over $3,000
in energy assistance during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q94rn2
Did you receive less than $100, between $100 and $500, or over $500 in energy
assistance during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Page 143 of 206
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q62E1PR
What is the easiest way for you
to tell us (name's/your) (first fill from Q62cR or Q62cs1);
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q62E1R
How much did (name/you) receive
(weekly/every other week/ twice a month/monthly/ ) in (first fill from Q62cR or Q62cs1)
in set date-1?
Enter dollar amount
Q62E12R
How many (weekly/every other week/ twice a month/monthly/ ) payments did
(name/you) receive in (first fill from Q62cR or Q62cs1) in set date-1?
Pension/Retirement #1 (1-12; 1-52)
Q62E1rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in (first fill from Q62cR or Q62cs1) in set date-1?
Page 144 of 206
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q62E1rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (first fill
from Q62cR or Q62cs1) in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q62E13R
According to my calculations (name/you)
received (total) dollars altogether from
(first fill from Q62cR or Q62cs1) in set date-1 .
Does that sound about right?
1. Yes
2. No
Q62E14R
What is your best estimate of the
correct amount (name/you)
received in (first fill from Q62cR or Q62cs1)
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q62E1P: ^Q62E1P_fill
Q62E12: (number of pay periods)
Enter dollar amount
Q62E1T
*NON-SCREEN ITEM*
Page 145 of 206
Q62E2PR
What is the easiest way for you
to tell us (name's/your) (second fill from 62c@2 or 62c@s1);
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q62E2R
How much did (name/you) receive
(weekly/every other week/ twice a month/monthly/ ) in (second fill from 62c@2 or 62c@s1)
in set date-1?
Enter dollar amount
Q62E22R
How many (weekly/every other week/ twice a month/monthly/ ) payments did
(name/you) receive in (second fill from 62c@2 or 62c@s1) in set date-1?
Survivor 2 payment type 1 (1-12; 1-52)
Q62E2rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in (second fill from 62c@2 or 62c@s1) in set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q62E2rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in (second fill
from 62c@2 or 62c@s1) in set date-1?
1. Less than $1,000
Page 146 of 206
2. Between 1,000 and $5,000
3. Over $5,000
Q62E23R
According to my calculations (name/you)
received (total) dollars altogether from
(second fill from 62c@2 or 62c@s1) in set date-1.
Does that sound about right?
1. Yes
2. No
Q62E24R
What is your best estimate of the
correct amount (name/you)
received in (second fill from 62c@2 or 62c@s1)
during set date-1?
PREVIOUS ENTRIES: (amount)
Q62E2P: ^Q62E2P_fill
Q62E22: (number of pay periods)
Enter dollar amount
Q62E2T
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
Page 147 of 206
LINENO
*NON-SCREEN ITEM
ANNNEW1
What is the easiest way for you to tell me (name's/your) annuity income;
weekly, every other week, twice a month, monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
ANNNEW2
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/ ) in
annuities in set date-1?
ANNNEW3
How many (weekly/every other week/ twice a month/monthly/ ) payments did
(name/you) receive in set date-1?
ANNNEWrn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in annuity payments in set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
ANNNEWrn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000
in annuity payments in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
Page 148 of 206
3. Over $5,000
ANNNEW4
According to my calculations (name/you)
received (total) dollars altogether from
from annuities in set date-1 .
Does that sound about right?
1. Yes
2. No
ANNNEW5
What is your best estimate of the
correct amount (name/you)
received in annuities
during set date-1?
Enter dollar amount
ANNNEWT
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Page 149 of 206
DISTNEW1
What is the easiest way for you to tell me the amount of money withdrawn
or distributed from (name's/your) Account withdrawn/distributed from in set date-1;
monthly, quarterly, every 6 months, or yearly?
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
DISTNEW2
How much was (name's/your) withdrawal or distribution (monthly/ quarterly/6months/ ) from
(your/his/her) Account withdrawn/distributed from in set date-1?
Enter dollar amount
DISTNEW3
How many (monthly/ quarterly/6months/ ) withdrawals or distributions did
(name/you) make in set date-1 from the Account withdrawn/distributed from?
Valid entries are 1-12 if monthly; 1-4 if quarterly; 1-2 if every six months
DISTNEWrn1
Could you please tell me if (name's/your) withdrawal or distribution was less than $10,000,
between $10,000 and $20,000, or over $20,000 from (your/his/her) Account withdrawn/distributed
from in set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
DISTNEWrn2
Was (name's/your) withdrawal or distribution less than $1,000, between $1,000 and $5,000, or
over $5,000
from (your/his/her) Account withdrawn/distributed from in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Page 150 of 206
DISTNEW4
According to my calculations (name/you) withdrew or was distributed
(total) dollars altogether from the
Account withdrawn/distributed from in set date-1 .
Does that sound about right?
1. Yes
2. No
DISTNEW5
What is your best estimate of the correct amount (name/you)
withdrew or the distribution from the Account withdrawn/distributed from
during set date-1?
Enter dollar amount
ROLLA
Did (name/you) re-invest or "roll over" any of the money into an IA or some other kind of
retirement plan?
1. Yes
2. No
ROLLAMTA
How much did (name/you) re-invest or "roll over" into an IRA or some other kind of retirement
plan in set date-1?
Enter dollar amount
ROLLB
(do/does) (name/you) plan to re-invest or "roll over" any of the money?
1. Yes
2. No
ROLLAMTB
Page 151 of 206
How much (do/does) (name/you) plan to re-invest or "roll over" into an IRA or some other kind of
retirement plan?
Enter dollar amount
DISTNEWT1
*NON-SCREEN ITEM*
DISTNEW6
What is the easiest way for you to tell me the amount of money withdrawn
or distributed from (name's/your) Account withdrawn/distributed from in set date-1;
monthly, quarterly, every 6 months, or yearly?
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
DISTNEW7
How much was (name's/your) withdrawal or distribution (monthly/ quarterly/6months/ ) from
(your/his/her) Account withdrawn/distributed from in set date-1?
Enter dollar amount
DISTNEW8
How many (monthly/ quarterly/6months/ ) withdrawals or distributions did
(name/you) make in set date-1 from the Account withdrawn/distributed from?
Valid entries are 1-12 if monthly; 1-4 if quarterly; 1-2 if every six months
DISTNEWrn3
Could you please tell me if (name's/your) withdrawal or distribution was less than $10,000,
between $10,000 and $20,000, or over $20,000 from (your/his/her) Account withdrawn/distributed
from in set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Page 152 of 206
DISTNEWrn4
Was (name's/your) withdrawal or distribution less than $1,000, between $1,000 and $5,000, or
over $5,000
from (your/his/her) Account withdrawn/distributed from in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
DISTNEW9
According to my calculations (name/you) withdrew or was distributed
(total) dollars altogether from the
Account withdrawn/distributed from in set date-1 .
Does that sound about right?
1. Yes
2. No
DISTNEW10
What is your best estimate of the correct amount (name/you)
withdrew or the distribution from the Account withdrawn/distributed from
during set date-1?
Enter dollar amount
ROLLC
Did (name/you) re-invest or "roll over" any of the money into an IA or some other kind of
retirement plan?
1. Yes
2. No
ROLLAMTC
How much did (name/you) re-invest or "roll over" into an IRA or some other kind of retirement
plan in set date-1?
Page 153 of 206
Enter dollar amount
ROLLD
(do/does) (name/you) plan to re-invest or "roll over" any of the money?
1. Yes
2. No
ROLLAMTD
How much (do/does) (name/you) plan to re-invest or "roll over" into an IRA or some other kind of
retirement plan?
Enter dollar amount
DISTNEWT2
*NON-SCREEN ITEM*
DISTNEWO
**NON-SCREEN ITEM**
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
RETIRENEW1
Within the Account type - retirement account(s), how much did
(name/you) earn in interest or dividends during set date-1?
Please include small amounts reinvested or credited to the account.
Page 154 of 206
Enter dollar amount
RETIRENEW2
The Census Bureau can estimate the amount earned in this account
based on the size of the account. So can you tell me how much money
was in (name's/your) Account type - retirement account at the end of set date-1?
Enter dollar amount
RETIRENEWrn1
Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest or dividends from Account type - retirement account during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
RETIRENEWrn2
Did (name/you) earn less than $100, between $100 and $500,
or over $500 in interest or dividends from Account type - retirement account during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
RETIRENEWT1
*NON-SCREEN ITEM*
RETIRENEW3
Within Account type - retirement account(s), how much did
(name/you) earn in interest or dividends during set date-1?
Please include small amounts reinvested or credited to the account.
Enter dollar amount
Page 155 of 206
RETIRENEW4
The Census Bureau can estimate the amount earned in this account
based on the size of the account. So can you tell me how much money
was in (name's/your) Account type - retirement account at the end of set date-1?
Enter dollar amount
RETIRENEWrn3
Could you tell me if (name/you) earned less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest or dividends from Account type - retirement account during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
RETIRENEWrn4
Did (name/you) earn less than $100, between $100 and $500,
or over $500 in interest or dividends from Account type - retirement account during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
RETIRENEWT2
*NON-SCREEN ITEM*
RETIRENEWO
**NON-SCREEN ITEM**
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
Page 156 of 206
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
NONRETIRENEW11
How much did (name/you) receive in interest from checking accounts
during set date-1, including even small amounts reinvested or credited to the account.
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63c_Char
Enter A for "Already Included"
NONRETIRENEW12
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in checking accounts at the end of set date-1?
Enter dollar amount
NONRETIRENEW1rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest from checking accounts during set date-1?
Page 157 of 206
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW1rn2
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in interest from checking accounts during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q63cp
Read if necessary
Is this a weekly, every other week,
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
Q63c2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
did (name/you) receive in
interest income from checking accounts set date-1?
Interest (1-2; 1-52)
Page 158 of 206
Q63c3
According to my calculations (name/you)
received (total) dollars altogether from
interest income from checking accounts in set date-1.
Does that sound about right?
1. Yes
2. No
Q63c4
What is your best estimate of the
correct amount (name/you)
received from interest payments for checking accounts
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63CT
*NON-SCREEN ITEM*
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
NONRETIRENEW21
How much did (name/you) receive in interest from savings accounts
during set date-1, including even small amounts reinvested or credited to the account.
Page 159 of 206
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63d_Char
Enter A for "Already Included"
NONRETIRENEW22
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in savings accounts at the end of set date-1?
Enter dollar amount
NONRETIRENEW2rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest from savings accounts during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW2rn2
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in interest from savings accounts during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q63dp
Read if necessary
Page 160 of 206
Is this a weekly, every other week,
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
Q63d2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
did (name/you) receive in
interest income from savings accounts set date-1?
Interest (1-2; 1-52)
Q63d3
According to my calculations (name/you)
received (total) dollars altogether from
interest income from checking accounts in set date-1.
Does that sound about right?
1. Yes
2. No
Q63d4
What is your best estimate of the
correct amount (name/you)
received from interest payments for savings accounts
during set date-1?
Page 161 of 206
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63DT
*NON-SCREEN ITEM*
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
NONRETIRENEW31
How much did (name/you) receive in interest from money market accounts
during set date-1, including even small amounts reinvested or credited to the account.
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63e_Char
Enter A for "Already Included"
NONRETIRENEW32
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in money market accounts at the end of set date-1?
Enter dollar amount
Page 162 of 206
NONRETIRENEW3rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest from money market accounts during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW3rn2
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in interest from money market accounts during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q63ep
Read if necessary
Is this a weekly, every other week,
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
Q63e2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
did (name/you) receive in
Page 163 of 206
interest income from money market accounts set date-1?
Interest (1-2; 1-52)
Q63e3
According to my calculations (name/you)
received (total) dollars altogether from
interest income from money market accounts in set date-1.
Does that sound about right?
1. Yes
2. No
Q63e4
What is your best estimate of the
correct amount (name/you)
received from interest payments for money market accounts
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63ET
*NON-SCREEN ITEM*
LINENO
*NON-SCREEN ITEM
CTRLNUM
Page 164 of 206
**Non-Displayed Item**
NONRETIRENEW41
How much did (name/you) receive in interest from CD accounts
during set date-1, including even small amounts reinvested or credited to the account.
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63f_Char
Enter A for "Already Included"
NONRETIRENEW42
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in CD accounts at the end of set date-1?
Enter dollar amount
NONRETIRENEW4rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest from CD accounts during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW4rn2
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in interest from CD accounts during set date-1?
1. Less than $100
Page 165 of 206
2. Between $100 and $500
3. More than $500
Q63fp
Read if necessary
Is this a weekly, every other week,
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
Q63f2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
did (name/you) receive in
interest income from CD accounts set date-1?
Interest (1-2; 1-52)
Q63f3
According to my calculations (name/you)
received (total) dollars altogether from
interest income from CD accounts in set date-1.
Does that sound about right?
1. Yes
2. No
Page 166 of 206
Q63f4
What is your best estimate of the
correct amount (name/you)
received from interest payments for CD accounts
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63FT
*NON-SCREEN ITEM*
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
NONRETIRENEW51
How much did (name/you) receive in interest from savings bond accounts
during set date-1, including even small amounts reinvested or credited to the account.
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63g_Char
Enter A for "Already Included"
NONRETIRENEW52
Page 167 of 206
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in saving bond accounts at the end of set date-1?
Enter dollar amount
NONRETIRENEW5rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest from savings bond accounts during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW5rn2
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in interest from savings bond accounts during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q63gp
Read if necessary
Is this a weekly, every other week,
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
Page 168 of 206
7. Yearly
Q63g2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
did (name/you) receive in
interest income from savings bond accounts set date-1?
Interest (1-2; 1-52)
Q63g3
According to my calculations (name/you)
received (total) dollars altogether from
interest income from savings bond accounts in set date-1.
Does that sound about right?
1. Yes
2. No
Q63g4
What is your best estimate of the
correct amount (name/you)
received from interest payments from savings bond accounts
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63GT
*NON-SCREEN ITEM*
Page 169 of 206
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
NONRETIRENEW61
How much did (name/you) receive in dividends from shares of stock in corporations or mutual
funds
during set date-1, including even small amounts reinvested or credited to the account.
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63h_Char
Enter A for "Already Included"
NONRETIRENEW62
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in shares of stock or mutual funds at the end of set date-1?
Enter dollar amount
NONRETIRENEW6rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in dividends from stocks or mutual funds during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW6rn2
Page 170 of 206
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in dividends from stocks or mutual funds during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
CAPGDAMT
How much did (name's/your) receive in capital gains
distributions in set date-1?
Enter dollar amount
CAPGDAMTrn1
Could you tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 in capital gains distributions during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
CAPGDAMTrn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000,
or over $5,000 in capital gains distributions during set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q63hp
Read if necessary
Is this a weekly, every other week,
Page 171 of 206
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
Q63h2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
did (name/you) receive in
dividends from stocks or mutual funds in set date-1?
Dividends (1-2; 1-52)
Q63h3
According to my calculations (name/you)
received (total) dollars altogether from
interest income from savings bond accounts in set date-1.
Does that sound about right?
1. Yes
2. No
Q63h4
What is your best estimate of the
correct amount (name/you)
received in dividends from shares of stocks or mutual funds
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Page 172 of 206
Q63c2: (number of pay periods)
Enter dollar amount
Q63HT
*NON-SCREEN ITEM*
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
NONRETIRENEW71
How much did (name/you) receive in interest or dividends from Other source of interest or
dividend income
during set date-1, including even small amounts reinvested or credited to the account.
Separate amounts for joint ownership
If already included in amount reported for another household member, press Enter
Enter dollar amount
Q63i_Char
Enter A for "Already Included"
NONRETIRENEW72
The Census Bureau can estimate the amount earned in this account
based on the size of the account. How much money did (name's/your) have
in Other source of interest or dividend income at the end of set date-1?
Enter dollar amount
Page 173 of 206
NONRETIRENEW7rn1
Could you tell me if (name/you) received less than $1,000, between $1,000 and $3,000,
or over $3,000 in interest from Other source of interest or dividend income during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
NONRETIRENEW7rn2
Did (name/you) receive less than $100, between $100 and $500,
or over $500 in interest or dividends from Other source of interest or dividend income during set
date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q63ip
Read if necessary
Is this a weekly, every other week,
twice a month, monthly, quarterly,
every 6 months, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
6. Every 6 months
7. Yearly
Q63i2
How many (weekly/ every other week/ twice a month/ monthly/ quarterly/ every 6 months)
payments
Page 174 of 206
did (name/you) receive in
interest or dividends from Other source of interest or dividend income in set date-1?
Dividends (1-2; 1-52)
Q63i3
According to my calculations (name/you)
received (total) dollars altogether from
interest or dividends from Other source of interest or dividend income in set date-1.
Does that sound about right?
1. Yes
2. No
Q63i4
What is your best estimate of the
correct amount (name/you)
received from interest or dividends from Other source of interest or dividend income
during set date-1?
PREVIOUS ENTRIES: $ (amount)
Q63cp: (periodicity)
Q63c2: (number of pay periods)
Enter dollar amount
Q63IT
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
Page 175 of 206
LINENO
*NON-SCREEN ITEM
Q65c
How much did (name/you) receive in
income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders,
or royalties/, es AFTER EXPENSES during set date-1?
Separate amounts for joint ownership
if response is "Broke Even" then enter 1.
Enter dollar amount
Already included
If response is "None" or "Lost Money", press key
Q65crn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in income from rent (blank/, roomers
or boarders, estates, trusts, or royalties/, roomers or boarders, or royalties/, es AFTER
EXPENSES during set date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q65crn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in income
from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or boarders, or
royalties/, es AFTER EXPENSES during set date-1in child support payments in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q65c_Char
Page 176 of 206
Enter "A" for Already included
Enter "L" for Lost Money
Enter "X" for None
Q65cL
Enter amount of money lost in set date-1.
Q65cp
Is this a weekly, every other week, twice a month,monthly, quarterly, or yearly amount?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
5. Quarterly
7. Yearly
Q65c2
What is your best estimate of (name's/your)
ANNUAL net income from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers
or boarders, or royalties/, es AFTER
EXPENSES in set date-1?
PREVIOUS ENTRIES: (amount)
Q65cp: (periodicity)
Enter dollar amount
Page 177 of 206
Q65c2L
What is your best estimate of (name's/your)
ANNUAL LOSS from rent (blank/, roomers or boarders, estates, trusts, or royalties/, roomers or
boarders, or royalties/, es AFTER
EXPENSES in set date-1?
PREVIOUS ENTRIES: $ (amount)
Q65cp: (periodicity)
Enter dollar amount
Q65CT
*NON-SCREEN ITEM*
Q65CLO
**Non-Screen Item
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q69F88
How much did (name/you) receive in Pell Grants during set date-1?
Enter annual amount only
Page 178 of 206
Q69frn1
Could you please tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or
over $3,000 for the TOTAL amount (name/you) received in Pell Grants during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q69frn2
Did (name/you) receive less than $100, between $100 and $500, or over $500 in Pell Grants during
set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q66HP
What is the easiest way for you to tell us (name's/your) ^ED_OTHER
educational assistance during set date-1;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q66H
(blank/Aside from the Pell Grant assistance,) (How/how) much did (name/you) receive
(weekly/every other week/ twice a month/ monthly) in educational assistance
during set date-1?
Enter dollar amount
Page 179 of 206
Q66H2
How many (weekly/every other week/ twice a month/ monthly) payments did (name/you) receive
in educational assistance in set date-1?
^PERNUM
Q66hrn1
Could you please tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or
over $3,000 for the TOTAL amount (name/you) received in educational assistance during set
date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q66hrn2
Did (name/you) receive less than $100, between $100 and $500, or over $500 in educational
assistance during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q66H3
According to my calculations (name/you) received (total) altogether
from educational assistance in set date-1.
Does that sound about right?
1. Yes
2. No
Q66H4
What is your best estimate of the correct amount (name/you)
received from educational assistance during set date-1?
Page 180 of 206
Previous entries: (amount)
Q66hp: (periodicity)
Q66h2: (number of pay periods)
Enter dollar amount
Q66HT
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q70cp
What is the easiest way for you to tell us (name's/your)
child support payments;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Page 181 of 206
Q70c
How much did (name/you) receive
(weekly/every other week/ twice a month/ monthly/ ) in child support payments
in set date-1?
Enter dollar amount
Q70c2
How many (weekly/every other week/ twice a month/ monthly/ ) child support payments did
(name/you) receive in set date-1?
Child Support payment type 1 (1-12; 1-52)
Q70c1rn1
Could you please tell me if (name/you) received less than $10,000, between $10,000 and $20,000,
or over $20,000 for the TOTAL amount (name/you) received in child support payments in set
date-1?
1. Less than $10,000
2. Between $10,000 and $20,000
3. $20,000 or more
Q70c1rn2
Did (name/you) receive less than $1,000, between $1,000 and $5,000, or over $5,000 in child
support payments in set date-1?
1. Less than $1,000
2. Between 1,000 and $5,000
3. Over $5,000
Q70c3
According to my calculations (name/you) received ^TQ70C3 altogether
from child support payments in set date-1.
Does that sound about right?
Page 182 of 206
1. Yes
2. No
Q70c4
What is your best estimate of the correct amount (name/you)
received from child support payments during set date-1?
PREVIOUS ENTRIES: (amount)
Q70cp: (periodicity)
Q70c2: (number of pay periods)
Enter dollar amount
Q70CT
*Non-Screen Item*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q72cp
What is the easiest way for you to tell us (name's/your)
regular financial assistance;
weekly, every other week, twice a month,
monthly, or yearly?
Page 183 of 206
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q72c
How much did (name/you) receive
(weekly/every other week/twice a month/monthly/
in set date-1?
) in regular financial assistance
Enter dollar amount
Q72c2
How many (weekly/every other week/twice a month/monthly/
in regular financial assistance in set date-1?
) payments did (name/you) receive
Regular Financial Assistance payment type 1 (1-12; 1-52)
Q72crn1
Could you please tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or
over $3,000 in regualr financial assistance in set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q72crn2
Did (name/you) receive less than $100, between $100 and $500, or over $500 in regular financial
assistance in set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Page 184 of 206
Q72c3
According to my calculations (name/you) received (total) altogether
from regular financial assistance in set date-1.
Does that sound about right?
1. Yes
2. No
Q72c4
What is your best estimate of the correct amount (name/you)
received from regular financial assistance during set date-1?
PREVIOUS ENTRIES: (amount)
Q72cp: (periodicity)
Q72c2: (number of pay periods)
Enter dollar amount
Q72CT
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q731P
Page 185 of 206
What is the easiest way for you to tell us (name's/your)
income from ^OtherInc1 during set date-1;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q731
How much did (name/you) receive (weekly/every other week/ twice a month/ monthly/
in income from hobbies, home businesses,
farms, or business interests not already covered
during set date-1?
)
Enter dollar amount
Q7312
How many (weekly/every other week/ twice a month/ monthly/
receive
in income from hobbies, home businesses, farms,
or business interests not already covered in set date-1?
) payments did (name/you)
^OI_CK
Q73rn1
Could you please tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or
over $3,000 in in income from hobbies, home businesses, farms, or business interests not
already covered during set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
Page 186 of 206
3. $3,000 or more
Q73rn2
Did (name/you) receive less than $100, between $100 and $500, or over $500 in income from
hobbies, home businesses, farms, or business interests not already covered during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q7313
According to my calculations (name/you) received (total) altogether
from hobbies, home businesses, farms, or business interests
not already covered in set date-1.
Does that sound about right?
1. Yes
2. No
Q7314
What is your best estimate of the correct amount (name/you)
received in income from hobbies, home businesses, farms,
or business interests not already covered during set date-1?
PREVIOUS ENTRIES: (amount)
Q731P: ^Q731P_fill
Q7312: (number of pay periods)
Enter dollar amount
Q731T
*NON-SCREEN ITEM*
Page 187 of 206
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q732P
What is the easiest way for you to tell us (name's/your)
income from any severance pay, welfare, emergency assistance,
other short-term cash assistance, foster child care payments,
or any other money income not already covered during set date-1;
weekly, every other week, twice a month,
monthly, or yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Q732
How much did (name/you) receive (weekly/every other week/ twice a month/monthly/
income
from any severance pay, welfare, emergency assistance,
other short-term cash assistance, foster child care payments,
or any other money income not already covered during set date-1?
) in
Enter dollar amount
Q7322
How many (weekly/every other week/ twice a month/monthly/ ) payments did (name/you)
receive
in income from any severance pay, welfare, emergency assistance,
other short-term cash assistance, foster child care payments,
Page 188 of 206
or any other money income not already covered during set date-1?
Other Income type 2 (1-12; 1-52)
Q732rn1
Could you please tell me if (name/you) received less than $1,000, between $1,000 and $3,000, or
over $3,000 from any severence pay, welfare, emergency assistance, other short-term cash
assistance, foster child care payments, or any other money income not already covered duringin
income from hobbies, home businesses, farms, or business interests not already covered during
set date-1?
1. Less than $1,000
2. Between $1,000 and $3,000
3. $3,000 or more
Q732rn2
Did (name/you) receive less than $100, between $100 and $500, or over $500 from any severence
pay, welfare, emergency assistance, other short-term cash assistance, foster child care
payments, or any other money income not already covered during set date-1?
1. Less than $100
2. Between $100 and $500
3. More than $500
Q7323
According to my calculations (name/you) received (total) altogether
from any severance pay, welfare, emergency assistance,
other short-term cash assistance, foster child care payments,
or any other money income not already covered during set date-1.
Does that sound about right?
1. Yes
2. No
Q7324
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What is your best estimate of the correct amount (name/you) received
in income from any severance pay, welfare, emergency assistance,
other short-term cash assistance, foster child care payments,
or any other money income not already covered during set date-1?
PREVIOUS ENTRIES: (amount)
Q732P: ^Q732P_fill
Q7322: (number of pay periods)
Enter dollar amount
Q732T
*NON-SCREEN ITEM*
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
MIGSAM
(were/was) (reference person's name/you) living in this
house (or apartment) one year ago?
1. Yes, this house (apt)
2. No, different house in the U.S.
3. No, outside the U.S.
MIGPLC
Where did (reference person's name/you) live one year ago?
Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME
Page 190 of 206
MIGSTA
Where did (reference person's name/you) live one year ago?
Name of State
Current: (state)
Enter W for person living on a ship at sea
Enter correct State or press ENTER for SAME
MIGZIP
Where did (reference person's name/you) live one year ago?
Zip Code
Current: (zip)
Enter correct Zip Code or press ENTER for SAME
MIGCLM
Did (reference person's name/you) live inside the city limits of (place name)?
1. Yes, inside city limits
2. No, outside city limits or post office name only
MIGCOU
What (county/parish) is (place name) in?
Enter "IND CITY" if an independent city, not a county
S_MIGCN1
What country did (reference person's name/you) live in one year ago?
MIGCN1
Page 191 of 206
**NON-DISPLAYED ITEM**
MI1RES
What was [your/name's] main reason for moving to this house (apartment)?
The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-13
OTHER REASONS 14-18
1. change in marital status
2. to establish own household
3. other family reason
4. new job or job transfer
5. to look for work or lost job
6. to be closer to work/easier commute
7. retired
8. other job-related reason
9. wanted to own home, not rent
10. wanted new or better house/ apartment
11. wanted better neighborhood/less crime
12. wanted cheaper housing
13. foreclosure/eviction
14. other housing reason
15. to attend or leave college
16. change of climate
17. health reasons
18. natural disaster (hurricane, tornado, etc.)
19. other reason (specify)
MI1s
What was the reason for moving?
MIGALL
(There are (number) other persons in this household ages 1 year or over/
Did (this person/all of these persons)
Page 192 of 206
)
live with ^REf_NAME
(in this house/in City, State/outside the U.S.) one year ago?
LN
NAME
RELATION
^lineno What are the names of all persons living or staying here? /
next person ^RRP_FILL
What is the name of the
1. Yes, all lived with ^REFYOU
2. No, some or all did not live with ^REFYOU
MIGM
Which of the other members of this household did NOT live with (reference person's name/you)
one year ago?
PROBE: Anyone else?
Enter all that apply, separate using the space bar or a comma.
Enter line number
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
LINENO
*NON-SCREEN ITEM
Page 193 of 206
NXTSAM
Did (name/you) live in this house (apartment) one year ago?
1. Yes, this house (apt)
2. No, different house in the U.S.
3. No, outside the U.S.
NXTPLC
Where did (name/you) live one year ago?
Name of city/town/post office
Current: (city)
Enter correct city/town/post office or press ENTER for SAME
NXTSTA
Where did (name/you) live one year ago?
Name of State
Current: (state)
Enter correct State or press ENTER for SAME
NXTZIP
Where did (name/you) live one year ago?
Zip Code
Current: (zip)
Enter correct zip code or press ENTER for SAME
NXTCLM
Did (name/you) live inside the city limits of (place name)?
1. Yes, inside city limits
2. No, outside city limits or post office name only
Page 194 of 206
NXTCOU
What (county/parish) is (place name) in?
Enter "IND CITY" if an independent city, not a county
S_NXTCN1
What country did (name/you) live in one year ago?
NXTCN1
**NON_DISPLAYED ITEM**
NX1RES
What was (name's/your) main reason for moving to this house (apartment)?
The answer categories are separated into the following groups:
FAMILY-RELATED REASONS 1-3
EMPLOYMENT-RELATED REASONS 4-8
HOUSING-RELATED REASONS 9-13
OTHER REASONS 14-18
1. change in marital status
2. to establish own household
3. other family reason
4. new job or job transfer
5. to look for work or lost job
6. to be closer to work/easier commute
7. retired
8. other job-related reason
9. wanted to own home, not rent
10. wanted new or better house/ apartment
11. wanted better neighborhood/less crime
12. wanted cheaper housing
13. foreclosure/eviction
14. other housing reason
15. to attend or leave college
Page 195 of 206
16. change of climate
17. health reasons
18. natural disaster (hurricane, tornado, etc.)
19. other reason (specify)
NX1OTH
What was the reason for moving?
CTRLNUM
**Non-Displayed Item**
CTRLNUM
**Non-Displayed Item**
MedExp_Intro
Next we would like to ask about actual medical expenditures, and not those
that have been, or will be, returned in the form of a reimbursement.
In other words, please report amounts spent that will not be reimbursed.
1. Enter 1 to Continue
HIPREM
fill for HIPREM
Please include premiums paid for HMOs, Fee for Service Plans,
Commercial Medicare Supplements, or other special purpose plans,
such as vision or dental plans. Include prescription drug insurance
such as medicare Part D premiums,and Medicare Advantage premiums.
DO NOT include Medicare Part B premiums.
Enter dollar amount
OTCMEDAMT
During set date-1, about how much was paid for
(name/you) for over-the-counter health-related products,
Page 196 of 206
such as aspirin, cold remedies, bandages,
first aid supplies, or other items?
^INCLUDE
Enter dollar amount
If unsure of the amount, a best guess is acceptable.
MEDAMT
Aside from over-the-counter items, during set date-1, about how much was paid for (name's/your)
own medical care, including payments and co-payments for hospital visits, medical providers,
dental services, prescription medicine, vision aids, and medical supplies?
^INCLUDE
Enter dollar amount
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
COTCAMT
How about (name/you)?
During set date-1, about how much was paid by anyone in this household
for (name/you) for over-the-counter health related products, such as aspirin,
cold remedies, bandages, first aid supplies, and other items?
Include only amounts that were not reimbursed.
If unsure of the amount, a best guess is acceptable.
CMEDAMT
Page 197 of 206
Aside from over-the-counter items, during set date-1,
about how much was paid by anyone in this household for
(name's/your) medical care, including payments and co-payments
for hospital visits, medical providers, dental services,
prescription medicine, vision aids and medical supplies?
Include only amounts paid that were not reimbursed.
LINENO
*NON-SCREEN ITEM
CTRLNUM
**Non-Displayed Item**
LINENO
*NON-SCREEN ITEM
Q74a
Other than Social Security did (ANY) employer or union
that (name/you) worked for in set date-1 have a pension
or other type of retirement plan for any of its employees?
1. Yes
2. No
Q74b
^C_WereWas (name/you) included in that plan?
1. Yes
2. No
CTRLNUM
Page 198 of 206
**Non-Displayed Item**
SUNITS
Ask if necessary
How many housing units are in your building?
1. Only one
2. Two
3. Three or four
4. Five to nine
5. Ten or more
VALPROP
About how much do you think this (house and lot/apartment/mobile home)
would sell for if it were for sale?
Enter dollar amount
VALPROPR
Could you tell me if (name/you) think this (house and lot/apartment/mobile home) would sell for
less than $100,000, between $100,00 and $250,000, between $250,000 and $500,000, or $500,000
or more?
1. Less than $100,000
2. Between $100,000 and $250,000
3. Between $250,000 and $500,000
4. $500,000 or more
Page 199 of 206
MORTYN
Not counting home equity loans, do you or any other member of this household have a mortgage,
deed of trust, contract to purchase, or similar debt on THIS property?
1. Yes
2. No
SMORTYN
Do you or any member of this household have a second mortgage or a home equity loan on THIS
property?
1. Yes, home equity loan.
2. Yes, second mortgage.
3. Yes, second mortgage and home equity loan.
4. No
CTRLNUM
**Non-Displayed Item**
Q95
Now we want to ask about some of your expenses
for children.
Did (you/ anyone in this household) PAY for the care of (your/their)
(child/children) while (you/they) worked in set date-1?
Include: All child care expenses including
preschool and nursery school expenses,
before and after school care, and
summer care.
Do not include: cost of kindergarten or
grade/elementary school.
1. Yes
2. No
Q95A
Page 200 of 206
Which children needed care while their parents worked?
Enter all that apply, separate using the space bar or a comma.
Probe: Anyone else?
Enter 96 for All People
Enter 0 if None
0. No one listed
1. Person 1's name
2. Person 2's name
3. Person 3's name
4. Person 4's name
5. Person 5's name
6. Person 6's name
7. Person 7's name
8. Person 8's name
9. Person 9's name
10. Person 10's name
11. Person 11's name
12. Person 12's name
13. Person 13's name
14. Person 14's name
15. Person 15's name
16. Person 16's name
96. All persons listed
CCFREQ
What is the easiest way for you to tell us how much ^YOUTHEY_CC paid for child care while
^YOUTHEY_CC worked in set date-1: weekly, every other week, twice a month, monthly, or
yearly?
1. Weekly
2. Every other week
3. Twice a month
4. Monthly
7. Yearly
Page 201 of 206
CCAMT
How much did ^YOUTHEY_CC pay ^CCFREQ for child care?
Include child care payments made for all children in the household.
For example, if there are two adults in the household with childcare
expenses use the total paid by both adults. Do not try to separate
the payments. Record one total for the entire household.
CCNUMPAY
How many ^CCFREQ payments did (you/they) make during set date-1?
^CCNUMPAY
CCTOT
Then (you/they) paid ^CCTOT_fill altogether in child care while (you/they) worked during set
date-1. Does that sound about right?
1. Yes
2. No
CCEST
What is your best estimate of the correct amount (you/they) paid for child care while (you/they)
worked in set date-1?
CCOUT
*NON-DISPLAY ITEM*
CSPCHILD
(Do you/Does anyone in the household) have any children who lived elsewhere with their other
parent or guardian at anytime during set date-1?
1. Yes
2. No
CSPWHO
Page 202 of 206
Who had children who lived elswhere? Anyone else?
Enter line number
Enter all that apply, separate using the space bar or a comma.
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
LINENO
*NON-SCREEN ITEM
CSPREQ
In set date-1, did (name/you) pay any child support for children
living elsewhere with their other parent or guardian?
1. Yes
2. No
CSPAMT
How much child support did (name/you) pay in set date-1?
Page 203 of 206
Enter dollar amount
COUNT ALL FORMS OF CHILD SUPPORT PAYMENTS, INCLUDING:
...PAYMENTS MADE DIRECTLY TO THE OTHER PARENT/GUARDIAN;
...PAYMENTS MADE THROUGH A COURT OR AGENCY; AND
...PAYMENTS WITHHELD FROM THIS PERSON'S PAYCHECK
CTRLNUM
**Non-Displayed Item**
LCSPWHO1
*NON-SCREEN ITEM
1. NAME[1]
2. NAME[2]
3. NAME[3]
4. NAME[4]
5. NAME[5]
6. NAME[6]
7. NAME[7]
8. NAME[8]
9. NAME[9]
10. NAME[10]
11. NAME[11]
12. NAME[12]
13. NAME[13]
14. NAME[14]
15. NAME[15]
16. NAME[16]
CTRLNUM
**Non-Displayed Item**
SUPP_COMP
*NON-SCREEN ITEM
CTRLNUM
Page 204 of 206
**Non-Displayed Item**
DNPER_S2
** NON-DISPLAYED ITEM **
HHS_PEL
** NON-DISPLAYED ITEM **
CK_PERSON
The following household members are missing data. Select the row number to provide missing data
for the person.
1. Person1
2. Person2
3. Person3
4. Person4
5. Person5
6. Person6
7. Person7
8. Person8
8. Person9
10. Person10
11. Person11
12. Person12
13. Person13
14. Person14
15. Person15
16. Person16
95. None
CK_DISPLAY
Person: (name of person talking about)[CK_PERSON]
Can you or someone in this household provide the amount of:
Enter number for missing data item. After correcting entry, press END
Page 205 of 206
Skip to Fin (F10) to schedule callback for missing data
(0) No more information possible from anyone at the household
0. No more information possible from anyone at household
1. Q48AA: EARNINGS - EMPLOYER
2. Q4788, Q48B: EARNINGS - BUSINESS
3. Q51a1T: EMPLOYEE BENEFITS
4. Q52CT: WORKER'S COMPENSATION
5. Q56D: SOCIAL SECURITY
6. Q57CT: SUPP SECURITY INCOME
7. Q58E1: SURVIVOR BENEFITS
8. Q58E2: SURVIVOR BENEFITS
9. Q58E3: SURVIVOR BENEFITS
10. Q59ET: PUBLIC ASS/WELFARE
11. Q62E1: PENSION/RETIREMENT
12. Q62E2: PENSION/RETIREMENT
96. Select another person
95. None
Page 206 of 206
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2012-11-20 |